Barriers and facilitators of linkage to HIV primary care in New York City
Design/Methods: We interviewed directors and administrators of 24 HIV testing sites to identify linkage problems and successes, and selected 9 for case studies of best linkage practices.
Results: There were three problem domains: (1) system factors (long wait for provider appointments; requirement of a positive confirmatory test before scheduling an appointment; lack of staff respect for patients); (2) social factors (HIV stigma, public, perceived and enacted); (3) stigmatizing patient statuses (e.g., mental illness, homelessness, substance use, immigrant). Best practices for linkage included networking among community organizations; individualized care plans; team approach; and patient peer navigation. No providers cited decreased community viral load as a rationale for prioritizing linkage.
Conclusions: Successful linkage requires a comprehensive individualized approach that reduces the compounded stigma that risk populations face, minimizes delays in seeing a care provider, and provides patient navigation services to address system complexity. Providers defined their role as caring for patients, overlooking the broader public health impact of preventing HIV transmission.
Learning Areas:Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Protection of the public in relation to communicable diseases including prevention or control
Provision of health care to the public
Public health or related research
Social and behavioral sciences
Identify the major barriers to linkage to HIV care. Describe 3 best practices to remove barriers to successful linkage to HIV care.
Keyword(s): HIV/AIDS, Health Care Access
Qualified on the content I am responsible for because: I am the Principal Investigator of multiple federally funded grants focusing on HIV/AIDs, risk behaviors and health systems. I am the PI of the research study that generated the data that will be reported. I wrote the proposal for the project, designed the project methods, and supervised its implementation. With my abstract colleagues, I analyzed the data and prepared the abstract. I have published multiple articles on children with HIV.
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.