AEGiS-NHIVPC: Timely Linkage to HIV Treatment and Care: Impact and Costs of ARTAS Case Management

National HIV Prevention Conference

Atlanta, Georgia, USA — July 27 - 30, 2003

Timely Linkage to HIV Treatment and Care: Impact and Costs of ARTAS Case Management

Natl HIV Prev Conf 2003 July 27-30:abstract no. M1-F0703
Sansom SL, Gardner L, Gaul Z, Sadek R, Anderson-Mahoney P, del Rio C, Loughlin A, Metsch L
Epidemiology Branch, DHAP, NCHSTP, CDC, Atlanta, GA

BACKGROUND/OBJECTIVES:: Individuals diagnosed with HIV may not seek care soon after their diagnosis when treatment may be most beneficial. From March 23, 2001, through Aug. 31, 2002, the Antiretroviral Treatment and Access Study (ARTAS) randomly assigned HIV-diagnosed clients in Atlanta, Baltimore, Los Angeles and Miami to an intensive case management intervention arm or to a standard-of-care arm. Case managers worked one-on-one with clients to identify and address any barriers to HIV care initiation.

METHODS: This analysis describes the proportion of case-managed clients linked to care within the first 90 days of case management. For each client, case managers recorded the number of face-to-face visits and telephone contacts, and whether clients were linked to HIV care. We assessed program costs based on reported wages for case managers and supervisors, and the costs of transportation, communication, supplies, rent and overhead. All costs are expressed in 2002 dollars.

RESULTS: Among 135 clients assigned to case management, 99 (73.9%) were linked to HIV care within 90 days of enrollment, 16 (11.9%) were not linked to care, linkage status was unknown for 18 (13%), and data were missing for one (.7%). Clients linked to care had a median of 3.0 face-to-face visits with case managers (range: 0 to 5 visits), compared with a median of 1.5 visits (range: 0 to 5 visits) among 16 clients not linked to care. Case managers spent a median of 343 minutes (range: 13 to 1,140 minutes) working directly with clients who were linked to care within 90 days, compared with 95 minutes (range: 0 to 720 minutes) with clients not linked to care (p<.01). ARTAS sites varied in the average number of clients receiving case management during each 90-day period. With an average enrollment of 10 clients per 90-day period, average program costs were $2,230 per client; with 20 clients per 90-day period, average program costs were $1,151 per client.

CONCLUSIONS: Most HIV-diagnosed clients who received case management were linked to HIV care within 90 days of enrollment. Clients not linked to care typically spent considerably less time with case managers. Overall, case management costs per client appeared to be modest. The assessment of program costs will permit a cost-effectiveness analysis of the ARTAS intervention when final effectiveness outcomes are determined.

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