Locating and linking to medical care HIV-positive persons without a history of care: findings from the California Bridge Project.

The California Bridge Project was developed to actively locate out-of-treatment HIV-positive persons and link them to HIV care and treatment services. Three hundred and twenty five clients had never received HIV medical care. Among these clients the average time from HIV diagnosis to contact with project staff was one-and-a-half years. Nearly three-fourth of clients were persons of color and almost half were men who have sex with men (MSM). The project was effective in linking 29.2% of clients to medical care. First contact to linkage required an average of 15.4 client contacts. During these encounters project staff assessed clients' risk behaviors and physical and mental health status and addressed real or perceived barriers to care. Latinos were over two times (adjusted OR = 2.33, p=0.034) and African Americans over three times (adjusted OR = 3.69, p=0.002) more likely than whites to be linked to medical care. Success in linking persons of color to medical care may have been because the majority of project staff were persons of color who were purposely hired with characteristics similar to those of the target population. The Bridge Project demonstrates the challenges faced in attempting to link HIV-positive persons from underserved and marginalized populations to medical care.