Background:
Reducing the delay between HIV diagnosis and linkage to appropriate medical care is the goal of the CDC's Antiretroviral Treatment Access Studies (ARTAS-I, 1999-2004 and ARTAS-II, 2004-2006).

Objective:
To report the results of the ARTAS-I linkage to care trial and to describe the follow-up project (ARTAS-II) which implements the successful intervention in non-research settings.

Method:
ARTAS-I randomized 316 recently diagnosed HIV-infected persons to brief strengths-based case management (five sessions/90 days) or a passive referral to care. Participants were re-interviewed at 6 and 12 months to determine rates of linkage to HIV care. We report adjusted odds ratios for factors associated with linkage to care in ARTAS-I. ARTAS-II is taking place in 10 non-research sites (5 health department sponsored; 5 CBO sponsored). Linkage to HIV care is being assessed by self-report interview and abstraction of outpatient medical records.

Result:
ARTAS-I: of 273 participants followed for 12 months, more were linked to care using strengths-based case management than passive referral (64% vs. 49%, p<0.001). The following were associated with linkage to care: being 1 to 6 months beyond an HIV diagnosis vs. >6 months (ORadj=3.4, p<0.01); Hispanic race/ethnicity vs. black (ORadj =6.3, p<0.001); reporting ‘I felt well' as a barrier (ORadj =0.32, p<0.001). ARTAS-II has collected 273 baseline interviews and 13 six-month interviews to date.

Conclusion:
Strengths-based case management in ARTAS-I significantly improved linkage to care compared to a passive referral, and found significant correlates to linkage.

Implications:
Many HIV-infected persons delay care for years following an HIV diagnosis. A major challenge is that existing counseling testing and referral programs have not, for the most part, evaluated the success rates of referrals to HIV care. It's important to demonstrate whether the ARTAS model is as effective in non-research settings. Challenges in implementing and evaluating ARTAS-II at the 10 non-research sites will be discussed.