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Points of Entry into the Care Continuum

(Table 1 from the HRSA-funded AIDS Alliance 2005 Report)

  • HIV counseling, testing, and referral (CTR) sites
  • Emergency rooms and urgent care centers
  • Substance abuse treatment programs
  • Detoxification programs
  • Adult and juvenile detention facilities
  • Sexually transmitted infection (STI) clinics
  • Federally qualified health centers
  • HIV disease counseling and testing sites
  • Mental health programs
  • Homeless shelters
  • Public health departments
  • Current Title I, II, III, and IV (now Part A, B, C and D) providers
  • Hemophilia diagnostic and treatment centers
  • Migrant health centers
  • Community health and family planning centers
  • Nonprofit private agencies providing comprehensive primary care to youth at risk of HIV.

Source: AIDS Alliance for Children, Youth & Families. Finding HIV-positive Youth and Bringing Them Into Care. 2005.

Overcoming Barriers to Care

As part of the ongoing effort to improve the response to HIV/AIDS among youth, HRSA/HAB provided funding to AIDS Alliance for Children, Youth, and Families for the development of a resource guide for Ryan White HIV/AIDS Program grantees, as well as other HIV care providers. Published in 2005, Finding HIV-Positive Youth and Bringing Them Into Care provides many practical suggestions and checklists designed to help providers organize youth-centered outreach programs and deliver services (see “Points of Entry into the Care Continuum” for an example). The guide (PDF – 934 KB) Exit Disclaimer incorporated findings from a study of over 30 youth-centered HIV programs funded through the Ryan White HIV/AIDS Program.

Polly Ross, M.D., currently the director for the Division of Community HIV/AIDS Programs for HRSA, previously worked for Western North Carolina (WNC) Community Health Services, a Ryan White HIV/AIDS Program grantee in Asheville. Ross says that WNC first started seeing youth in 2005. “One of the challenges then that is still the challenge now is how to bring youth into care.”

Dr. Ross says there is a major effort to link youth to care and to provide support to Ryan White HIV/AIDS Program grantees as they address the community level barriers that are keeping youth out of care. “Our providers know how to provide care, but we are now discussing at the public health and community levels just how we find out about all the barriers so that we can address them.”

In 2004, SPNS launched Outreach, Care, and Prevention to Engage HIV Seropositive Young MSM of Color (YMSM of Color Initiative). This initiative funded eight demonstration projects targeting young (ages 13–24) MSM of color through 2010. Each grantee engaged in innovative recruitment and intervention strategies designed to reach HIV-infected young MSM not engaged in clinical care and link them to appropriate clinical, supportive, and preventive services. Those strategies included the following:

  • Social outreach: Sending outreach workers on foot or in testing vans to venues believed to be popular with YMSM of color.

  • Motivational interviewing: Providing information about HIV testing and offering individualized counseling and encouragement to get tested and engage in care.

  • Internet-based interventions: Using Internet chat rooms and social networks to disseminate health messages and engage YMSM in health discussions.

  • In-reach efforts: Identifying HIV-positive YMSM of color who had fallen out of care through local health care and youth-focused service systems.

Several grantees engaged members of their local target populations in focus groups, a process that provided insight into perceived barriers to care and what YMSM thought would best promote HIV care in their communities and improve service delivery. This proved highly successful and supports findings from the earlier Adolescent Initiative that engaging young people as partners in developing appropriate outreach strategies is critically important for reaching them effectively.

Other success factors included making sure that linkage to care occurred as quickly as possible, providing assistance with transportation and offering comprehensive support services. This kind of hands-on approach proved essential to retaining YMSM of color in care and is a hallmark of the care that Ryan White HIV/AIDS Program grantees provide to their patients.

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