Implementation guidance for health providers and planners

Linkage to prevention, treatment and care

HTC is an entry point for other services. In isolation, HTC is of limited benefit. When effectively linked to prevention, treatment and care services, however, HTC facilitates engagement in services and enables those being tested to make positive health-related decisions.

These linkages are especially important for adolescents. The ongoing developmental changes experienced by adolescents mean that not all of them have the ability to emotionally and psychologically cope with an HIV diagnosis or understand the need for additional services. This can be exacerbated by stigma, fear of rejection from family, friends or partners, concerns about the future and legal consequences. Many adolescents also face difficulties in engaging with referral services. They may lack the experience and capability to navigate fragmented health systems and services.

Clear mechanisms and pathways of linkage and referral are essential to facilitating adolescents' access to services. It is the responsibility of health care providers to identify appropriate services, connect with referral services, clearly outline pathways of linkage, and support adolescents to engage with the services that are available.

Current linkage strategies for promoting linkage and referral between services include:

  • Services provided within the same setting/institution.
  • Directly making appointments with/for the adolescent.
  • Provision of contact information for referral services.
  • Accompanying the person to services.
  • Post-diagnosis support groups.
  • Use of SMS technology and call centres to remind adolescents of appointments etc.
  • Integration and support for peer support worker approaches and community-based outreach workers.
  • Buddy systems — mutual support from someone in a similar situation, or with a similar past experience.
  • Loss to follow-up protocols to keep track of adolescents through the system.
  • Making a list of people close to the adolescent who could assist the adolescent to attend/adhere.

Post-test counselling. Counselling at the time HIV test results are known by an adolescent provides an opportunity to discuss the importance of linking to other HIV-related services and set out referral pathways. It is imperative that those receiving both positive and negative HIV test results are provided with post-test counselling. If acceptable to the adolescent, allow and encourage them to invite a supportive adult or friend to be present to support them.