Interprofessional Collaboration Is Key to Improving Client Access to HIV Testing, Primary Care and Lifesaving Pre-Exposure Prophylaxis (PrEP) Medication

Background: HIV continues to spread globally but implementation of life-saving prevention services remains sub-optimal. The HIV Continuum of Care – HIV testing, primary care, antiretroviral therapy (ART), and viral suppression – is a global priority, yet many vulnerable clients do not access these services. The literature suggests that training and interprofessional collaboration have potential to narrow this gap – providers of social and public health services (“providers”) – e.g., social workers, health educators, navigators – can improve HIV prevention and care by linking clients to HIV testing and primary care, and by offering Pre-Exposure Prophylaxis (PrEP) psychoeducation. Therefore, this study assessed the direct effects of interprofessional collaboration (IPC) and training on both linkage-making and on PrEP psychoeducation.

Methods: Cross-sectional data collected in 2014-15 from 285 providers in 34 community agencies (primary care, outpatient, and prevention) in New York City. We used structural equation modeling to examine the effects of provider attitudes toward interprofessional collaboration (IPC) and on-the-job training on how frequently they linked clients to (1) HIV testing, (2) primary care, and offered (3) PrEP psychoeducation. IPC was measured by Bronstein’s 49-item, five-domain, scale (Interdependence, Professional Activities, Flexibility, Ownership of Outcomes, and Reflection on Process; Cronbach alpha = 0.84). On-the-job linkage training by, “When were providers in your agency trained to help clients access HIV testing and primary care?”  These outcomes were treated as a latent variable, “providers’ engagement in the care continuum.” Covariates included, work positions; caseload; demographics; and agency size and capacity.

Results: Compared to those in small agencies (less than $1M budget), providers in agencies with mid-size budgets ($1M-$5M) were negatively related to IPC; providers with curriculum-based HIV prevention knowledge had higher IPC scores than providers without HIV knowledge; and those who identified as supervisors/administrators had higher IPC scores compared to direct service staff. In the six months prior to this study, nearly half (48%) of providers had not offered PrEP psychoeducation and had linked fewer than five clients to HIV testing and primary care per week. However, in multivariate analysis higher IPC was associated with more frequent linkages to HIV testing and primary care, and PrEP psychoeducation. Moreover, after adjusting for IPC, providers who received linkage training within the past two years more frequently linked clients to testing and primary care and offered PrEP psychoeducation. Additional tests of modification indices indicated that no specific domain of IPC was more strongly related to any of the three outcome services.

Conclusions: The influence of IPC and linkage training indicate potential interventions targeting providers in primary care, outpatient, and prevention settings can improve the number of clients accessing the HIV Continuum of Care. By partnering with organizations and service providers in communities suffering health disparities and social inequities, we provided a unique snapshot of how HIV continuum of care services are provided in a large diffusion system. We found implications for service implementation in other systems nationally and globally. This study advances social justice by generating findings with the potential to narrow health disparities.