The factors related to HIV prevention - continuation
3. Geographic coverage
Similarly, integrated services provide the opportunity for people-centred prevention, care and treatment for PWID, who have complex health and social care needs. Such services also facilitate better communication and multidisciplinary care, and are likely to increase efficiency and cost–effectiveness. Thus, wherever feasible, programs should work towards delivering integrated services for PWID in ways that are informed by PWID and that foster trust in service delivery settings and providers. When this is not possible, strong links among health and social services working with PWID should be established and maintained.
4. Standardized care delivery
PWID commonly experience multiple comorbidities, often in a context of marginalization and deprivation. Rates of TB, HIV, viral hepatitis and other infectious diseases are high among PWID, as are mental health conditions.
If the client is not ready to make a medical appointment, the linkage goal then becomes to get the client “as close to comprehensive medical care as possible” through one or more of the following referrals:
- To a case manager at medically-linked site.
- To a case manager at non-medically linked site.
5. Information system
Information technology that supports the linkage, especially via the electronic medical record and the use of clinical decision support systems, and through the ability to identify and target ‘at risk’ patients.
6. Leadership
There may also be policies that prevent HIV-positive people who use drugs from accessing care. It will be important for program planners to understand which laws exist and which behaviours the laws criminalize (e.g., drug possession, drug use, etc.). Understanding the policy and legal environment will provide insight into potential barriers to implementation and uptake of services. Effective leadership at all levels with a focus on continuous quality improvement is essential.
7. Financial management
Effective linkage to HIV/HCV care and treatment following a positive diagnosis is expected to improve programme effectiveness, support earlier treatment initiation and reduce loss to follow up before treatment initiation, thus resulting in potential cost savings along the continuum of care.
The international framework for measuring integrated care encourages:
- Coordination within care teams.
- Coordination across care teams.
- Coordination between care teams and community resources.
- Continuous familiarity with patient over time.
- Continuous proactive and responsive action between visits.