Outcomes of HIV/AIDS case management in New York

The purpose of this study was to examine HIV case management (CM) outcomes in New York State. The results presented here are part of a larger study that explored: client needs identified during CM, success in arranging needs, other case managers used by the client, coordination between multiple case managers, client satisfaction with CM, and the correlation between health care costs and CM. This paper focuses on the linkage of clients with services. Twenty-eight agencies and 588 clients participated in the study. Each client's chart was reviewed; clients and case managers were interviewed. Almost 9,000 client needs were identified; 79.3% of these needs were for services. Over 72% of needed services were arranged for clients. However, of the services arranged, 12.9% were never utilized. Success in arranging services did not vary based on client demographics; client utilization of services, once arranged, varied based on only one demographic factor (clients who lived outside of New York City had higher utilization rates than those who lived in the city, p < or = 0.05). Services provided directly by the CM agency were arranged and utilized more frequently than services provided by another agency (p < or = 0.05). Medical needs were arranged and utilized at a higher rate-and legal needs at a lower rate-than other services, regardless of where the service was provided (p < or = 0.05). On average it took 2.3 months to arrange a service; however it took less time to arrange medical services and more time to arrange legal services (p < or = 0.05). Females, individuals whose mode of HIV transmission was heterosexual contact, clients whose children were living with them, the inadequately housed, and those without a high school diploma had significantly more needs than other clients (p < or = 0.05). Our study supports CM models that provide intensive services to women with children; the provision of multiple services, in addition to CM, within a single agency; and the need for case manager training on how to work with clients to increase service utilization.