TY - JOUR
T1 - Understanding care linkage and engagement across 15 adolescent clinics
T2 - Provider perspectives and implications for newly HIV-infected youth
AU - The Adolescent Trials Network for HIV/AIDS Interventions
AU - Philbin, Morgan M.
AU - Tanner, Amanda E.
AU - DuVal, Anna
AU - Ellen, Jonathan M.
AU - Kapogiannis, Bill
AU - Dennis Fortenberry, J.
N1 - Funding Information:
This work was supported by grants to the Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN): 5 U01 HD 40533 and 5 U01 HD 40474 from the National Institutes of Health through the National Institute of Child Health and Human Development (Bill Kapogiannis, MD; Sonia Lee, PhD) with supplemental funding from the National Institutes on Drug Abuse (Shoshana Kahana, PhD) and Mental Health (Susannah Allison, PhD; Pim Brouwers, PhD). Additional support was provided by an administrative supplement, 3 U01 HD 040533-09S1, awarded through funds from the American Recovery and Reinvestment Act (ARRA) of 2009. The comments and views of the authors do not necessarily represent the views of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. We acknowledge the contribution of the investigators and staff at the following sites that participated in this study: University of South Florida, Tampa (Emmanuel, Straub, McKinney), Children’s Hospital of Los Angeles (Belzer, Brown), Children’s National Medical Center (D’Angelo, Fawehinmi, Hoyte), Children’s Hospital of Philadelphia (Douglas, Tanney, Kerfren, Louis), John H. Stroger Jr. Hospital of Cook County and the Ruth M. Rothstein CORE Center (Martinez, Henry-Reid, McFadden), University of Puerto Rico (Febo, Cruz), Montefiore Medical Center (Futterman, Jackson), Mount Sinai Medical Center (Steever, Maxwell), University of California-San Francisco (Moscicki, Auerswald, Bowman), Tulane University Health Sciences Center (Abdalian, McFarlane, Jeanjacques), University of Maryland (Peralta, Bishop), University of Miami School of Medicine (Friedman, Mills), Children’s Diagnostic and Treatment Center (Puga, Archibald), St. Jude’s Children’s Research Hospital (Flynn, Askew), and Children’s Memorial Hospital (Garofalo, Vulpas, Heine). The study was scientifically reviewed by the ATN Community Prevention Leadership Group. Network, scientific, and logistical support was provided by the ATN Coordinating Center (Craig Wilson, MD; Cynthia Partlow, MEd). Project support and coordination were provided by the ATN Data and Operations Center at Westat, Inc. (Jim Korelitz, PhD; Barbara Driver, RN, MS). Dr. Philbin was supported by a NIDA-funded K01 (K01DA039804A).
Publisher Copyright:
© 2017 The Guilford Press.
PY - 2017
Y1 - 2017
N2 - The National HIV/AIDS Strategy emphasizes rapid care linkage and engagement for HIV-infected individuals, though many adolescents are never tested, delay entering care, and frequently drop out. We conducted 183 staff interviews at 15 adolescent medicine clinics (baseline, n = 64; Year 1, n = 60; Year 2, = 59). We used a constant comparative thematic method to examine how providers approached and discussed care linkage/engagement. Qualitative analyses revealed differences in providers’ conceptualizations of linkage and engagement. Providers saw linkage as mechanistic and health system driven. It was defined by number of clinic visits and involved relatively little youth agency. In contrast, providers defined engagement by youths’ responsibility and participation in their own care. Linkage and engagement are related but distinct aspects of care that require different resources and levels of staff involvement. Integrating an understanding of these differences into future interventions will allow clinic staff to help youth improve long-term health outcomes.
AB - The National HIV/AIDS Strategy emphasizes rapid care linkage and engagement for HIV-infected individuals, though many adolescents are never tested, delay entering care, and frequently drop out. We conducted 183 staff interviews at 15 adolescent medicine clinics (baseline, n = 64; Year 1, n = 60; Year 2, = 59). We used a constant comparative thematic method to examine how providers approached and discussed care linkage/engagement. Qualitative analyses revealed differences in providers’ conceptualizations of linkage and engagement. Providers saw linkage as mechanistic and health system driven. It was defined by number of clinic visits and involved relatively little youth agency. In contrast, providers defined engagement by youths’ responsibility and participation in their own care. Linkage and engagement are related but distinct aspects of care that require different resources and levels of staff involvement. Integrating an understanding of these differences into future interventions will allow clinic staff to help youth improve long-term health outcomes.
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U2 - 10.1521/aeap.2017.29.2.93
DO - 10.1521/aeap.2017.29.2.93
M3 - Article
C2 - 28467164
AN - SCOPUS:85018426312
SN - 0899-9546
VL - 29
SP - 93
EP - 104
JO - AIDS Education and Prevention
JF - AIDS Education and Prevention
IS - 2
ER -