Barriers to HIV care cannot be resolved by health care reform alone—lessons learned from an AIDS services organization in Massachusetts

Massachusetts healthcare reform has minimized the barrier of health insurance for people living with HIV/AIDS (PLWHA), but there still exist many systemic and personal barriers to care, barriers which PLWHA across the nation will likely experience even with the implementation of national healthcare reform. AIDS Action Committee of Massachusetts (AAC) is a community-based organization participating in a national initiative aimed at improving access to care for PLWHA by addressing many of these barriers. AAC targets out of care PLWHA through drop-in and needle exchange programs. Once identified as out of care, an Integrated Advocacy Team (IAT) of case managers, peers advocates, and mental health clinicians provide clients with wraparound support. Case managers take the lead in the service coordination while peer advocates maintain regular contact with clients and provide accompaniment to medical appointments. Through developing this model, we have learned that drop-in mental health services allow us to address mental health and substance use barriers to care with clients who cannot keep scheduled appointments. There have been, however, systemic challenges coordinating with clinical sites and documenting health outcomes due to the lack of a clear contact person, patient confidentiality concerns, and unresponsiveness. In response, we have begun using quality assurance tools at IAT meetings as well as starting an integrated partnership with a local hospital that clearly defines responsibilities of communication and coordination. This model demonstrates the advantages of using low-threshold, multidisciplinary teams to engage out of care PLWHA while developing creative partnerships between clinical sites and AIDS service organizations.