HIV Education and Welfare Services in Primary Care: An Empirical Model of Integration in Brazil’s Unified Health System

Abstract

Integration of health education and welfare services in primary care systems is a key strategy to solve the multiple determinants of chronic diseases, such as Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome (HIV/AIDS). However, there is a scarcity of conceptual models from which to build integration strategies. We provide a model based on cross-sectional data from 168 Community Health Agents, 62 nurses, and 32 physicians in two municipalities in Brazil’s Unified Health System (UHS). The outcome, service integration, comprised HIV education, community activities (e.g., health walks and workshops), and documentation services (e.g., obtainment of working papers and birth certificates). Predictors included individual factors (provider confidence, knowledge/skills, perseverance, efficacy); job characteristics (interprofessional collaboration, work-autonomy, decision-making autonomy, skill variety); and organizational factors (work conditions and work resources). Structural equation modeling was used to identify factors associated with service integration. Knowledge and skills, skill variety, confidence, and perseverance predicted greater integration of HIV education alongside community activities and documentation services. Job characteristics and organizational factors did not predict integration. Our study offers an explanatory model that can be adapted to examine other variables that may influence integration of different services in global primary healthcare systems. Findings suggest that practitioner trainings to improve integration should focus on cognitive constructs—confidence, perseverance, knowledge, and skills.

Investigation on Task Shifting of HIV/AIDS Follow-Up Management Workers in New Launched Areas, China

“…For providers, the professionals need to organize more professional training and guidelines that will help providers to learn how to communicate with PLWHA and improve follow-up work. Providers also need to get continuous in-service education and effective supervision, focus more on cognitive constructs-confidence, perseverance, knowledge, and medical care skills [ 41 , 42 ]. From this study it shows that the providers should focus more on the PLWHA, rather than themselves, since this is one of the reasons that the providers are more willing to accept task shifting.…”

Developing a Scale to Measure Interprofessional Collaboration in HIV Prevention and Care: Implications for Research on Patient Access and Retention in the HIV Continuum of Care

“…The developing literature on IPC in HIV prevention and care unequivocally supports interprofessional collaboration as having the potential to enhance access to and retention in HIV services (Chetty & Maharaj, 2013;Doriccah Peu et al, 2014;Olivier & Dykeman, 2003). This literature recommends building and supporting providers' capacity to collaborate across disciplines and to integrate HIV prevention with other services-e.g., HIV testing, substance misuse treatment, and support services (Rahman, Pinto, & Wall, 2017;Spector, Pinto, Rahman, & da Fonseca, 2015). Collaborations involving members of specific professions (e.g., between nurse practitioners and dentists for HIV testing in dental care) have been recommended (Hutchinson & Lloyd, 2012).…”