266722 Understanding linkage to care and engagement in care across 15 Adolescent Medicine Trials Network (ATN) clinics: Adolescent provider perspectives and implications for newly HIV-infected youth

Tuesday, October 30, 2012 : 11:15 AM - 11:30 AM

Morgan M. Philbin, MHS , Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Amanda Tanner, PhD, MPH , Public Health Education, University of North Carolina Greensboro, Greensboro, NC
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: The National HIV/AIDS Strategy emphasizes rapid linkage to care for HIV-infected individuals. Understanding how providers initially link youth to care (linkage to care/LTC) and maintain youth in care (engagement in care/EIC) has implications for delivery of HIV-related services during early, critical years of HIV infection and treatment.

Methods: 124 staff interviews were conducted at 15 adolescent medicine clinics through an Adolescent Trials Network HIV LTC/EIC program evaluation. Content analysis examined differences and similarities of linkage and engagement in care. Data related to LTC and EIC rates were collected through clinic diaries completed by program staff.

Results: 1408 HIV-positive adolescents were enrolled, with successful LTC for 763 (i.e. a first medical visit within 42 days), and successful EIC for 681 (i.e. a second visit within 90 days). Qualitative data revealed differences in conceptualizations of LTC and EIC. Linkage was seen as mechanistic and health system driven. It was defined by the number of clinic visits, and included relatively little youth agency or involvement. In contrast, EIC was defined by youth taking responsibility and actively participating in their own care (e.g., “a year later, show up on own” or “accepting diagnosis”), involvement in clinical wrap-around services such as housing and mental health, and developing relationships with clinic staff.

Conclusions: Linkage and engagement are related but distinct aspects of care that require different resources and provider orientation toward newly diagnosed youth. Systematic implementation of seamless linkage and engagement services require refined understandings of similarities and differences between linkage and engagement in care.

Learning Areas:
Other professions or practice related to public health
Public health or related education
Social and behavioral sciences

Learning Objectives:
1. Identify similarities and differences between linkage to and engagement in HIV-related care. 2. Describe the importance of the continuity between HIV surveillance, testing, and care linkage and engagement.

Keywords: Adolescent Health, HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been working in the field of HIV/AIDS for nearly 10 years, specifically with youth and adolescents. I have been a researcher on multiple federally funded studies focusing on both HIV/AIDS and qualitative methodologies.
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.

Back to: 4120.0: HIV and Youth