Linking HIV-positive adolescents to care in 15 different clinics across the United States: creating solutions to address structural barriers for linkage to care.
Linking HIV-positive adolescents to care in 15 different clinics across the United States: creating solutions to address structural barriers for linkage to care.
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DOI：
10.1080/09540121.2013.808730
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发表时间：
2014-01
期刊：
影响因子：
1.7
通讯作者：
Fortenberry JD
中科院分区：
文献类型：
--
作者：
Philbin MM;Tanner AE;Duval A;Ellen J;Kapogiannis B;Fortenberry JD
与护理的联系是扩大艾滋病毒检测的一个重要必然结果，但许多青少年未能成功地与护理联系起来，部分原因是护理系统不完整。通过国家卫生研究院（NIH）、疾病控制和预防中心（CDC）和青少年试验网络（ATN）的合作，向青少年试验网络诊所提供了与护理外展工作者的联系。探讨了与联系有关的因素，以便更好地了解如何提高艾滋病毒阳性青少年的保留率和健康结果。我们对15个青少年试验网络诊所的工作人员进行了124次访谈，以更好地了解与护理过程、障碍和促进因素的联系。内容分析侧重于结构性障碍护理和潜在的解决方案，特别是在宏观，中观和微观层面。宏观层面的障碍包括浏览健康保险政策、前往预约的交通，以及在检测机构、地方卫生部门和诊所之间收集和共享客户级联系信息的便利性；中层障碍包括诊所空间和工作人员缺乏对青年的友好，以及联动服务的重复；微观层面的障碍包括青少年对照料的准备程度和青少年发展能力。工作人员提出的解决办法包括：在等待保险批准期间，为预约提供交通服务，用一系列赠款和诊所基金资助诊所访问和检查。然而，这样的解决方案往往是特别的和局部的，使用微观层面的解决方案来解决宏观层面的障碍。需要采取综合行动，改善与护理的联系，以消除青少年获得艾滋病毒护理的障碍，他们独特的发展需求使获得护理特别具有挑战性。将结构性解决方案的水平与结构性障碍的水平相匹配（即宏观层面与宏观层面相匹配），例如制定政策以解决所需的青年保健权利问题，而不是用诊所资金覆盖未投保的患者，这对于实现与新诊断的青少年的护理率增加联系的目标至关重要。
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.
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影响因子：
4.9
作者：
Gardner, Lytt I.;Marks, Gary;del Rio, Carlos
通讯作者：
del Rio, Carlos
DOI：
10.1080/09540120412331336652
发表时间：
2005-08-01
影响因子：
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作者：
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作者：
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