A Novel Approach to Realizing Routine HIV Screening and Enhancing Linkage to Care in the United States: Protocol of the FOCUS Program and Early Results.

BACKGROUND: The United States health care system remains far from implementing the Centers for Disease Control and Prevention's recommendation of routine human immunodeficiency virus (HIV) screening as part of health care for adults. Although consensus for the importance of screening has grown, innovations in implementing routine screening are still lacking. HIV on the Frontlines of Communities in the United States (FOCUS) was launched in 2010 to provide an environment for testing innovative approaches to routine HIV screening and linkage to care. OBJECTIVE: The strategy of the FOCUS program was to develop models that maximize the use of information systems, fully integrate HIV screening into clinical practice, transform basic perceptions about routine HIV screening, and capitalize on emerging technologies in health care settings and laboratories. METHODS: In 10 of the most highly impacted cities, the FOCUS program supports 153 partnerships to increase routine HIV screening in clinical and community settings. RESULTS: From program launch in 2010 through October 2013, the partnerships have resulted in a total of 799,573 HIV tests and 0.68% (5425/799,573) tested positive. CONCLUSIONS: The FOCUS program is a unique model that will identify best practices for HIV screening and linkage to care.

Does patient-provider racial/ethnic concordance influence ratings of trust in people with HIV infection?

Despite widely available and effective treatments, there are racial/ethnic disparities in HIV-related mortality rates. The reason for inadequate HIV/AIDS management among minority populations is not fully understood, however recent research indicates that patients rate the quality of their health care higher if they are racially/ethnically concordant with their providers. As trust plays prominently on health care ratings, we examined whether racial/ethnicity concordance was associated with two dimensions of trust, trust in the provider and mistrust in the health care system, in 380 HIV infected people New York City. In this sample, concordance was associated with lower mistrust in the health care system, but not with trust in provider. We conclude that in this patient population and within the health care system available to them, racial/ethnic concordance might be more important for helping patients to understand and navigate the health care system rather than in interpersonal relationships with a single provider.

Toward eliminating health disparities in HIV/AIDS: the importance of the minority investigator in addressing scientific gaps in Black and Latino communities.

Dialogue in the medical and public health communities has increasingly focused attention in the area of health disparities. We believe that the elimination of health disparities in the United States will require a multipronged approach that includes, at the very least, new approaches in both biomedical and prevention interventions. We also believe that since health disparities primarily affect communities of color, a model which fosters the development of junior scientists, clinicians and researchers of color who serve these communities will yield important progress in this field. The Minority HIV/AIDS Research Initiative at the Centers for Disease Control and Prevention (CDC) is a program that, through targeted research, aims to address health disparities in HIV/AIDS. Although the program is disease specific, there are a variety of lessons learned from its inception and implementation that can be useful throughout the scientific, medical and public health communities.