264551 Linking HIV-positive adolescents to care: The role and process of ‘youth friendly' clinical environments

Wednesday, October 31, 2012

Amanda Tanner, PhD, MPH , Public Health Education, University of North Carolina Greensboro, Greensboro, 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 , Department of Pediatrics and Neonatology, Johns Hopkins University School of Medicine, Baltimore, MD
Bill Kapogiannis, MD , Pediatric, Adolescent and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD
J. Dennis Fortenberry, MD, MS , Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
Background: Linkage to care for HIV-infected individuals is important at both the individual and population level. Clinic-specific factors, including physical space and staff characteristics, affect care linkage for HIV-infected youth. However, little research has addressed staff insight into how ‘youth friendly' clinics may influence linkage.

Methods: 124 interviews (Baseline n=64, Year 1 n=60) were conducted with staff at 15 Adolescent Medicine Trials Network clinics (e.g., outreach workers, providers) through an HIV care linkage program evaluation. Interviews explored definitions of, and changes in, clinic and staff ‘youth friendliness'. Photographs focused on the clinics' physical space. Content and visual narrative analysis examined clinic environments.

Results: ‘Youth-friendly' definitions included responsiveness to a range of patient characteristics (e.g., gender, sexual orientation); three primary elements were identified as important for linkage. Firstly, the structure of the clinical space that served HIV-infected youth (e.g., adolescent specific or combined with pediatrics). Secondly, specific clinical characteristics including: structural barriers and facilitators to interactions (e.g., security windows, open reception areas), complex signage, targeted educational/entertainment materials, and adolescent-oriented décor. Thirdly, staff attitudes towards, and training around, adolescent needs (e.g., acceptance across gender/sexual orientation/development). Several staff reported increased attention to improve ‘youth friendliness' between baseline and Year 1 through attending trainings, replacing clinic signage, and updating décor.

Conclusions: Linkage and engagement in care is critical to the long-term health of HIV-infected youth. Understanding and working to create ‘youth friendly' clinical environments, including: space, staff, and programming that address these elements may reduce the unique barriers to care linkage faced by adolescents.

Learning Areas:
Planning of health education strategies, interventions, and programs
Public health or related research

Learning Objectives:
1. Identify ‘youth friendly’ clinical characteristics that may affect the successful linkage of HIV positive adolescents to care services. 2. Explain the importance of youth friendliness for care engagement of HIV-infected youth.

Keywords: Adolescent Health, Youth Access

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have my PhD and have been conducting HIV-related research for the past 9 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.