“For our clients, that was gold”: The role played by a central agency in an HIV services network and the consequences of its closure for the community

Background

This case study describes losses and unexpected benefits after the unplanned exit of a central agency from an HIV services network and raises issues about planning for sustainability of HIV services.

Methods

HIV-service agencies in Baltimore, Maryland were purposively selected and key informants interviewed in 2010 about inter-agency collaboration. They were also asked about the impact of the exit of the central agency from the network. A thematic analysis was conducted.

Results

The iconic agency started in 1983 in response to the HIV/AIDS epidemic. It quickly became a focal point for clients' entry into the HIV services system. In 2008, its closure created disruption in the system. The gaps that continue are: 1) no common entry point for HIV services 2) men have fewer support groups 3) many clients possibly lost to follow-up 4) clients feel displaced 5) clients lost a valuable space for social networking 6) clients lost access to services such as showers, laundry, mailboxes. Further, smaller agencies lost mentoring. Unexpectedly, on the positive side, 1) clients learned about services at other agencies 2) some good agencies were re-allocated the agency's funding 3) agencies focus strongly on financial planning 4) agencies are required to furnish a transition plan in event of their shutdown.

Thus while some gaps remain, the system has evolved to fill many needs.

Conclusions

HIV service systems need to plan for sustainability so that a key agency's closure will not disrupt service delivery. Such planning should be a part of all healthcare systems.