Tricks and Tips for Coordinating HIV Care

Findings from two studies from the University of Missouri in Columbia, MO, may help agencies that provide services to people living with HIV improve their collaborative efforts.

A wide mix of different types of social service agencies, including local health departments, non-profit organizations, faith-based groups, and state government offices must work together to offer medical care, housing, psycho-social support, nutrition, and other help to this vulnerable population.

In an effort to better understand the points of connection between these groups and to improve coordination, a team of researchers used a mix of surveys and analyses to better understand how they currently work together and what more they could do.

In the first study, published online ahead of print in AIDS Care on February 10, Nidhi Khosla, PhD, MPH, assistant professor of health sciences in the School of Health Professions and Iris Zachary, PhD, assistant research professor of health informatics, conducted semi-structured interviews with representatives from 21 HIV agencies in Baltimore, Md. Analyses of the feedback revealed six themes of areas for improvement: improving focus on HIV prevention; establishing common entry-points for the services; improving the availability of information; streamlining sources of funding; removing competition between agencies; and building trust within the community.

"HIV remains a major health care concern in the U.S.," said Khosla. "The diversity in types of agencies can create problems in coordinating services, either in duplicating services or inadvertently ignoring a need or a population."

In the second study, Khosla and colleagues from the Johns Hopkins Bloomberg School of Public Health in Baltimore, Md., used social network theory and relational coordination theory to analyze how HIV service agencies interacted with one another. Social network theory suggests that the agencies will establish relationships amongst themselves to access resources. Relational coordination theory assumes that coordination among agencies relies on seven factors: frequency, timeliness and accuracy of communication, problem-solving communication, knowledge of agencies' work, mutual respect and shared goals.

The team first surveyed 57 agencies to measure how often they worked with other area agencies, on a scale that ranged from ‘not at all’ to ‘daily.’ Of those agencies, 11 had monthly or more frequently interactions with the others in at least one-third of the sample, or a network density, defined as the proportion of existing connections to all possible ones, of 20 percent.

Kholsa and team then administered a second survey to these agencies to measure the seven relational factors. Among these teams, they found the highest scores for shared goals and mutual respect, whereas scores for factors such as knowledge of one another’s work and problem solving communication were relatively lower.

"Understanding the breadth and depth of the relationships allows us to better understand inter-agency collaboration." said Jill Anne Marsteller, Ph.D., associate professor at Johns Hopkins and co-author of the study. It can allow agencies to identify weak points, and create policies to strengthen them.

The second study was published in the February issue of Social Science and Medicine.