Creating systems change to support goals for HIV continuum of care: The role of community coalitions to reduce structural barriers for adolescents and young adults

ABSTRACT

Routine HIV screening, linkage, and retention in health care are nodes of the HIV continuum of care and goals of the National HIV/AIDS Strategy. However, up to 80% of youth are unaware of their HIV status, 29% are linked to and less than 50% are engaged in HIV health care, and fewer maintain viral suppression. To fill these gaps and to address the national call to establish a seamless system for quality HIV health care, the authors describe the processes by which the SMILE Program, with ATN-affiliated Connect-to-Protect® (C2P) community coalitions, addressed structural barriers that prevented HIV testing, linkage, and engagement in HIV health care among youth.

KEYWORDS:

• adolescents/young adults
• community coalitions
• HIV continuum of care
• structural barriers

Acknowledgments

The authors would like to acknowledge our collaborators from the Centers for Disease Control and Prevention (Linda Koenig, PhD). We also thank the Connect to Protect® (C2P) Community Coordinators and SMILE Linkage to Care (LTC) Coordinators, in the cities featured, for their support and insights: Andrea L. Williams, MPH; and Brooke Askew, MHSA (St. Jude Children’s Research Hospital); Kenia Sanchez, MSW; and Grechen Mills, BS (University of Miami-Miller School of Medicine); Cristian Chandler, MPH; and Michelle McKinney, BS (University of South Florida); Nadrine P. Hayden, BS; and Trina Jean Jacques, MSW (Tulane University Health Science Center); Milton Smith, BA; and Raenisha Brown, LCSW (Children’s Hospital of Los Angeles). We are grateful to the Principal Investigators of the participating AMTUs and their entire staff for their contributions to this project, including Patricia Emmanuel, MD; Diane M. Straub, MD; Marvin Belzer, MD; Lawrence D’Angelo, MD; Steven Douglas, MD; Jaime Martinez, MD; Lisa Henry-Reid, MD; Donna Futterman, MD; Sue Ellen Abdalian, MD; Lawrence Friedman, MD; Patricia Flynn, MD; Aditya Gaur, MD; Mary Paul, MD; Elizabeth Secord, MD; Allison George Agwu, MD; Renata Arrington-Sanders, MD; Kenneth Mayer, MD; Elizabeth J. McFarland, MD; and Daniel Rierden, MD. We appreciate the scientific review provided by members of the Community Prevention Leadership Group of the ATN. We are grateful to the ATN Coordinating Center at the University of Alabama for their network, scientific, and logistical support (Craig Wilson, Principal Investigator; Cynthia Partlow, Med, Project Director) and to the ATN Data and Operations Center at Westat for their network operations and analytical support (James Korelitz, PhD, Principal Investigator; Barbara Driver, RN, MS, Project Director). Technical assistance, training, and protocol support were provided by the National Coordinating Center at Johns Hopkins University. We are indebted to members of our community coalitions for their commitment and dedication to this work and to the SMILE LTC Coordinators and C2P Community Coordinators for their passion and devotion to helping at-risk and HIV-infected youth in their communities and for their overall contributions to the project’s implementation.