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Factors Affecting Linkage to Care and Engagement in Care for Newly Diagnosed HIV-Positive Adolescents Within Fifteen Adolescent Medicine Clinics in the United States

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Abstract

Early linkage to care and engagement in care are critical for initiation of medical interventions. However, over 50 % of newly diagnosed persons do not receive HIV-related care within 6 months of diagnosis. We evaluated a linkage to care and engagement in care initiative for HIV-positive adolescents in 15 U.S.-based clinics. Structural and client-level factors (e.g. demographic and behavioral characteristics, clinic staff and location) were evaluated as predictors of successful linkage and engagement. Within 32 months, 1,172/1,679 (69.8 %) of adolescents were linked to care of which 1,043/1,172 (89 %) were engaged in care. Only 62.1 % (1,043/1,679) of adolescents were linked and engaged in care. Linkage to care failure was attributed to adolescent, provider, and clinic-specific factors. Many adolescents provided incomplete data during the linkage process or failed to attend appointments, both associated with failure to linkage to care. Additional improvements in HIV care will require creative approaches to coordinated data sharing, as well as continued outreach services to support newly diagnosed adolescents.

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Acknowledgments

The Adolescent Medicine Trials Network for HIV/AIDS Interventions is funded by grants 5 U01 HD 40533 and 5 U01 HD 40474 from the National Institutes of Health through the National Institute of Child Health and Human Development (Bill Kapogiannis, MD) with supplemental funding from the National Institutes on Drug Abuse (Nicolette Borek, PhD) and Mental Health (Susannah Allison, PhD; Pim Brouwers, PhD). Additional support was provided by an administrative supplement awarded through funds from the American Recovery and Reinvestment Act (ARRA) of 2009. The study was scientifically reviewed by the Adolescent Trials Network Community Prevention Leadership Group. Network, scientific, and logistical support was provided by the Adolescent Trials Network Coordinating Center (Craig Wilson, MD; Cynthia Partlow, MEd). Project support and coordination was provided by the Adolescent Trials Network Data and Operations Center at Westat, Inc. (Jim Korelitz, PhD; Barbara Driver RN, MS). We acknowledge the investigators and staff at the of the Adolescent Trials Network sites that participated in the study: Children’s Diagnostic and Treatment Center, Fort Lauderdale, FL (Ana Puga, MD, Esmine Leonard, RN, Amy Inman, BS); Children’s Hospital of Los Angeles, Los Angeles, CA (Marvin Belzer, MD, Diane Tucker, RN, MSN); Children’s Hospital of Philadelphia (Bret Rudy, MD, Mary Tanney, RN, MSN, CRNP, Adrienne DiBenedetto, BSN), Children’s Memorial Hospital, Chicago, IL (Robert Garofalo, MD, Julia Brennan, RN, MSN, ANP-C, Jennifer Kershaw, CPNP); Children’s National Medical Center, Washington, DC (Lawrence J. D’Angelo, MD, Connie Trexler, RN, CPN, BSN, Rita Hagler, CPNP, Amy Klamberg, CPNP); John H. Stroger Jr. Hospital of Cook County and the Ruth M. Rothstein CORE Center, Chicago, IL (Jaime Martinez, MD, Lisa Henry-Reid, MD, Kelly Bojan, DNP, RN, CFNP, Rachel Jackson, MSN, APN, CFNP); Montefiore Medical Center, Bronx, NY (Donna Futterman, MD, Elizabeth Enriquez-Bruce, MD, Maria Campos, RN); Mount Sinai Medical Center, New York, NY (John Steever, MD, Mary Geiger, RN); St. Jude Children’s Research Hospital, Memphis, TN (Pat Flynn, MD, Mary Dillard, RN, Carla McKinley, FNP); Tulane University Health Sciences Center, New Orleans, LA (Sue Ellen Abdalian, MD, Alyne Baker, RN, MN, Leslie Kozina, RN, CCRC); University of California at San Francisco, San Francisco, CA (Barbara Moscicki, MD, Lisa D. Irish, BSN, J. B. Molaghan, BA); University of Maryland, Baltimore, MD (Ligia Peralta, MD, Leonel Flores, MD, Reshma S. Gorle, MPH); University of Miami School of Medicine (Larry Friedman, MD, Donna Maturo, ARNP, Hanna Major-Wilson, ARNP), University of Puerto Rico, San Juan, PR (Irma L. Febo, MD, Hazel T Ayala-Flores, BSN, Anne T. F. Gomez, BA); University of South Florida, Tampa, FL (Patricia Emmanuel, MD, Diane M. Straub, MD, MPH, Silvia Callejas, BSN, ACRN, CCRC, Priscilla C. Julian, RN).

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Authors and Affiliations

  1. HIV Center for Clinical and Behavioral Studies, Columbia University, New York State Psychiatric Institute, New York, NY, USA

    Morgan M. Philbin

  2. Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, USA

    Amanda E. Tanner

  3. Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Anna DuVal

  4. Department of Pediatrics, All Children’s Hospital, Johns Hopkins Medicine, Johns Hopkins University School of Medicine, St. Petersburg, FL, USA

    Jonathan M. Ellen

  5. Westat, Rockville, MD, USA

    Jiahong Xu & Jim Bethel

  6. Pediatric, Adolescent and Maternal AIDS Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA

    Bill Kapogiannis

  7. Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA

    J. Dennis Fortenberry

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  1. Morgan M. Philbin
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  2. Amanda E. Tanner
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  3. Anna DuVal
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  4. Jonathan M. Ellen
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  5. Jiahong Xu
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  6. Bill Kapogiannis
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  7. Jim Bethel
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  8. J. Dennis Fortenberry
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The Adolescent Trials Network for HIV/AIDS Interventions

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Correspondence to Morgan M. Philbin.

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Philbin, M.M., Tanner, A.E., DuVal, A. et al. Factors Affecting Linkage to Care and Engagement in Care for Newly Diagnosed HIV-Positive Adolescents Within Fifteen Adolescent Medicine Clinics in the United States. AIDS Behav 18, 1501–1510 (2014). https://doi.org/10.1007/s10461-013-0650-6

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  • DOI: https://doi.org/10.1007/s10461-013-0650-6

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