Do we need one stop shops or smaller agencies? Views of HIV service agencies on how to best serve clients

Background: The multiple medical and psycho-social needs of HIV positive clients can rarely be served by any single agency alone. Yet clients may get lost to the system during the process of referrals. This raises the question whether such needs are better served by a number of smaller agencies or a few large one-stop shops that are agencies that provide comprehensive services.

Methods: Data was collected in Baltimore, Maryland over late 2010-early 2012. The purposive sample comprised nineteen HIV/AIDS service agencies including Ryan White grantees and other agencies. Twenty-three semi-structured key-informant interviews were conducted. Key themes were identified and analyzed using the constant comparison method.

Results: Many agencies spontaneously suggested that an ideal system of HIV prevention care and treatment would involve the concept of one-stop shops. Some conceptualized this as several entities where services were co-located, and which were based in different zip codes corresponding to sub-regions within the city. One respondent suggested that agencies should merge to form a one-stop shop. A community-based organization expressed that in an ideal system they themselves would be a one stop shop. This suggests that smaller agencies support the concept as well. Another community based organization expressed that an ideal system would include a one stop shop acting as a clearinghouse of information and smaller agencies offering services.

Conclusions: Exploring co-location of services may be an effective strategy to serve the diverse needs of HIV clients and prevent clients falling through the cracks, while at the same time maintaining agency autonomy.