Healthcare/Behavioral Health and HIV Prevention

Miami-Dade has an estimated 8,490 HIV+ persons not in care for reasons including drug and mental health issues; estrangement from the system of care; lack of information about available services; and stigma. The National HIV/AIDS Strategy and the Affordable Care Act (ACA) prompted funding for the 12 cities most impacted by HIV/AIDS, including this project funded under SAMHSA and a simultaneous project funded under CDC. This abstract describes an integrated care program aimed at early screening and intervention for persons at risk for HIV with behavioral health issues seeking care in clinical settings. 

Two Federally Qualified Health Centers (FQHC) were targeted for this project because of their linkage to low income, minority consumers. Comprehensive, integrated and non-duplicative screening and assessment was established within these clinics, creating access to interventions and supportive services, including behavioral outpatient treatment, several Evidence-Based Practices (SBIRT, RESPECT, Trans-Theoretical stress-based Management, Healthy Living Project) which were operationalized within participating FQHC’s. Efforts were made to empower consumers through the use of peers and other engagement and retention strategies so that services could be delivered to high risk consumers.

The project goal was to provide and evaluate the integration of prevention and behavioral health services in a healthcare environment (FQHC).  The project incorporated integrated care models including co-located and fully integrated care (CIHS, 2013).  Client-level outcome data was collected across a broad spectrum of HIV risk, general health, and behavioral health domains.  Qualitative data was collected from staff and administration on integrated care ideas, barriers, and challenges, and from clients on care perceptions and satisfaction.

Results affirmed that these interventions resulted in fewer hospitalizations, ER visits, and jail admissions.  Participants showed gains in their understanding of HIV/STD prevention.  Improved health, reduced MH symptomology, and reduced substance use was also noted.  Qualitative findings reflected provider staff had varying levels of understanding regarding integrated care and the ACA; however, all believed in the need for integrated services based on their experiences. Client-level findings suggested that integrated services were easier to access logistically, and many clients mentioned a perception of “community/team” regarding behavioral health services that was lacking with medical services. Within the broader picture of the ACA  this type of behavioral health/primary care integration supports the need to modify the front door of the care system to increase access to comprehensive, prevention and treatment services for those most vulnerable.