Understanding Care Linkage and Engagement Across 15 Adolescent Clinics: Provider Perspectives and Implications for Newly HIV-Infected Youth

AIDS Educ Prev. 2017 Apr;29(2):93-104. doi: 10.1521/aeap.2017.29.2.93.


The National HIV/AIDS Strategy emphasizes rapid care linkage and engagement for HIV-infected individuals, though many adolescents are never tested, delay entering care, and frequently drop out. We conducted 183 staff interviews at 15 adolescent medicine clinics (baseline, n = 64; Year 1, n = 60; Year 2, = 59). We used a constant comparative thematic method to examine how providers approached and discussed care linkage/engagement. Qualitative analyses revealed differences in providers' conceptualizations of linkage and engagement. Providers saw linkage as mechanistic and health system driven. It was defined by number of clinic visits and involved relatively little youth agency. In contrast, providers defined engagement by youths' responsibility and participation in their own care. Linkage and engagement are related but distinct aspects of care that require different resources and levels of staff involvement. Integrating an understanding of these differences into future interventions will allow clinic staff to help youth improve long-term health outcomes.

MeSH terms

  • Adolescent
  • Adolescent Behavior
  • Adolescent Health Services / organization & administration*
  • Ambulatory Care Facilities / organization & administration
  • Anti-HIV Agents / therapeutic use
  • Attitude of Health Personnel*
  • Continuity of Patient Care / organization & administration*
  • Delivery of Health Care / organization & administration*
  • Female
  • HIV Infections / diagnosis*
  • HIV Infections / drug therapy
  • HIV Infections / psychology
  • Health Services Accessibility
  • Humans
  • Male
  • Patient Acceptance of Health Care / psychology*
  • Qualitative Research
  • Referral and Consultation / organization & administration
  • United States / epidemiology


  • Anti-HIV Agents