Navigating the Front-Line: Situating Interprofessional Collaboration in the HIV Continuum of Care

Background & Purpose: The HIV Continuum of Care, which emerged as a concept in 2011, refers to the process by which healthcare professionals (e.g. social workers and health educators) and paraprofessionals (e.g. community-health workers) link at-risk individuals to services provided by trained medical personnel – HIV testing, subsequent primary care, and antiretroviral treatment. Much of the literature has been focused on practitioners’ failures to move patients along this continuum, as many patients are not successfully linked to or retained in care. In this literature, the language used to describe the roles of “frontline workers” reflects ambiguities surrounding the complimentary value of interprofessional collaboration among professional and paraprofessional workers and medical staff. Here we provide a focused review of this literature to (1) expand our understanding of how interprofessional collaboration is conceptualized in the HIV Continuum of Care, (2) identify specific roles of different professionals and paraprofessionals, and (3) make a case for best practices to improve access to life saving services.

Methods: We draw on a sociomedical perspective highlighting personal, interpersonal, and job roles that may influence how front-line workers engage and keep patients in care. We have conducted a focused review of the literature (starting four years before the HIV Continuum of Care emerged in the literature, 2007-17). Our search involved 15 search term combinations in ArticlesPlus, a comprehensive database of peer-reviewed journals. We selected articles published in clinical and academic journals in social work, nursing, and public health. This literature was categorized based on professional discipline and key terminologies. We used an interpretive analysis informed by anthropological and social work methods and a modified grounded theory approach to identify patterns and terminologies regarding the three aims above.

Findings: Despite the diversity of descriptions and definitions of interdisciplinary practitioners and paraprofessionals in clinical and academic literature about HIV treatment and prevention, healthcare workers are consistently described in terms of visibility (i.e., the “frontline”) which imply a corollary – the figure of a hiddenmedical provider who can only be accessed with the help of the frontline worker. Additionally, the language of emerging paraprofessional roles in HIV prevention and care (e.g. “navigators”) and the “continuum of care” imply a terrain that is lengthy, circuitous, and difficult to traverse. We find that these underlying assumptions about the environment of HIV treatment and prevention set the scope of possibility for social work best practices of engagement and retention in care, as well as macro-level interventions to improve service delivery.

Conclusions & Implications: The language used to describe emerging roles and practices in the field of HIV treatment and prevention (“navigators” along the “continuum of care”) indicate structural and macro-level challenges in health care service delivery that ought to be addressed alongside micro-level interventions. There is a need to train interdisciplinary professionals and paraprofessionals in health care together and not in siloes, and to include social work best practices in such training.