The Metropolitan Atlanta Community Adolescent Rapid Testing Initiative (MACARTI) with Linkage to Care and Counseling Trial is a multidisciplinary proposal which responds to the United States National Strategy for HIV/AIDS and aims to increase testing and linkage into care of HIV-positive adolescents and young adults 18-25 years of age. This proposal is particularly relevant given the incidence and prevalence of new HIV infections among young adults in the Atlanta Metropolitan Statistical Area. We hypothesize that implementing sixty second rapid HIV testing in non-traditional venues is a feasible and acceptable alternative to traditional forms of testing and will help increase prevention and early detection in an at-risk population. Following consultation with focus groups from the Ponce Family and Youth HIV clinic as well as ethnographic studies, we will decide which venues are suitable for testing. As a second objective we will apply a new model of intervention aiming to increase linkage into care of HIV- infected youth using a combination of motivational interview techniques with intensive case management support starting at the time of testing. We will compare our current referral system that has an average time to first medical visit of 9 weeks and a retention rate of 60%to the new model, which aims to decrease the average time to first medical visit to 2 weeks and increase the retention rate to at least 80%.We will also look at time to second visit and permanence in care after 6 months between the two arms, and differences in variables that are associated with advanced immunosuppression and delay of treatment. Novel ways of approaching HIV-infected adolescents and young adults as well as decreasing health disparities among youth are needed and we anticipate the MACARTI trial to be a useful strategy in this regard.
Expansion of HIV screening among adolescents and young adults is necessary since they constitute an age group in which the disease continues to expand. Public Health officials have made clear that providers need to target high-risk populations. New approaches specifically designed for the adolescent population are required to increase acceptability of testing and continuity of care.