Linkage to care: Establishing pathways to prevention services, confirmatory testing, HIV care and other services
Connecting people who self-test to a wide variety of health and social services (i.e., prevention services, confirmatory testing, HIV treatment) is an important part of HIV self-test kit distribution and should emphasize collaboration and client-centred care. Pathways to services should be established before your organization begins to distribute HIV self-test kits. Different pathways are appropriate for different people, so it is important to have multiple pathways to similar services, if possible, as well as pathways to the array of services that a client may need (e.g., pre-exposure prophylaxis prescribing, confirmatory testing, housing supports). Organizations can facilitate linkage to care by providing comprehensive information about the possible pathways to care and respecting individual preferences and choices. Information on pathways can be shared in pre- and post-test conversations or through materials in a self-test kit. Staff should be available to support people to link to needed services when they are ready and be prepared to provide options.
“Be informed about different pathways to care and understand that not everyone will want to take the same path” – Dialogue participant
“Use it as an opportunity to assess other needs and promote other services” – Dialogue participant
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The following best-practice recommendations outline strategies to consider when establishing pathways to care and linking clients to prevention services, confirmatory testing, HIV care and other health and social services.
Practice-based recommendations:
1. Establish a list of referral pathways for prevention services, confirmatory testing, linkage to care and treatment and other health and social services. You can do this by working with local healthcare providers, community organizations and public health authorities, as well as through recommendations from partner organizations and word of mouth from community members.
2. Consider developing service agreements to support care and referrals.
3. Ensure that everyone, regardless of their test results, receives equitable access to relevant care including prevention, confirmatory testing, treatment supports and other health and social services.
4. Provide accessible resources, such as informational cards, QR codes, pamphlets and a dedicated webpage, to empower individuals with information on care pathways.
5. Facilitate timely linkage to confirmatory testing for people with a reactive test result. Consider different pathways to encourage confirmatory testing including on-site confirmatory testing, mobile testing clinics, and partnerships with public health, laboratories and/or physicians.
6. Consider offering warm referrals, appointment accompaniment and peer support, to help individuals access the services they need.
7. Consider offering transportation assistance to individuals who need to access confirmatory testing, healthcare appointments or other services.
8. Consider advocating for needed services such as expanded access to HIV testing and treatment services (e.g., expanded clinic hours and flexible scheduling to accommodate diverse needs). As appropriate, work with stakeholders to address barriers and improve healthcare delivery.
9. Prioritize client-centred care by empowering individuals to make informed decisions about their healthcare journey, including the timing of treatment initiation. Ensure that individuals are aware of their rights and options regarding treatment.
10. Consider how to support or refer individuals to comprehensive support services beyond care and prevention of sexually transmitted and blood-borne infections, including assistance with housing, legal support, food security, mental health services and income support.