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Strengthening Systems for HIV Diagnosis & Linkage to Care in Adolescents

This presentation discusses the challenges and barriers faced in diagnosing and linking HIV-positive adolescents to care. It highlights the need for routine testing, improved provider training, streamlined administrative systems, and enhanced youth-friendly healthcare. The recommendations include promoting routine testing in youth-serving institutions, addressing legal and policy barriers, monitoring testing and service gaps, and ensuring funding for youth care.

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Strengthening Systems for HIV Diagnosis & Linkage to Care in Adolescents

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  1. ADOLESCENTS Strengthening Systems for Diagnosis of HIV & Linkage to Care Institute of Medicine April 15-16, 2010 Donna Futterman, MD | Professor of Clinical Pediatrics, AECOM Director, Adolescent AIDS Program, Montefiore AdolescentAIDS.org

  2. AIDS is NOT Over for Youth 35% New HIV infections among youth 13-29 20,000 Youth infected annually - 1 every hour 54% YMSM; 35% young women; 11% other young men >85% HIV+ youth sexually infected >80% HIV+ youth are racial/ethnic minorities >50% HIV+ youth untested (80% HIV+ gay youth unaware) Growing numbers Perinatally-infected reaching adolescence (2,700) AdolescentAIDS.org

  3. HIV/AIDS Among Youth Youth Population 42,500,000 (15-24) HIV/AIDS Cases 56,500 (13-24) AdolescentAIDS.org

  4. HIV Testing & Youth Who gets tested? (CDC 2009) 16% US 18-24yr olds 13% HS youth (19% 12th grade) • 15% Females, 11% Males • 22% Blacks, 13% Hispanics, 11% Whites • 22% of youth who ever had sex No youth-specific data on testing venues AdolescentAIDS.org

  5. HIV+ Youth Engaged in Care in 2009 (12 ATN Sites) • Bronx • NYC Philadelphia  Chicago - Stroger   Baltimore San Francisco  • Washington, DC Chicago - Children’s  • Memphis St Petersburg & Tampa  • Miami • Puerto Rico AdolescentAIDS.org

  6. ATN Survey of 2009 HIV+ YouthN=400 AdolescentAIDS.org

  7. ATN Survey of 2009 HIV+ YouthN=400 AdolescentAIDS.org

  8. HIV Testing Among Youth:Barriers & Facilitators • Medical • Institutional and Legal • Youth and Cultural AdolescentAIDS.org

  9. Medical Barriers • Most providers don’t see testing as part of routine care • Prevention counseling still assumed integral to HIV testing so think they don’t have the time or training needed to test • Provider’s fear delivering a positive diagnosis • Youth diagnosed late (CD4 = 378/mmc) • Providers unaware of risk, even for STI patients • Not all insurance companies reimburse for testing • Confidentiality and consent a problem for youth • Lack of streamlined administrative systems • Youth friendly health care not widely available AdolescentAIDS.org

  10. Medical Facilitators • CDC and medical societies support routine testing • Most youth accept test when offered • Most states now have laws that streamline C&T and eliminate written consent • Tools exist for implementing routine testing and streamlining counseling (ACTS) • Increasingly, public health focused on improved case finding (Municipal scale-ups) • The Medical System holds the key: • Linkage to care is optimized in these settings • Consumers expect to receive confidential, quality care • Yet, potential not reached AdolescentAIDS.org

  11. AdolescentAIDS.org

  12. Municipal Scale-Ups AdolescentAIDS.org

  13. It’s Time for a Paradigm Shift! HIV/AIDS is a medical condition. Providers and institutions must stop sailing around HIV testing obstacles.

  14. The real mountain of work begins when patients learn they are HIV+ We must put our resources where they are needed by shifting tasks…

  15. Institutional and Legal • Youth among the least insured (25% lack insurance) • Vulnerable communities not well served • Economic, racial, gender, and sexual orientation disparities • Homophobia and lack of data and effective outreach to LGBTQ communities • Sex education is inadequate • Lack of coordination within and between federal and local agencies serving youth • Confidentiality & Consent: Young people have legal rights and protections but many providers and youth unaware of laws • FACILITATOR: Youth can consent to HIV test and in 26 states can consent to treatment without parent AdolescentAIDS.org

  16. Youth and Cultural • New generation every 5 years so need ongoing and updated programming and social marketing • Youth feel invincible, not afraid of HIV • AIDS is invisible in many communities • Fear of disclosure to parents; HIV, sex and sexual orientation • FACILITATOR: Free, rapid and painless testing AdolescentAIDS.org

  17. Recommendations • National strategy to promote the routine offer of HIV testing in all youth serving organizations/institutions (i.e. medical, education, social services, corrections) • Make HIV testing a quality indicator for facility accreditation/evaluation • Mobilize and train providers to offer culturally competent testing routinely • Enhance promotion of testing among highest risk youth: msm, youth of color, youth with mental illness or substance use • Help newly diagnosed youth accept their status and access care AdolescentAIDS.org

  18. Recommendations • Address laws/policies that impede youth from testing (i.e. age of consent, parental notification) • Address insurance coverage, stigma, housing instability, lack of HIV information • Monitor youth testing and service gaps • Enhance testing among youth-serving institutions • Ensure that youth care continues to be funded in era of health reform and budget cutbacks AdolescentAIDS.org

  19. Contact Us Donna Futterman, MD DFutterman@AdolescentAIDS.org 718-882-0232 Learn more about routine HIV testing: ACTSHIVTest.org

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