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Linking HIV-positive adolescents to care in 15 different clinics across the United States: Creating solutions to address structural barriers for linkage to care

Linkage to care is a critical corollary to expanded HIV testing, but many adolescents are not successfully linked to care, in part due to fragmented care systems. Through a collaboration of the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC) and the Adolescent T... Full description

Journal Title: AIDS care 2014-01-02, Vol.26 (1), p.12-19
Main Author: Philbin, Morgan M.
Other Authors: Tanner, Amanda E. , DuVal, Anna , Ellen, Jonathan , Kapogiannis, Bill , Fortenberry, J. Dennis
Format: Electronic Article Electronic Article
Language: English
Subjects:
HIV
Quelle: Alma/SFX Local Collection
Publisher: Abingdon: Routledge
ID: ISSN: 0954-0121
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recordid: cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3872213
title: Linking HIV-positive adolescents to care in 15 different clinics across the United States: Creating solutions to address structural barriers for linkage to care
format: Article
creator:
  • Philbin, Morgan M.
  • Tanner, Amanda E.
  • DuVal, Anna
  • Ellen, Jonathan
  • Kapogiannis, Bill
  • Fortenberry, J. Dennis
subjects:
  • Adolescent
  • Adolescent Health Services - organization & administration
  • Adolescents
  • AIDS
  • AIDS/HIV
  • Ambulatory Care Facilities - utilization
  • Appointments
  • Appointments and Schedules
  • Article
  • Attitude of Health Personnel
  • Biological and medical sciences
  • Clinical outcomes
  • Clinics
  • Community health care
  • Constraints
  • Content analysis
  • Continuity of Patient Care
  • Delivery of Health Care
  • Funds
  • Health
  • Health care
  • Health care delivery
  • Health Care Services
  • Health Problems
  • Health Services Accessibility
  • Health Services Needs and Demand
  • HIV
  • HIV Infections - psychology
  • HIV Infections - therapy
  • HIV/AIDS
  • Human immunodeficiency virus
  • Human viral diseases
  • Humans
  • Immunodeficiencies
  • Immunodeficiencies. Immunoglobulinopathies
  • Immunopathology
  • Infectious diseases
  • Information Dissemination
  • Interviews as Topic
  • linkage to care
  • Male
  • Medical sciences
  • Patient Acceptance of Health Care
  • Patients
  • Professional-Patient Relations
  • Qualitative analysis
  • qualitative methods
  • Qualitative Research
  • structural barriers
  • Surveys and Questionnaires
  • Teenagers
  • Transportation
  • Trials
  • U.S.A
  • United States
  • Viral diseases
  • Viral diseases of the lymphoid tissue and the blood. Aids
  • Youth
ispartof: AIDS care, 2014-01-02, Vol.26 (1), p.12-19
description: Linkage to care is a critical corollary to expanded HIV testing, but many adolescents are not successfully linked to care, in part due to fragmented care systems. Through a collaboration of the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC) and the Adolescent Trials Network (ATN), a linkage to care outreach worker was provided to ATN clinics. Factors related to linkage were explored to better understand how to improve retention rates and health outcomes for HIV-positive adolescents. We conducted 124 interviews with staff at 15 Adolescent Trials Network clinics to better understand linkage to care processes, barriers, and facilitators. Content analysis was conducted focusing on structural barriers to care and potential solutions, specifically at the macro-, meso-, and micro-levels. Macro-level barriers included navigating health insurance policies, transportation to appointments, and ease of collecting and sharing client-level contact information between testing agencies, local health departments and clinics; meso-level barriers included lack of youth friendliness within clinic space and staff, and duplication of linkage services; micro-level barriers included adolescents' readiness for care and adolescent developmental capacity. Staff initiated solutions included providing transportation for appointments and funding clinic visits and tests with a range of grants and clinic funds while waiting for insurance approval. However, such solutions were often ad hoc and partial, using micro-level solutions to address macro-level barriers. Comprehensive initiatives to improve linkage to care are needed to address barriers to HIV-care for adolescents, whose unique developmental needs make accessing care particularly challenging. Matching the level of structural solution to the level of structural barriers (i.e., macro-level with macro-level), such as creating policy to address needed youth healthcare entitlements versus covering uninsured patients with clinic funds is imperative to achieving the goal of increasing linkage to care rates for newly diagnosed adolescents.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0954-0121
fulltext: fulltext
issn:
  • 0954-0121
  • 1360-0451
url: Link


