Linkage and Referral to HIV and Other Medical and Social Services: A Focused Literature Review for Sexually Transmitted Disease Prevention and Control Programs

BACKGROUND: Sexually transmitted disease (STD) program and clinic staff play an important role in providing linkage and referrals to programs and services that address the complex medical and psychosocial needs of their clients. We synthesized recent published literature related to effective practices for linkage to care for HIV and referral to other medical and social services. METHODS: Three PubMed searches were conducted to identify relevant studies published since 2004 on (1) linkage to HIV care, (2) referral within STD clinical contexts, and (3) (review articles only) referral practices among all medical specialties. Systematic review procedures were not used. RESULTS: Thirty-three studies were included in this review. Studies highlight the limited value of passive referral practices and the increased effectiveness of active referral and linkage practices. Numerous studies on linkage to HIV care suggest that case management approaches, cultural-linguistic concordance between linkage staff and clients, and structural features such as colocation facilitate timely linkage to care. Integration of other medical and social services such as family planning and alcohol screening services into STD settings may be optimal but resource-intensive. Active referral practices such as having a written referral protocols and agreements, using information technology to help transfer information between providers, and making appointments for clients may offer some benefit. Few studies included information on program costs associated with linkage and referral. CONCLUSIONS: Recent literature provides some guideposts for STD program and clinical staff to use in determining their approach to helping link and refer clients to needed care. Much experience with these issues within STD services remains unpublished, and key gaps in the literature remain

Preferred Family Planning Method.^*

*<p>Choices were not mutually exclusive. Number (percent) indicates the number (percentage) of women of the total who chose each FP method. Totals may vary due to missing data.</p

Baseline Maternal Characteristics of 522 HIV-Infected Women Initiating ARV Therapy for PMTCT in the Kisumu Breastfeeding Study, July 2003 to November 2006.^*

*<p>Number indicates the number of women who chose each response. Percentages may not add up to 100% due to rounding. Sample sizes (in parentheses) may vary due to missing data.</p>§<p>KSh 85 per 1 US dollar (rate varies).</p

Reasons Given by Women Who Had Never Used a Condom.^*

*<p>Number (percent) indicates the number (percentage) of women who chose each response. Percentages may not add up to 100% due to rounding. Sample sizes (in parentheses) may vary due to missing data.</p

Predictors of Intention to Use Family Planning.^*

*<p>Number (percent) indicates the number (percentage) of women of the total who intended to use family planning. Sample sizes (in parentheses) may vary due to missing data.</p>§<p>Only for 63 participants who had a previous history of an STI other than HIV.</p

Flow diagram of women enrolled n the Kisumu breastfeeding study.

<p>Flow diagram of women enrolled n the Kisumu breastfeeding study.</p

Women's Perception of Family Planning Acceptance by Spouse or Partner.^*

*<p>Number (percent) indicates the number (percentage) of women who chose each response. Percentages may not add up to 100% due to rounding. Sample sizes (in parentheses) may vary due to missing data.</p