Fostering a “Feeling of Worth” Among Vulnerable HIV Populations: The Role of Linkage to Care Specialists

Abstract

To address barriers to adequate engagement in medical care among people living with HIV, Wisconsin's AIDS/HIV Program created a new position, the Linkage to Care (LTC) Specialist. Specialists provide intensive, short-term case management and patient navigation services for small caseloads of individuals at high risk of disengaging with medical care. Clients are eligible if they are newly diagnosed with HIV or new to medical care, recently released from incarceration, recently out of care, nonadherent to scheduled medical care visits, or have detectable viral load while in care. Interviews with 30 clients of Specialists were conducted to understand experiences with the program and medical care. Common themes included the ability of Specialists to navigate complex systems of care and support services, the unique role Specialists played in their clients' lives, and the challenges of transitioning out of the program. Although the primary goal of Specialists is to address barriers to medical care, they often adopted a holistic approach that also included housing, financial assistance, and other social determinants of health. Descriptions of the Specialist's role in implementation manuals focus on their functional roles and the services provided. However, clients often discussed the emotional support they received, especially for clients without strong social support networks. Many clients also desired an ongoing relationship with their Specialists even after discharge, but had been able to establish independence and self-efficacy. The LTC Specialists are resource-intensive considering their small caseloads, but fill an important gap in existing, often overtaxed case management systems.

Improving HIV Care Engagement in the South from the Patient and Provider Perspective: The Role of Stigma, Social Support, and Shared Decision-Making

“…18,21,35,44,50 For example, participants working with linkage to care specialists in Wisconsin focused on the emotional support and a ''feeling of worth'' they gained from the program. 51 The relational intervention that was most appealing to patient and provider par-ticipants in this study was support from peer navigators. Several providers who had worked at clinics with peer navigators in the past spoke about how peers can provide structural support, such as appointment reminders and linkage to community resources, and also relational support that emphasizes the healthy future ahead of those living with HIV who engage in care.…”

Client Perspectives and Experiences With HIV Patient Navigation in the United States: A Qualitative Meta-Synthesis

“…Seven studies were identified as relevant (Broaddus, Hanna, Schumann, & Meier, 2015; Broaddus, Owczarzak, Schumann, & Koester, 2017; Fuller et al, 2018; Koester et al, 2014; Parnell et al, 2017; Sullivan et al, 2015; Westergaard et al, 2017). Primary data across all studies were collected via in-depth interviews, and data were analyzed using thematic analysis (Sullivan et al, 2015; Westergaard et al, 2017), directed qualitative content analysis (Broaddus et al, 2017), framework analysis (Fuller et al, 2018), ethnographic inductive methodology and grounded theory (Koester et al, 2014), and an unnamed systematic method (Broaddus et al, 2015). CASP study quality scores ranged from 7.5 to 9.5/10 ( M = 8.4), or moderate to high quality (Table 1).…”

“She is Like a Sister to Me.” Gender-Affirming Services and Relationships are Key to the Implementation of HIV Care Engagement Interventions with Transgender Women of Color

“…The role of interventionists in the provision of navigation services and their relationship with participants, characterized by the attention, time and the social and emotional support they provide may be important for engagement in HIV care [42,43]. The navigation services in these interventions correspond to those described or implemented with different populations [29,44]; we believe, however, that the role and functions of interventionists working with TWOC to engage them in HIV care have not been characterized before.…”