TABLE 1.

Examples of HIV Surveillance-Based Activities to Promote Linkage and Retention in HIV Medical Care

Location	Follow-Up Triggered by Records of	Type and Content of Follow-Up Contacts	Who Initiates Follow-Up?	Key Features
New York City	Health department	Letter, phone call, and/or home visit to offer persons diagnosed with HIV information about HIV, HIV prevention, and HIV medical care; ascertain their reasons for not receiving care; and offer assistance with linkage or reengagement in care.	Health department DISa	Authorized staff regularly review surveillance records to identify HIV-diagnosed persons who have had no CD4b or VLc test results for ≥9 months or who appear to lack medical follow-up of detectable VL. Assistance with connecting to care is offered through an expansion of the infrastructure supporting HIV partner services. Collaborations with providers were extended to include all major HIV care centers. Incremental structural, legal, and policy changes provided the necessary foundation.
Seattle–King County, Washington	Health department	Phone call, then in-person interview to ascertain the primary reason for not receiving care and to provide guidance to resources for obtaining and remaining in care.	Health department; staff doing follow-up are trained as peer navigators.	Authorized staff review surveillance records to identify HIV-diagnosed persons with no CD4 or VL tests reported for ≥12 months or with a most recent CD4 count of <500 mm3 and a VL of >500 copies/mL. Health department confirms “out of care” status with provider first before following up with individuals. Reengagement activities involve stipend for interview. Formative work included assessments of provider and patient acceptability and a pilot to assess feasibility and limitations of surveillance.
Washington, DC	HIV medical care provider or clinic	Phone call to remind patients of the need for continuous care and to assist them in reengaging with their Ryan White care provider.	HIV care provider/clinic	Ryan White providers send a list of patients without a clinic visit in >6 months; the health department matches these lists to surveillance data and AIDS Drug Assistance Program databases to identify patients receiving care in another location. Ryan White–funded providers initiate a 90-day intensive effort to reengage those not receiving care elsewhere. Rules for sharing the minimum amount of information necessary are strict. No additional health department staff are hired; rather, the program relies on existing relationships with providers that have a fiscal relationship with the health department.
Louisiana	Health department	During patient-initiated visit for any type of care in the system's emergency department or inpatient or outpatient settings. Providers receive a public health message that they then discuss with their patients to determine whether they are receiving HIV medical care, and if not, whether they want to receive HIV care. The providers may then take action, such as referring the patients for treatment or scheduling an appointment, discussing the importance of treatment with the patients, and assessing the patients’ health and disease stage.	Medical care provider/clinic	Triggers a real-time point-of-service alert when an HIV-diagnosed person who has no reported CD4 or VL tests in >12 months presents for any medical care visit in the participating health care system. This alert involves connecting information systems infrastructures of the public health department and the health care delivery system, creating an electronic medical record alert, and instituting a formal governance structure for ongoing evaluation. The formative work included ethical and legal reviews and assessments of provider and patient acceptability.

Notes: All programs are ongoing.

^aDIS = Disease intervention specialist

^bCD4 = CD4+ T lymphocyte

^cVL = viral load