Background:
Contemporary HIV linkage theory puts the onus of care linkage on either the client, or utilization of traditional ‘outreach' techniques. These efforts have proven ineffective, resulting in unacceptable numbers of clients remaining unlinked. The Baltimore City Health Department, in conjunction with Johns Hopkins University (JHU) and several community partners designed a linkage method based on the highly effective efforts of Disease Intervention Specialists meshed with traditional outreach techniques.

Objective:
Local Ryan White funding objectives require the linkage of 100 HIV positive persons to primary medical care,verified by the clients' attendance at two appointments.

Method:
A coordinator from JHU was given access to the database of all newly identified HIV positive persons through city testing efforts (N=300). The coordinator compiled information onto field records and distributed them to collaborating CBO case workers. These case workers were trained by Baltimore City Health Department in a method consistent with CDC ISDTI training and traditional outreach training. Staff forged agreements with primary care providers in the city allowing collection of required information (appointments made, CD4 count, viral load). Successful linkages were reported back to the coordinator for confirmation and collection.

Result:
Community case finders were able to find 85% of the clients assigned, and linked 72% of those located directly to care. Compliance of those linked to care was in excess of 90%.

Conclusion:
Linkage of HIV positive clients is a critical step that requires skills beyond traditional outreach. Location of these persons requires intensive case finding methods. Newly identified clients are more apt to enter care if provided a direct connection.

Implications:
Development of a ‘critical juncture' training, combining the best elements of ISTDI and CDC Outreach training for the purpose of training those who might encounter new positive persons.