Implementation of an Integrated Approach to the National HIV/AIDS Strategy for Improving Human Immunodeficiency Virus Care for Youths

Abstract

IMPORTANCEYouths aged 13 to 24 years old living with human immunodeficiency virus (HIV) are less likely than adults to receive the health and prevention benefits of HIV treatments, with only a small proportion having achieved sustained viral suppression. These age-related disparities in HIV continuum of care are owing in part to the unique developmental issues of adolescents and young adults as well as the complexity and fragmentation of HIV care and related services. This article summarizes a national, multiagency, and multilevel approach to HIV care for newly diagnosed youths designed to bridge some of these fragmentations by addressing National HIV/AIDS Strategy goals for people living with HIV.DESIGN, SETTING, AND PARTICIPANTS Three federal agencies developed memoranda of understanding to sequentially implement 3 protocols addressing key National HIV/AIDS Strategy goals. The goals were addressed in the Adolescent Trials Network, with protocols implemented in 12 to 15 sites across the United States. Outcome data were collected from recently diagnosed youth referred to the program.MAIN OUTCOMES AND MEASURES Cross-agency collaboration, youth-friendly linkage to care services, community mobilization to address structural barriers to care, cooperation among services, proportion of all men who have sex with men who tested, and rates of linkage to prevention services. RESULTSThe program addressed National HIV/AIDS Strategy goals 2 through 4 including steps within each goal. A total of 3986 HIV-positive youths were referred for care, with more than 75% linked to care within 6 weeks of referral, with almost 90% of those youths engaged in subsequent HIV care. Community mobilization efforts implemented and completed structural change objectives to address local barriers to care. Age and racial/ethnic group disparities were addressed through targeted training for culturally competent, youth-friendly care, and intensive motivational interviewing training. CONCLUSIONS AND RELEVANCEA national program to address the National HIV/AIDS Strategy specifically for youths can improve coordination of federal resources as well as implement best-practice models that are adapted to decrease service fragmentation and systemic barriers at local jurisdictions.

Structural and Community Change Outcomes of the Connect‐to‐Protect Coalitions: Trials and Triumphs Securing Adolescent Access to HIV Prevention, Testing, and Medical Care

“…However, companion ATN studies operating simultaneously capitalized on the C2P infrastructure. These studies suggest it is probable C2P made a positive contribution to local HIV testing of high‐risk youth and to timely linkage‐to‐care (see, for example, Fortenberry et al., and Miller et al., ).…”

“…During their initial years, the coalitions focused almost exclusively on structural and community changes related to HIV prevention, access to HIV testing, and community capacity development. In 2009, the coalitions expanded their efforts to include a focus on linking newly diagnosed HIV‐infected youth to medical care, in partnership with another ATN demonstration initiative on linkage to and sustained engagement in care (Fortenberry et al., ; Philbin et al., ). Coalitions received annual financial support for one full‐time master's level coalition coordinator (roughly $65,000 per year plus fringe benefits, depending on the local labor market), and approximately $17,000 each year to support local travel, coalition activities, and basic operations.…”

Testing a Motivational Interviewing Implementation Intervention in Adolescent HIV Clinics: Protocol for a Type 3, Hybrid Implementation-Effectiveness Trial

“…Every 3 months over the 36 months of the study, providers complete a 15-minute, phone-based standard patient interaction developed in our previous studies [32]. There is a growing body of literature supporting the educational use of standardized patients in teaching and learning [47,48], including teaching MI skills and practice [49,50].…”

“…In addition, we have learned in our preliminary studies that recording actual patient-provider interactions in some HIV clinic settings is not feasible. As a result, we have developed a standard patient interaction model of fidelity monitoring using our trainer or coach rating scale as an alternative choice for implementation [32].…”

Optimizing HIV transition services for young adults

“…Community mobilisation, targeted training for culturally competent, youth-friendly care, and intensive motivational interviewing training, more than 75% of youth linked to care with 90% retained. 15,45 Adolescent development or health care transition? Perhaps to further understand the issues faced during healthcare transition we need to consider the wider transition adolescents negotiate and the neurobiological changes occurring.…”