Objective 4: Promote the optimal level of medical services for patients diagnosed with HIV to benefit individual health and reduce the likelihood of further transmission of HIV.

CDC has funded several activities which enhance the level of medical services for HIV-infected persons. One was the AHP demonstration project, “Prevention Case Management (PCM) for Persons Living with HIV/AIDS.” In November 2005, CDC officially changed the name of PCM to comprehensive risk counseling and services (CRCS). CRCS is a client-centered HIV prevention activity that combines HIV risk reduction counseling and traditional case management to provide intensive, on-going, individualized prevention counseling and support. CDC funded nine CBOs in Maryland, Massachusetts, Michigan, Missouri, California, Pennsylvania, New York, and Washington, D.C., to provide specialized CRCS to HIV-infected persons with multiple and complex HIV risk reduction needs. As of January 2006, 480 persons have been enrolled in the CRCS; of these 66% were African American and 14% were Hispanic. The primary referrals provided through this program were for housing assistance, drug counseling and treatment, mental health services, Ryan White case management, and psychosocial support groups.

Objective 5: Increase the proportion of persons diagnosed with HIV who are successfully linked to medical care no later than 3 months after learning their HIV status or re-identified as being HIV infected but out of care.

In an effort to enhance the proportion of HIV-infected people who are linked to HIV care in a timely manner, CDC has funded the Antiretroviral Treatment Access Studies (ARTAS) I & II. Both studies examine the impact of linkage case management on getting HIV-infected persons into care. In the linkage case management approach, a person who has recently received an HIV diagnosis is assigned a linkage case manager to ensure that he or she accesses HIV primary care. Results from the ARTAS I study show that when individuals with a recent HIV diagnosis meet with a linkage case manager up to 5 times in a 3-month period, they have a greater chance of being linked to care. To further test these results, the ARTAS II demonstration project was implemented to compare rates of linkage (to HIV care providers) before and after instituting the linkage case management. These findings will enhance the understanding about how well linkage case management works in typical HIV program settings. The primary objective of this demonstration project is to reach a 75% rate of HIV care use associated with linkage case management after six months of follow up. The 10 collaborating sites for ARTAS II include five local or state health departments and five CBOs, each with at least one ARTAS II linkage case manager. As of August 2005, 137 HIV-infected persons had been enrolled.