I. The Linkage to Care Specialist (LTCS) is a new position that was developed as part of the SPNS initiative to improve linkage and retention to HIV medical care. The Linkage to Care service is a time-limited, intensive form of case management that is focused on linking or re-linking and engaging individuals in HIV medical care; identifying barriers to care and working with the individual to address the barriers; educating individuals on self-management of their HIV disease; and transitioning the individual to the appropriate service provider, as necessary, for longer-term case management. The LTCS are working with four primary population types:
• Newly diagnosed,
• New to care
• Post-incarcerated, and
• Out of care.
The LTCS will:
· Conduct an intake at the time of service enrollment for all clients, including an assessment of barriers to care.
· Develop a service plan with the individual to identify the primary barriers to HIV medical care.
· Link or re-link individuals to HIV primary care.
· Ensure early retention to HIV care by attending the client’s routine HIV medical visits.
· Transition clients to the appropriate service level(s) (self-management, non-medical case management, and/or medical case management) at the time of service discharge.
II. Social Networks (SNS) testing is based on the notion that individuals are linked together to form social networks, which among other things serve as a route to spread infectious diseases. This peer-driven, recruitment strategy allows HIV testing and prevention messages to reach the highest risk persons who may be infected but unaware of their status. This technique is accomplished by enlisting newly and previously diagnosed HIV-positive and high-risk HIV negative recruiters on an ongoing basis and providing HIV counseling, testing and referral to people in their networks. SNS testing has been in place in Wisconsin since 2008 and has proven effective for identifying high risk individuals with HIV infection and has a higher positivity rate than traditional HIV testing in Wisconsin. The goal for this strategy is to improve the existing social networks testing model to better reach young MSM of color and transgender individuals. Specifically, a protocol standardizes SNS testing will be developed and implemented, demographic targets will be put in place for recruiters and associates, and alternative venues will be identified to better enlist recruiters and associates of the target demographic.
Agencies conducting SNS testing will:
· Develop agency-level implementation plans that are consistent with the DPH protocol for SNS testing.
· Identify venues that are more amenable to finding both recruiters and associates who meet the target demographic.
· Enlist potential recruiters who match the target demographic.
· Provide the orientation and regular coaching to the recruiter, in a manner consistent with the DPH protocol.
· Provide incentives to the recruiter and his/her associates as dictated in the agency’s implementation plan.
· Provide counseling, testing and referral to all associates presenting for HIV testing.
· Provide linkage to care services for individuals testing positive by making referrals to Linkage to Care Specialists (LTCS) for eligible clients or using standard linkage mechanisms.
Currently more than two-thirds of all new HIV diagnoses and prevalent HIV cases in Wisconsin are in the Southern and Southeastern Region of the state. Therefore, the scale-up will focus on increasing the number of agencies providing the Linkage to Care (LTC) service in Southern and Southeastern Wisconsin, broadening the population that is eligible for the service, and fine-tuning the service so that LTCS are able to serve a larger number of clients.
The scale-up of the SNS testing strategy will focus on: increasing the number and type of agencies providing SNS testing, expanding the target population to include young MSM of color and transgendered individuals, and increasing the number of SNS tests.