The routine screening process does not simply end with diagnosis. Care team members must be confident and clear on next steps after result notification. Inadequate linkage to care processes and procedures prevent many clinicians from initiating routine screening. It can be a struggle to obtain reliable patient contact information to follow up with result disclosure. 

Without a strong linkage to care infrastructure, positive results fall in the patient’s hands, leaving a huge responsibility on the individual to seek and manage treatment, often resulting in fallout. Routine screening is also critical for re-linking people previously diagnosed back to care.

• Inconsistent patient contact information 
• Day-to-day unpredictability with patients in precarious situations 
• Multiple follow-ups needed to bring patients back into care 
• Patient resistance to initiating long term treatment
• Lack of education on current treatment guidelines

1. Form a strong referral network 

   1. A robust referral list can help connect patients with linkage venues that meet their needs including both treatment for a positive diagnosis as well as support for other wrap around services.

   2. Related resources

   • Partnership Mapping Template (PDF): This template provides a framework to help your organization keep track of relationships with non-clinical services and outpatient clinics that will support both community outreach and a sustainable linkage to care program.
   • Tool for Tracking Partners and Partnership Activities: Pages 81-88 from HRSA’s Integrating HIV Care, Treatment & Prevention Services into Primary Care–A Toolkit for Health Centers guide includes a Partnership Toolkit that provides a comprehensive list of key considerations, steps, and Partnership-Focused Templates to help guide organizations’ relationship building and tracking.
   • Effective Interventions to Treat HIV: This webpage from the CDC outlines resources that are available for the HIV prevention workforce to increase their capacity to link, retain, and re-engage people for HIV care and treatment.
   • The Case for Behavioral Health Settings in HIV Care Settings: This report from Substance Abuse and Mental Health Services Administration (SAHMSA) and HRSA highlights the need for HIV treatment providers to address behavioral health concerns with HIV and offers strategies for clinicians to implement screening practices for mental health and substance use disorders.
   • Behavioral Health Treatment Services Locator: This resource from SAHMSA helps connect persons seeking treatment facilities in the United States for substance use and addiction as well as mental health problems.

Disclaimer: This page contains resources supplied by third party organizations. Inclusion of these materials on this page does not imply endorsement of these resources or corresponding organization.

The HIV, STIs, Viral Hepatitis and LTBI Routine Screening Toolkit is organized across the screening continuum and offers helpful resources and best practices for the care team.

Step 1: Community outreach

Step 2: Patient intake

Step 3: Initiating standard screening protocols

Step 4: Testing and diagnosis

Step 5: Patient education and post-test counseling

Step 6: Linkage to care