The study highlights the crucial role of providers of social and public health services in helping patients to access lifesaving HIV services, said Rogério Meireles Pinto, associate professor and associate dean for research in the School of Social Work and the study's lead author.
‘Public health providers whose organizations offer HIV prevention and behavioral interventions are more likely to link patients to HIV testing and HIV primary care. The providers also need to guide patients through the healthcare system to increase retention in care, by using an intensive contact in the first six months of care.
Before 2012, providers had been encouraged and trained to link patients to behavioral interventions to help patients modify their behaviors and protect themselves againstHIV transmission and infection
. A shift in policy (from targeting anyone at risk to those at highest risk, called "High Impact Prevention") made these interventions less available (they were discontinued).
The new policy dictated that providers should get as many people to access HIV testing as possible and to link them to HIV primary care to receive antiretroviral medication
that can keep patients alive and thrive.
"It took some time for providers to make the switch in priorities and also to begin to trust that making referrals to other providers in other service agencies would not lead to loss of patients," Pinto said.
Pinto and colleagues used data from nearly 380 providers--which include social workers, health educators, and patient navigators--from 36 agencies in New York City in 2013-2014. The agencies provided medical services such as HIV testing and care, and psychosocial assistance, including HIV counseling, substance misuse treatment, and housing services.
The study's key finding is that providers whose organizations offer HIV prevention behavioral interventions are more likely to link patients to HIV testing and HIV primary care.
It's important that providers "guide clients through the health care system to increase retention in care by using an intensive contact in the first six months of care," said Pinto, who is an expert at the U-M Institute for Healthcare Policy & Innovation.
The study also factored the race of the providers, which consisted of many who identified as Hispanic or African-American. Nonwhite providers were less likely to link clients to certain services, perhaps due to racial disparities in levels of trust in how these high-impact services were launched without strong community participation, Pinto said.