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Factors That Influence Linkages to HIV Continuum of Care Services: Implications for Multi-Level Interventions

School of Social Work, University of Michigan—Ann Arbor, 1080 South University, Room 3792, Ann Arbor, MI 48109, USA
School of Social Work, Columbia University, 1255 Amsterdam Avenue, 8th Floor, New York, NY 10027, USA
Department of Political Science, Purchase College, 735 Anderson Hill Road, Purchase, NY 10577, USA
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2017, 14(11), 1355;
Received: 28 September 2017 / Revised: 26 October 2017 / Accepted: 2 November 2017 / Published: 7 November 2017
PDF [497 KB, uploaded 7 November 2017]


Worldwide, the human immunodeficiency virus (HIV) continuum of care involves health promotion providers (e.g., social workers and health educators) linking patients to medical personnel who provide HIV testing, primary care, and antiretroviral treatments. Regrettably, these life-saving linkages are not always made consistently and many patients are not retained in care. To design, test and implement effective interventions, we need to first identify key factors that may improve linkage-making. To help close this gap, we used in-depth interviews with 20 providers selected from a sample of 250 participants in a mixed-method longitudinal study conducted in New York City (2012–2017) in order to examine the implementation of HIV services for at-risk populations. Following a sociomedical framework, we identified provider-, interpersonal- and environmental-level factors that influence how providers engage patients in the care continuum by linking them to HIV testing, HIV care, and other support services. These factors occurred in four domains of reference: Providers’ Professional Knowledge Base; Providers’ Interprofessional Collaboration; Providers’ Work-Related Changes; and Best Practices in a Competitive Environment. Of particular importance, our findings show that a competitive environment and a fear of losing patients to other agencies may inhibit providers from engaging in linkage-making. Our results suggest relationships between factors within and across all four domains; we recommend interventions to modify factors in all domains for maximum effect toward improving care continuum linkage-making. Our findings may be applicable in different areas of the globe with high HIV prevalence. View Full-Text
Keywords: HIV continuum of care; service providers; linkage to care; multi-level interventions HIV continuum of care; service providers; linkage to care; multi-level interventions

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Pinto, R.M.; Witte, S.S.; Filippone, P.L.; Baird, K.L.; Whitman, W.R. Factors That Influence Linkages to HIV Continuum of Care Services: Implications for Multi-Level Interventions. Int. J. Environ. Res. Public Health 2017, 14, 1355.

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