239091 Linking adolescents infected with HIV into care: The effects of relationships between local health departments and adolescent medicine clinics

Monday, October 31, 2011: 12:30 PM

Amanda E. Tanner, PhD, MPH , Department of Public Health Sciences, University of North Carolina - Charlotte, Charlotte, NC
Morgan M. Philbin, MHS , Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Anna Duval, MPH , Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, MD
Jonathan Ellen, MD , Division of Pediatrics and Adolescent Medicine, Johns Hopkins University, Baltimore, MD
Bill Kapogiannis, MD , Pediatric, Adolescent and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health, Bethesda, MD
Erica Dunbar, MPH , Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
J. Dennis Fortenberry, MD, MS , Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
Background: HIV-related linkage to care (LTC) for youth requires coordination across institutional boundaries, challenging standards of confidentiality, including the provision of Public Health Authority (PHA)— sharing individual level data. Based in a NIH, CDC, and the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) partnership, we describe the formal relationships of local health departments (LHD) and 15 ATN clinics across the US initiating an adolescent HIV LTC program. Each site developed memoranda of understanding (MOU) with their LHD and manuals of procedures (MOP).

Methods: Each MOU and MOP was coded and sixty four in-depth interviews with ATN personnel were analyzed by two researchers. Discourse analysis was utilized to describe existing and subsequent relationships between LHDs and ATN clinics. PHA status at each site was recorded.

Results: Several MOU required multiple revisions, suggesting an evolving understanding of the LTC collaboration. Themes emerging related to: relationship characteristics (e.g., communication), prior collaborations (e.g., Connect 2 Protect® HIV prevention program), existing LTC programs, and data sharing (e.g., PHA). PHA and data sharing were negotiated at some sites (n=8). Sites with PHA appeared to have more successful LTC activities than those without.

Conclusions: Analyses revealed variability in the form of ATN/LHD relations. Sites with prior collaborations had an increased likelihood of LHDs providing PHA to clinics, optimizing the LTC processes. Data suggest that combined LHD and clinical resources can strengthen LTC programs. We will continue to monitor the effect of these relationships on LTC program implementation and the capacity to link HIV-infected adolescents to care.

Learning Areas:
Public health or related research
Social and behavioral sciences

Learning Objectives:
At the conclusion of the session, the participant (learner) in this session will be able to: 1. Describe relationships between local health departments and their partner academic/clinical institution. 2. Identify factors that challenge and facilitate these relationships that may affect the successful linkage of HIV positive youth to care services. 3. Convey the importance of integrating resources across partnerships for HIV surveillance, testing, and care linkage.

Keywords: Adolescents, Health Departments

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have my PhD in Health Behavior and been working in the HIV area for the last 7 years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: HIV/AIDS Linkage to Care
See more of: HIV/AIDS