title: Factors affecting linkage to care and engagement in care for newly diagnosed HIV-positive adolescents within fifteen adolescent medicine clinics in the United States.
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.
authors.affiliation: HIV Center for Clinical and Behavioral Studies, Columbia University, New York State Psychiatric Institute, New York, NY, USA, mp3243@columbia.edu.
authors.forename: Morgan M
authors.initials: MM
authors.lastname: Philbin
authors.forename: Amanda E
authors.initials: AE
authors.lastname: Tanner
authors.forename: Anna
authors.initials: A
authors.lastname: DuVal
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Ellen
authors.forename: Jiahong
authors.initials: J
authors.lastname: Xu
authors.forename: Bill
authors.initials: B
authors.lastname: Kapogiannis
authors.forename: Jim
authors.initials: J
authors.lastname: Bethel
authors.forename: J Dennis
authors.initials: JD
authors.lastname: Fortenberry
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration; D000554:Ambulatory Care Facilities; D003266:Continuity of Patient Care / Q000458:organization & administration; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D011369:Professional-Patient Relations; D014481:United States / Q000453:epidemiology