Table 2.

Summary of evidence-to-policy implications for qualitative findings of ARV linkage-to-care single interventions

Intervention	Relevant papers	Potential harms	Feasibility	Equity & human rights considerations	Acceptability	Evidence and research gaps
(1) TASK SHIFTING: Expansion of HIV care services to other health care professionals and CHW beyond primary care doctors from centralized testing and counseling centers to regional and local community centers. Non-HIV specialist doctors and nurses, and lay health workers assist PLHIV in accessing medical care	Ivers 2011; Jama 2013; Kroeger 2011; Uebel 2013	Overall low potential harm may compromise confidentiality PLHIV as facilities and health care professionals are closer to home communities may increase burden to providers	Overall feasible within several low and middle income settings possible in communities with proper knowledge of HIV education, presence of adequate social support and community health volunteers requires proper planning and adequate training of health professionals	improves access to HIV linkage-to-care in LMIC settings reduces wait times to seeking trained HIV medical professionals and CHW increased availability of health professionals improves continuity of care for PLHIV	increased risk of unintended disclosure and potential reduced control of confidentiality health facilities reduce acceptability for PLHIV some resistance by health care workers due to stigma of HIV because of inadequate training and sensitivity to complementary health and discrimination issues	Overall acceptable to PLHIV providers, and lay health workers 4 studies in LMIC (Botswana, Haiti, South Africa) includes adults, pregnant women, and adolescents more research on MSM, substance users, incarcerated individuals, and methods to reduce burden on providers and lay health workers
(2) COMMUNITY BASED MOBILE OUTREACH (TESTING) and LINKAGE: home- based testing and counseling and workplace-based voluntary testing and counseling intervention in rural/mining areas, with subsequent linkage to community health centers or on-site health services at therural worksite	Bhagwangee 2008; Kroeger 2011; Naik 2013	Overall low potential harm may compromise confidentiality of PLHIV and bring discrimination to family members because of unintended disclosure at proximity to testing facilities in community may increase distress and conflict in household because of unintended disclosure at testing facility	Overall feasible within several low income settings possible in rural communities and localities far from testing centers requires available health care professionals for testing and counseling	improves access to HIV linkage-to-care in LMIC settings reduces wait times to seeking trained HIV medical professionals and CHW increased availability of health care professionals improves continuity of care for PLHIV	likely reduced control of confidentiality, increased risk of unintended disclosure at home and work place, with increased likelihood of distress and conflict within household of PLHIV reduces acceptability	Overall limited acceptability to PLHIV, providers, and acceptable to lay health workers 3 studies in MIC (Botswana and South Africa) includes adults men and women at work and in communities more research on MSM, substance users, incarcerated individuals, pregnant women, and adolescents needed inclusion of research on how to reduce confidentiality issues and methods to address fears of unintended disclosure and familial conflict for PLHIV
(3) INTEGRATED CARE: systematic, institutional coordination and integration ofspecialized HIV care into general/ primary care services, with goalof reducing costs, the total number of medical facilities to travel to, andappointment wait times necessary for PLHIV seeking medical professionals for primary care, HIV linked care, and other health related services	Johnson 2003; Uebel 2013	Overall low/moderate potential harm may increase stigma or discrimination of PLHIV if administrative staff at integrated center are not adequately trained on HIV education or needs of PLHIV	Overall feasible within high income settings possible in communities with HIV education, adequate social support and community health volunteers requires health professional training and proper planning requires moderate to high resources for facilities and concentration of diversely skilled medical professionals	improves access to HIV linkage to care and PLHIV of low socio-economic background because of better navigation of care cascade in HIC, and assist marginalized key populations in gaining greater access to a ranges of supportive services	may reduce incentives to seek HIV care for PLHIV who prefer more discretion in HIV treatment services, and for PLHIV who prefer to continue care with existing providers health care providers may prefer current procedures and treatment methods , and may encounter administrative barriers, or face institutional differences in integration	Overall acceptable to PLHIV, and limited acceptability to providers and lay health workers 2 studies in MIC (South Africa) and HIC (US) included adults, youths, and transgendered individuals more research on MSM, substance users, incarcerated individuals, pregnant women and adolescents
(4) PROVIDER INITIATED TESTING AND COUNSELING (PITC) and LINKAGE: HIV testing intervention where health care providers at non HIV-specific medical centers initiate HIV testing for clients who originally scheduled health care visit for other services, such as seeking care at voluntary testing centers, primary care centers, and antenatal care centers	Ferguson 2014; Macpherson 2013	Overall low/moderate potential harm small scale operations may compromise confidentiality increasing HIV testing in LIC rural communities while clients visit health facilities for other services PLHIV may not have originally planned on getting tested and may be unprepared for HIV-positive result	Overall limited feasibility in several low- income rural contexts Difficult to implement on a larger scale because most PITC are operating at voluntary testing and counseling centers	improves testing availability, access to HIV education, and access to HIV linkage-to-care in LMIC settings reduces wait times to seeking trained HIV medical professionals for individuals discovering HIV-positive result because of testing at ANC, improves maternal health and survival of infants	increased risk of unintended disclosure and potential reduced control of confidentiality health facilities both reduce acceptability for PLHIV	Overall limited acceptability to PLHIV and acceptable to providers and lay health workers 2 studies in LIC (Kenya, Malawi) included adults, adolescents, and pregnant women more research on MSM, substance users, incarcerated individuals, pregnant women, and adolescents research needed on reducing confidentiality issues and distress of discovering HIV-positive status when testing was for other purposes
(5) CESSATION SUPPORT FOR SUBSTANCE USERS TO PREPARE HIV LINKAGE: intervention of giving PLHIV who are substance-users support to cease usage, and helping them understand the health and social benefits of entering linkage to care. Intervention was particularly useful for helping marginalized populations (Youth and Homeless) transition into linkage to care medical visits and related services	Johnson 2003; Nunn 2010	Overall limited potential harm	Overall feasible within high income settings substance use support services tend to be part of a larger, comprehensive active referral, case management system, or integrated care facility in HIC and high resource settings requires proper planning and adequate training of health professionals	improves readiness to accept HIV-positive status and increases motivation for seeking HIV primary care, improving linkage to care for individuals of low socio-economic background improves relationships with medical professional facilitates navigation of care cascade in HIC marginalized key populations gain greater knowledge of ranges of supportive services	PLHIV reported that successful treatment for substance use is vital to prepare them for HIV-status and motivating their desire for HIV primary care	Overall acceptable to PLHIV, providers, and lay health workers 2 studies in US on adults and adolescents, including transgender youths and recently released prison population further research in LMIC settings, and on MSM, injection drug-users, pregnant women, and adolescents