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. [ABSTRACT FROM PUBLISHER]