Integrating Service Models: Mobile HIV/AIDS Clinical Trials, Community-based Outreach and Testing, and Primary Health Services

Background:
Southeastern rural minorities experience morbidity and mortality from HIV/AIDS however due to geography, socioeconomics, and socio-cultural norms, they may not access HIV/AIDS clinical trials (CT) or other health services. As part of a larger study, we explored conceptualization and preferred utility of a mobile unit and other means of increasing access to CTs in two rural southeastern communities.

Objective:
1) Define barriers associated with HIV/AIDS CTs as singular services, 2) Describe community conceptualizations of HIV service delivery, 3) Identify barriers to service integration.

Method:
Conducted 40 interviews (32 English, 8 Spanish) with people living with HIV/AIDS and 10 focus groups (providers, community leaders, community advisory board). Sessions were audio-taped, transcribed, and independently analyzed by 2 research team members in a back/forth approach between discovery and verification of findings, and triangulated between sets of respondents for convergence and divergence.

Result:
Community members noted needs to integrate HIV/AIDS CT with HIV/AIDS outreach, testing, and non-HIV health services regardless of whether CTs were conducted on a mobile unit or another community-based venue. Barriers to unit use for HIV/AIDS CTs stem from concerns of stigma and confidentiality. Challenges to service integration include restrictive CT protocols, potentially misleading social marketing, lack of skilled staff, and questionable social acceptability of clinical services in communities.

Conclusion:
Integrating HIV/AIDS CTs with outreach and testing addresses a community expectation of a continuum of care that includes HIV/AIDS prevention and treatment in conjunction with non-HIV-related health services. The approach may lead to decreased stigma and concerns for confidentiality, addresses secondary prevention and multiple health concerns, and demonstrates investment in community health.

Implications:
Expanding CT protocols to include other health services, outreach, and prevention can increase programmatic reach and service utilization. Further research is needed to develop strategies to merge these services.