243810 “[Collaboration] in the field of HIV is not nice, it is necessary”: Issues in inter-agency collaboration among HIV service agencies

Tuesday, November 1, 2011: 5:06 PM

Nidhi Khosla, MPH , Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Jill A. Marsteller, PhD , Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

Collaboration among HIV service agencies is encouraged by policymakers to ensure that the clients' needs are being met. Yet little is known on how agencies themselves perceive collaboration and what factors affect collaboration between HIV service agencies.


Data were collected in Baltimore, Maryland in 2010 using surveys and interviews. Only the qualitative data are presented here. Nineteen key respondent interviews were conducted that represented one key agency that closed down in 2008 as well as eighteen existing agencies. These agencies were selected to represent diversity in mission, services provided and agency type, such as medical care, legal services, de-addiction, housing services, faith- based agencies, community based organizations and hospital based agencies. Interviews were conducted till saturation was obtained. A thematic analysis was conducted.


Collaboration was perceived positively. When asked to rank their collaborations with other HIV service agencies on an ascending scale from one to ten, most agencies rated themselves six and above. The following themes emerged: 1) Meaning: Most agencies reported collaboration meant working together in order to serve the client's multifarious needs which could not be served by any agency alone. 2) Size: Smaller agencies were more likely to collaborate than bigger agencies that had many in-house services. 3) Means of collaboration: Client referrals were the most common means of collaboration, others being co-managing HIV awareness events; giving office space to providers from another agency and membership on the Boards of other agencies. The requirement of memoranda of understanding between agencies was mostly perceived to be a nuisance.

Agencies reported the following advantages, disadvantages, barriers and facilitators of collaboration: Advantages: being able to serve a client's needs holistically; creating confidence in the client; strengthening interagency relationships and creating a diverse voice for advocating for clients' needs. Disadvantages: having to invest time in collaborations; and possibly not meeting their own goals while helping competing agencies. Barriers: lack of accurate information; turf issues; time scarcity; funding and staff cuts; personality differences; health insurance acceptability; differing standards of care and fear of losing clients to other agencies. Funding and time scarcity underlay many barriers. Facilitators: agencies being longstanding; personal relationships; a cooperative culture and presence of forums where agencies advocated together for their needs.


Agencies recognized the need for collaboration. The reasons underlying most barriers were staff and funding cuts, time and information scarcity. Policymakers should address these factors to foster collaboration.

Learning Areas:
Administration, management, leadership
Program planning
Protection of the public in relation to communicable diseases including prevention or control
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
1.Analyze the meaning agencies accord to collaboration 2.Identify the various advantages of collaboration between HIV service agencies 3.Identify the various disadvantages of collaboration between HIV service agencies 4.Differentiate the various barriers to collaboration between HIV service agencies 5.Differentiate the various facilitators of collaboration between HIV service agencies 6.Discuss how collaboration between HIV service agencies can be improved

Keywords: HIV/AIDS, Public Health Agency Roles

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: This presentation is based on the primary data that I collected for my dissertation. Further, I am well-informed of issues in HIV/AIDS program planning as I have worked internationally on sexual and reproductive health programs including HIV/AIDS programs for more than five years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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