METHODS: HIV case investigation data and laboratory data from EpiTrax were used to develop an enhanced link-to-care system to identify clients for retention and re-engagement. The care statuses of clients are tracked with an auto-generated link-to-care report within the Pentaho BI system, and the co-infection management module.
RESULTS: Since EpiTrax and the enhanced link-to-care system were in place, we have set up a passive follow-up system to identify newly diagnosed cases for follow-up. If the client was unable to attend his/her medical appointment, a linkage coordinator is assigned to help navigate the system. For clients who have a documented history of HIV infection, more out of care (OOC) cases were identified through the newly designed co-infection management and investigation module. HIV clients are identified as soon as their STD electronic lab reports are received by EpiTrax. These cases are classified as high priority investigation, and are expedited for field investigation. Before SNHD adopted EpiTrax, in 2013, only 35.7% of HIV clients who are newly diagnosed, out of care or new to jurisdiction and received services at SNHD have documented first medical appointments. The percent of HIV clients who have had their first medical appointment documented increased to 63% in 2014, and 82% in 2015. The retention of HIV clients in care didn’t follow HRSA recommendation and has since been improving with a documented 51% in 2015.
CONCLUSIONS: The integrated surveillance and investigation system coupled with automated laboratory data processing and reporting, significantly improves the timeliness of identifying OOC clients and rate of linkage and retention in HIV care. With a new requirement for CD4 and HIV viral load reporting and future EHR reporting, we will be able to further improve linkage and retention in HIV which are critical to improve the health of HIV infected persons and reduce transmission of new infections.