Care coordination outcomes in diverse models of HIV care: An analysis of patient and provider identified gaps in the continuum of care Restricted; Files Only

Abstract

The Southern region of the US is home to the highest rates of HIV-related mortality and morbidity in the entire country. A lack of functional and coordinated integration between various systems of HIV-care delivery, coupled with the complexities of the healthcare system, continue to serve as primary barriers to providing quality, holistic, and highly effective care for people living with HIV (PLWH), and to re-engaging and retaining PLWH who are out-out-care (PLWH- OOC) into care. This qualitative study aimed to understand the relationship between care coordination and sub-specialty care throughout varying models of HIV care delivery – mobile clinics, home-based care programs, traditional fixed clinic – and to investigate if/how this relationship influences the health outcomes of PLWH-OOC. From October 2022 to March 2023, 18 in-depth-interviews were conducted with six HIV-care providers, three clinic administrative staff members, two social workers, and seven Community Advisory Board members who also identified themselves as PLWH. Primary results from this study reveal that care coordination plays a central and unequivocal role in the continuum of care, and also highlight that HIV care systems must be 1) equipped with a comprehensive range of services outside of traditional HIV- care and 2) organized in a way that allows HIV-care to be delivered and received as easily as possible if efforts to prevent PLWH from falling out of care and to re-engage PLWH-OOC are to succeed. In summary, findings from this study investigate current gaps/barriers that impede effective care delivery and coordination within models of HIV care delivery, and also offer strategies for how health systems can navigate these barriers/gaps and ultimately increase the number of individuals that are engaged and retained in care. 

Table of Contents

Chapter I: Introduction....................................................................................1

Chapter II: Literature Review............................................................................7

Chapter III: Manuscript...................................................................................31

Chapter IV: Conclusion & Recommendations...................................................78

References.....................................................................................................82

Appendix.......................................................................................................89 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Stichwort	HIV AIDS Infectious Disease Global Health
Committee Chair / Thesis Advisor	Ameeta Kalokhe, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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