Improving Timely Linkage to Care among Newly Diagnosed HIV-Infected Youth: Results of SMILE

  • Robin Lin MillerEmail author
  • Danielle Chiaramonte
  • Trevor Strzyzykowski
  • Dhruv Sharma
  • Kaston Anderson-Carpenter
  • J. Dennis Fortenberry


Delayed linkage to care deprives youth living with HIV of the benefits of HIV treatment and risks increased HIV transmission. Developing and testing linkage-to-care models that are capable of simultaneously addressing structural and individual obstacles are necessary to attain national goals for timely linkage of newly diagnosed youth to care. We assessed an integrated, multi-pronged strategy for improving youth’s timely linkage to care carried out in eight adolescent medicine clinical trials units (AMTUs) in the USA. In phase I, the intervention strategy paired intensive medical case management with formalized relationships to local health departments, including granting of public health authority (PHA) to four of the AMTUs. In phase II, local coalitions run by the AMTUs to address structural changes to meet youth’s HIV prevention and HIV testing needs began to advocate for local structural changes to improve timely access to care. Results of an ARIMA model demonstrated sustained decline in the average number of days to link to care over a 6-year period (ARIMA (1,2,1) AIC = 245.74, BIC = 248.70, p < .01)). By the end of the study, approximately 90% of youth linked to care had an initial medical visit in 42 or fewer days post-diagnosis. PHA improved the timeliness of linkage to care (b = − 69.56, p < .05). A piecewise regression suggested the addition of structural change initiatives during phase II made a statistically significant contribution to reducing time to linkage over and above achievements attained via case management alone (F (3,19) = 5.48, p < .01; Adj. R2 = .3794). Multi-level linkage-to-care interventions show promise for improving youth’s timely access to HIV medical care.


Youth Adolescence HIV/AIDS Linkage-to-care Structural change 



This work was supported by Grants No. 5 U01 HD040533 and 5 U01 HD 40474 to the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) from the National Institutes of Health through the Eunice Kennedy Shriver National Institute of Child Health and Human Development (B. Kapogiannis, MD), with supplemental funding from the National Institute on Drug Abuse (K. Davenny, PhD) and National Institute on Mental Health (S. Allison, PhD, P. Brouwers, PhD). The study was scientifically reviewed by the ATN’s Community and Prevention Leadership Group. Network scientific and logistical support was provided by the ATN Coordinating Center (C. Wilson, C. Partlow, J. Merchant) at the University of Alabama at Birmingham. ATN Data and Operations support was provided by Westat, Inc. (Jim Korelitz, PhD, Barbara Driver, RN, MS). We are grateful to Chitrak Banerjee, Timothy Thompson, and Taylor Whittington for their research assistance.


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Copyright information

© The New York Academy of Medicine 2019

Authors and Affiliations

  1. 1.Michigan State UniversityEast LansingUSA

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