HIV testing, care referral and linkage to care intervals affect time to engagement in care for newly diagnosed HIV-infected adolescents in fifteen adolescent medicine clinics in the United States

OBJECTIVE:: 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. METHODS:: We evaluated the Care Initiative, a care linkage and engagement program for HIV-infected adolescents in 15 U.S. 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). RESULTS:: At 32 months, 2,143 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 (e.g., ≤7 days versus >365 days) was associated with engagement (AOR=2.91; 95% CI: 1.43-5.94) and shorter time to engagement (Adjusted HR=1.41; 95% CI: 1.11-1.79). Individuals with shorter care referral to linkage intervals (e.g., ≤7 days versus 22-42 days) engaged in care faster (Adjusted HR=2.90; 95% CI: 2.34-3.60) and more successfully (AOR=2.01; 95% CI: 1.04-3.89). CONCLUSIONS:: These data address a critical piece of the care continuum, and can offer suggestions of where and with whom to intervene in order to best achieve the care engagement goals outlined in the U.S. 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.