title: 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.
abstract: 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.
  
  
  
  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).
  
  
  
  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).
  
  
  
  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.
authors.affiliation: *HIV Center for Clinical and Behavioral Studies at Columbia University and New York State Psychiatric Institute, New York, NY; †Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC; ‡Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD; §Department of Pediatrics, Johns Hopkins University School of Medicine, All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, FL; ‖Westat, Rockville, MD; ¶Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD; and #Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.
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*; D000295:Adolescent Medicine; D000554:Ambulatory Care Facilities / Q000458:organization & administration; D003266:Continuity of Patient Care / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000523:psychology; D006297:Health Services Accessibility / Q000458:organization & administration*; 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; D012017:Referral and Consultation / Q000458:organization & administration*; D014481:United States / Q000453:epidemiology; D055815:Young Adult