HIV Testing, Care Referral, and Linkage to Care Intervals Affect Time to Engagement in Care for Newly Diagnosed HIV-Infected Adolescents in 15 Adolescent Medicine Clinics in the United States.

TitleHIV Testing, Care Referral, and Linkage to Care Intervals Affect Time to Engagement in Care for Newly Diagnosed HIV-Infected Adolescents in 15 Adolescent Medicine Clinics in the United States.
Publication TypePublication
Year of Publication2016
AuthorsPhilbin MM, Tanner AE, Duval A, Ellen JM, Xu J, Kapogiannis B, Bethel J, J Fortenberry D
Corporate AuthorsAdolescent Trials Network for HIVAIDS Interventions
JournalJ Acquir Immune Defic Syndr
Volume72
Issue2
Pagination222-9
Date Published2016 06 01
ISSN1944-7884
KeywordsAdolescent, Adolescent Health Services, Adolescent Medicine, Ambulatory Care Facilities, Continuity of Patient Care, Delivery of Health Care, Female, Health Services Accessibility, Health Services Needs and Demand, HIV Infections, Humans, Male, Patient Acceptance of Health Care, Professional-Patient Relations, Referral and Consultation, United States, Young Adult
Abstract

<p><b>OBJECTIVE: </b>To examine how the time from HIV testing to care referral and from referral to care linkage influenced time to care engagement for newly diagnosed HIV-infected adolescents.</p><p><b>METHODS: </b>We evaluated the Care Initiative, a care linkage and engagement program for HIV-infected adolescents in 15 US clinics. We analyzed client-level factors, provider type, and intervals from HIV testing to care referral and from referral to care linkage as predictors of care engagement. Engagement was defined as a second HIV-related medical visit within 16 weeks of initial HIV-related medical visit (linkage).</p><p><b>RESULTS: </b>At 32 months, 2143 youth had been referred. Of these, 866 were linked to care through the Care Initiative within 42 days and thus eligible for study inclusion. Of the linked youth, 90.8% were ultimately engaged in care. Time from HIV testing to referral (eg, ≤7 days versus >365 days) was associated with engagement [adjusted odds ratio = 2.91; 95% confidence interval (CI): 1.43 to 5.94] and shorter time to engagement (adjusted hazard ratio = 1.41; 95% CI: 1.11 to 1.79). Individuals with shorter care referral to linkage intervals (eg, ≤7 days versus 22-42 days) engaged in care faster (adjusted hazard ratio = 2.90; 95% CI: 2.34 to 3.60) and more successfully (adjusted odds ratio = 2.01; 95% CI: 1.04 to 3.89).</p><p><b>CONCLUSIONS: </b>These data address a critical piece of the care continuum and can offer suggestions of where and with whom to intervene to best achieve the care engagement goals outlined in the US National HIV/AIDS Strategy. These results may also inform programs and policies that set concrete milestones and strategies for optimal care linkage timing for newly diagnosed adolescents.</p>

DOI10.1097/QAI.0000000000000958
Alternate JournalJ. Acquir. Immune Defic. Syndr.
PubMed ID26885804
PubMed Central IDPMC4867127
Grant ListU01 HD040533 / HD / NICHD NIH HHS / United States
U01 HD040474 / HD / NICHD NIH HHS / United States
L60 MD009069 / MD / NIMHD NIH HHS / United States
P30 MH043520 / MH / NIMH NIH HHS / United States
T32 MH019139 / MH / NIMH NIH HHS / United States