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

Background

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.

Methods

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.

Results

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.

Conclusions

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.