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descriptionLinkage to care is a critical corollary to expanded HIV testing, but many adolescents are not successfully linked to care, in part due to fragmented care systems. Through a collaboration of the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC) and the Adolescent Trials Network (ATN), a linkage to care outreach worker was provided to ATN clinics. Factors related to linkage were explored to better understand how to improve retention rates and health outcomes for HIV-positive adolescents. We conducted 124 interviews with staff at 15 Adolescent Trials Network clinics to better understand linkage to care processes, barriers, and facilitators. Content analysis was conducted focusing on structural barriers to care and potential solutions, specifically at the macro-, meso-, and micro-levels. Macro-level barriers included navigating health insurance policies, transportation to appointments, and ease of collecting and sharing client-level contact information between testing agencies, local health departments and clinics; meso-level barriers included lack of youth friendliness within clinic space and staff, and duplication of linkage services; micro-level barriers included adolescents' readiness for care and adolescent developmental capacity. Staff initiated solutions included providing transportation for appointments and funding clinic visits and tests with a range of grants and clinic funds while waiting for insurance approval. However, such solutions were often ad hoc and partial, using micro-level solutions to address macro-level barriers. Comprehensive initiatives to improve linkage to care are needed to address barriers to HIV-care for adolescents, whose unique developmental needs make accessing care particularly challenging. Matching the level of structural solution to the level of structural barriers (i.e., macro-level with macro-level), such as creating policy to address needed youth healthcare entitlements versus covering uninsured patients with clinic funds is imperative to achieving the goal of increasing linkage to care rates for newly diagnosed adolescents.
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subjectAdolescent ; Adolescent Health Services - organization & administration ; Adolescents ; AIDS ; AIDS/HIV ; Ambulatory Care Facilities - utilization ; Appointments ; Appointments and Schedules ; Article ; Attitude of Health Personnel ; Biological and medical sciences ; Clinical outcomes ; Clinics ; Community health care ; Constraints ; Content analysis ; Continuity of Patient Care ; Delivery of Health Care ; Funds ; Health ; Health care ; Health care delivery ; Health Care Services ; Health Problems ; Health Services Accessibility ; Health Services Needs and Demand ; HIV ; HIV Infections - psychology ; HIV Infections - therapy ; HIV/AIDS ; Human immunodeficiency virus ; Human viral diseases ; Humans ; Immunodeficiencies ; Immunodeficiencies. Immunoglobulinopathies ; Immunopathology ; Infectious diseases ; Information Dissemination ; Interviews as Topic ; linkage to care ; Male ; Medical sciences ; Patient Acceptance of Health Care ; Patients ; Professional-Patient Relations ; Qualitative analysis ; qualitative methods ; Qualitative Research ; structural barriers ; Surveys and Questionnaires ; Teenagers ; Transportation ; Trials ; U.S.A ; United States ; Viral diseases ; Viral diseases of the lymphoid tissue and the blood. Aids ; Youth
ispartofAIDS care, 2014-01-02, Vol.26 (1), p.12-19
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descriptionLinkage to care is a critical corollary to expanded HIV testing, but many adolescents are not successfully linked to care, in part due to fragmented care systems. Through a collaboration of the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC) and the Adolescent Trials Network (ATN), a linkage to care outreach worker was provided to ATN clinics. Factors related to linkage were explored to better understand how to improve retention rates and health outcomes for HIV-positive adolescents. We conducted 124 interviews with staff at 15 Adolescent Trials Network clinics to better understand linkage to care processes, barriers, and facilitators. Content analysis was conducted focusing on structural barriers to care and potential solutions, specifically at the macro-, meso-, and micro-levels. Macro-level barriers included navigating health insurance policies, transportation to appointments, and ease of collecting and sharing client-level contact information between testing agencies, local health departments and clinics; meso-level barriers included lack of youth friendliness within clinic space and staff, and duplication of linkage services; micro-level barriers included adolescents' readiness for care and adolescent developmental capacity. Staff initiated solutions included providing transportation for appointments and funding clinic visits and tests with a range of grants and clinic funds while waiting for insurance approval. However, such solutions were often ad hoc and partial, using micro-level solutions to address macro-level barriers. Comprehensive initiatives to improve linkage to care are needed to address barriers to HIV-care for adolescents, whose unique developmental needs make accessing care particularly challenging. Matching the level of structural solution to the level of structural barriers (i.e., macro-level with macro-level), such as creating policy to address needed youth healthcare entitlements versus covering uninsured patients with clinic funds is imperative to achieving the goal of increasing linkage to care rates for newly diagnosed adolescents.
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22Health Care Services
23Health Problems
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25Health Services Needs and Demand
26HIV
27HIV Infections - psychology
28HIV Infections - therapy
29HIV/AIDS
30Human immunodeficiency virus
31Human viral diseases
32Humans
33Immunodeficiencies
34Immunodeficiencies. Immunoglobulinopathies
35Immunopathology
36Infectious diseases
37Information Dissemination
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39linkage to care
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41Medical sciences
42Patient Acceptance of Health Care
43Patients
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45Qualitative analysis
46qualitative methods
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51Transportation
52Trials
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titleLinking HIV-positive adolescents to care in 15 different clinics across the United States: Creating solutions to address structural barriers for linkage to care
authorPhilbin, Morgan M. ; Tanner, Amanda E. ; DuVal, Anna ; Ellen, Jonathan ; Kapogiannis, Bill ; Fortenberry, J. Dennis
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abstractLinkage to care is a critical corollary to expanded HIV testing, but many adolescents are not successfully linked to care, in part due to fragmented care systems. Through a collaboration of the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC) and the Adolescent Trials Network (ATN), a linkage to care outreach worker was provided to ATN clinics. Factors related to linkage were explored to better understand how to improve retention rates and health outcomes for HIV-positive adolescents. We conducted 124 interviews with staff at 15 Adolescent Trials Network clinics to better understand linkage to care processes, barriers, and facilitators. Content analysis was conducted focusing on structural barriers to care and potential solutions, specifically at the macro-, meso-, and micro-levels. Macro-level barriers included navigating health insurance policies, transportation to appointments, and ease of collecting and sharing client-level contact information between testing agencies, local health departments and clinics; meso-level barriers included lack of youth friendliness within clinic space and staff, and duplication of linkage services; micro-level barriers included adolescents' readiness for care and adolescent developmental capacity. Staff initiated solutions included providing transportation for appointments and funding clinic visits and tests with a range of grants and clinic funds while waiting for insurance approval. However, such solutions were often ad hoc and partial, using micro-level solutions to address macro-level barriers. Comprehensive initiatives to improve linkage to care are needed to address barriers to HIV-care for adolescents, whose unique developmental needs make accessing care particularly challenging. Matching the level of structural solution to the level of structural barriers (i.e., macro-level with macro-level), such as creating policy to address needed youth healthcare entitlements versus covering uninsured patients with clinic funds is imperative to achieving the goal of increasing linkage to care rates for newly diagnosed adolescents.
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