239047 Models of Linkage to Care for newly diagnosed HIV-positive adolescents within fifteen Adolescent Medicine Clinics in the United States

Monday, October 31, 2011: 12:50 PM

Morgan M. Philbin, MHS , Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Amanda E. Tanner, PhD, MPH , Department of Public Health Sciences, University of North Carolina - Charlotte, Charlotte, NC
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
     
Introduction: Linkage to care (LTC) is a critical corollary to expanded HIV testing but many youth are not linked to care within 6 months, in part due to fragmented care systems. Through an LTC collaboration of the NIH, CDC and Adolescent Medicine Trials Network (ATN), an outreach worker (OW) was provided to 15 ATN clinics, which formed partnerships with local health departments (LHD). Models of LTC were evaluated through assessment of ATN/LHD memoranda of understanding (MOU), procedure manuals (MOP), and 64 interviews with ATN staff.

Methods: Each ATN/LHD MOU, MOP, and staff interview was coded to identify local LTC models. Content analysis was conducted to identify LTC-related themes, including site-specific organization and LTC processes. Tentative models were additionally refined to produce the existing LTC process models.

Results: Three LTC models were identified: The OW as a case manager, case tracker, or gap filler. The case manager model had the most interaction with adolescents, directly helping youth navigate various LTC process steps. These OW often directly interacted with youth as they received results. Case trackers had little youth contact, but engaged community organizations providing testing and HIV-related care. Gap fillers integrated case management and case tracking, with infrequent youth interaction and less integration into the LTC processes.

Conclusions: New initiatives to improve LTC are needed to address fragmented and non-comprehensive care systems which are barriers to HIV-care for newly diagnosed youth. Commonalities across these 15 ATN clinics suggest a set of “best” practices that could guide the improvement of LTC services.

Learning Areas:
Chronic disease management and prevention
Public health or related laws, regulations, standards, or guidelines
Public health or related nursing
Social and behavioral sciences

Learning Objectives:
1) To compare and contrast different types of models for linking HIV positive adolescents into care. 2) To discuss the implications of linkage to care models on newly diagnosed HIV-positive adolescents, and how these might affect the care they receive. 3) To explain the strengths and weaknesses of different linkage to care models.

Keywords: Adolescent Health, HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked in the field of HIV/AIDS for over five years and currently manage the evaluation of a program addressing linkage to care, HIV/AIDS, and adolescent health.
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