26 Jun CDC’s Change in HIV Policy Impacted Providers’ Role in Prevention
MedicalResearch.com Interview with:
Rogério M. Pinto, LCSW, Ph.D.
Associate Dean for Research
School of Social Work
University of Michigan
Ann Arbor, Michigan
MedicalResearch.com: What is the background for this study?
Response: This research, published in Health Education & Behavior (https://doi.org/10.1177/1090198118760681),highlights the crucial role of providers of social and public health services in helping patients to access lifesaving HIV services. Before 2012, providers were encouraged and trained to link patients to behavioral interventions to help patients modify their behaviors to protect themselves against HIV 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 actually discontinued) and new policy dictated that providers should have as many people as possible access HIV testing and link them to HIV primary care in order to receive antiretroviral medication.
MedicalResearch.com: What are the main findings?
Response: We used data from 379 providers — including social workers, health educators, and patient navigators — from 36 service agencies in New York City. These agencies provide medical services such as HIV testing and care and/or psychosocial services including HIV counseling, substance misuse treatment, and housing services. The key finding is that providers whose organizations offered HIV prevention behavioral interventions are more likely also to link patients to other HIV services. Providers exposed to greater numbers of behavioral interventions more frequently link patients: to testing for HIV, hepatitis C (HEP-C), and sexually transmitted infections; to primary care; and to drug treatment and mental health services. Providers link patients most frequently to primary care and HIV testing and least frequently to HEP-C testing and syringe exchange. Findings suggest a dose effect, with providers exposed to more behavioral interventions making more linkages to HIV-related services.
MedicalResearch.com: What should readers take away from your report?
Response: It took some time for providers to make the switch in priorities and to begin to trust that referrals to other service agencies would not lead to loss of patients. Readers should know that HIV service providers can help individuals at risk for HIV in myriad ways. Patient navigators guide patients through the healthcare system to increase retention in care by using intensive contact in the first six months. Health educators offer educational workshops and programing specific to HIV prevention and strive to engage at-risk populations. Navigators and educators link clients to drug treatment and mental health services. Some providers refer their clients to outside services, even when their agencies have those same services—or example, to preserve a patients’ anonymity.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Since 2012, the Centers for Disease Control and prevention (CDC) has supported only cost-effective behavioral interventions for populations with the greatest HIV burden and risk. Research is needed on the effects of de-emphasis of long-running practices and the effects of providers’ trust in public health practice. As policies change the focus of practice, agencies adapt to new mandates. Future policies concerning HIV prevention ought to consider the benefit of exposing providers to one type of service as a strategy to potentiate adoption of other services. Research in this area is greatly needed.
MedicalResearch.com: Is there anything else you would like to add?
Response: Patients at risk for HIV infection should seek out providers to link them to behavioral services, so as to help them avoid or reduce HIV risk exposure and to increase HIV testing and HIV primary care. Patients need to be linked to mental health and syringe exchange programs that may help them stay in care, need to adhere to medication regimens, and need to avoid re-infection. Our study factored in the race/ethnicity of the providers, many of whom identified as Hispanic or African American. Non-white providers were less likely to link clients to certain services, perhaps due to racial disparities in levels of trust, as these high-impact services were launched without strong (minority) community participation.
Pinto, R. M.; Witte, S.; Filippone, P.: Wall, M.: Choi, J. (2018). Policy interventions shaping HIV prevention: Providers’ active role in the HIV Continuum of Care. Health Education & Behavior.
PMID: 29547342. https://doi.org/10.1177/1090198118760681
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