The North Carolina HIV Bridge Counselor Program: Outcomes From a Statewide Level Intervention to Link and Reengage HIV-Infected Persons in Care in the South

J Acquir Immune Defic Syndr. 2017 Sep 1;76(1):e7-e14. doi: 10.1097/QAI.0000000000001389.


Background: To improve the HIV continuum of care, a team of field service interventionists (State Bridge Counselors, SBC) was developed through a state public health system and provided brief (1-2) contacts for linkage of newly diagnosed persons with HIV and reengagement of persons living with HIV (PLWH) who were not in care.

Setting: North Carolina, United States.

Methods: Service data from January 2013 to June 2015 were analyzed to determine characteristics of clients referred to SBCs, proportions linked or reengaged in care, and/or achieved viral load suppression (VLs). We evaluated associations between client characteristics and outcomes using multivariable analyses and estimated odds ratios (OR) with 95% confidence intervals (CI).

Results: SBCs provided linkage services to 299 newly diagnosed individuals and reengagement services to 606 PLWH throughout North Carolina. Among persons who received linkage services, 189 (63%) had evidence of care within 90 days of referral and 205 (69%) had VLs within a year. Among PLWH who received reengagement services, 278 (46%) had care within 90 days and 308 (51%) had VLs within a year. Persons aged 30-39 years (OR, 2.1; 95% CI, 1.1 to 3.9) and 40-49 years had an increased likelihood (OR, 2.4; 95% CI, 1.1 to 5.2) of linkage within 90 days compared with persons aged 18-29 years. Non-white PLWH had an increased OR of 1.7; (95% CI, 1.2 to 2.5) of reengagement compared with whites.

Conclusions: Our SBC program successfully implemented a "low-touch" approach to provision of linkage and reengagement services, demonstrating that public health resources can be used to address the HIV care continuum on a statewide level.

MeSH terms

  • Adult
  • CD4 Lymphocyte Count
  • Continuity of Patient Care / organization & administration*
  • Counselors
  • Directive Counseling / organization & administration*
  • Ethnicity
  • Evidence-Based Practice / organization & administration*
  • Female
  • HIV Infections / epidemiology
  • HIV Infections / therapy*
  • Humans
  • Male
  • Middle Aged
  • North Carolina / epidemiology
  • Program Evaluation
  • Referral and Consultation / organization & administration*
  • Social Support
  • Viral Load