Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, USA.
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, USA.
Transl Behav Med. 2024 Oct 6;14(10):598-610. doi: 10.1093/tbm/ibae046.
Behavioral health conditions are disproportionately experienced by people living with Human immunodeficiency virus (HIV), including young Black gay, bisexual, and other men who have sex with men (GBMSM). Left unaddressed, these symptoms can adversely impact HIV care outcomes. Improving the integration of behavioral health and HIV care services has been proposed as a strategy to address this challenge. To conduct a pre-implementation study exploring barriers and facilitators to improving HIV and behavioral health care integration at two HIV clinics in Atlanta, Georgia. We conducted a mixed-methods study guided by the Consolidated Framework for Implementation Research (CFIR). Sixty (60) HIV care providers, behavioral health care providers, and social service providers participated in cross-sectional surveys, and a subset of survey participants (15) also participated in a qualitative in-depth interview to explore CFIR constructs in greater depth. We focused on Intervention Characteristics, Outer Setting, and Inner Setting as the most relevant CFIR domains. Within each of these domains, we identified both facilitators and barriers to improving HIV and behavioral care integration in the two clinics. Participants agreed that enhancing integration would provide a relative advantage over current practice, would address young Black GBMSM and other patient needs, and would be compatible with the organizational mission. However, they also expressed concerns about complexity, resource availability, and priority relative to other clinic initiatives. Participants were enthusiastic about improving care integration but also invoked practical challenges to translating this idea into practice. Future research should test specific implementation strategies and their potential effectiveness for improving the integration of behavioral health and HIV care, as a strategy for improving well-being among young Black GBMSM and other people living with HIV.
行为健康状况在感染人类免疫缺陷病毒 (HIV) 的人群中不成比例地存在,包括年轻的黑人男同性恋、双性恋和其他与男性发生性关系的男性 (GBMSM)。如果这些症状得不到解决,可能会对 HIV 护理结果产生不利影响。因此,提出了改善行为健康和 HIV 护理服务整合的策略。为了在佐治亚州亚特兰大的两家 HIV 诊所开展一项实施前研究,以探索改善 HIV 和行为健康护理整合的障碍和促进因素。我们进行了一项混合方法研究,该研究以实施研究综合框架 (CFIR) 为指导。60 名 HIV 护理提供者、行为健康护理提供者和社会服务提供者参加了横断面调查,其中一部分调查参与者 (15 人) 还参加了定性深入访谈,以更深入地探讨 CFIR 结构。我们重点关注干预措施特征、外部环境和内部环境作为最相关的 CFIR 领域。在这些领域中的每一个领域中,我们都确定了改善这两个诊所的 HIV 和行为护理整合的促进因素和障碍。参与者一致认为,增强整合将相对于当前实践具有相对优势,将解决年轻的黑人 GBMSM 和其他患者的需求,并且与组织使命兼容。然而,他们也对复杂性、资源可用性以及与其他诊所倡议的相对优先级表示担忧。参与者对改善护理整合充满热情,但也提出了将这一想法付诸实践所面临的实际挑战。未来的研究应该测试具体的实施策略及其潜在有效性,以改善行为健康和 HIV 护理的整合,作为改善年轻的黑人 GBMSM 和其他 HIV 感染者健康的一种策略。
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