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01.12.2017 | Research article | Ausgabe 1/2017 Open Access

BMC Health Services Research 1/2017

The structural and health policy environment for delivering integrated HIV and substance use disorder treatments in Puerto Rico

Zeitschrift:
BMC Health Services Research > Ausgabe 1/2017
Autoren:
Jared A. Leff, Diana Hernández, Paul A. Teixeira, Pedro C. Castellón, Daniel J. Feaster, Allan E. Rodriguez, Jorge L. Santana-Bagur, Sandra Miranda De León, José Vargas Vidot, Lisa R. Metsch, Bruce R. Schackman
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12913-017-2174-7) contains supplementary material, which is available to authorized users.

Abstract

Background

HIV prevalence in Puerto Rico is nearly twice that of the mainland United States, a level that was substantially fueled by injection drug use. Puerto Rico has a longstanding history of health provision by the public sector that directly affects how HIV and substance use disorder (SUD) treatment services are provided and funded. As part of pre-implementation research for a randomized trial of a community-level intervention to enhance HIV care access for substance users in San Juan, Puerto Rico, we sought to understand the structural and health policy environment for providing HIV and SUD treatments.

Methods

We conducted semi-structured qualitative interviews (n = 8) with government and program administrators in English and Spanish. Data were analyzed to identify dominant and recurrent themes.

Results

Participants discussed how lack of integration among medical and mental health service providers, lack of public transportation, and turnover in appointed government officials were barriers to integrated HIV and SUD treatment. Federal funding for support services for HIV patients was a facilitator. The Affordable Care Act has limited impact in Puerto Rico because provisions related to health insurance reform do not apply to U.S. territories.

Discussion and Conclusions

Implications for intervention design include the need to provide care coordination for services from multiple providers, who are often physically separated and working in different reimbursement systems, and the potential for mobile and patient transportation services to bridge these gaps. Continuous interaction with political leaders is needed to maintain current facilitators. These findings are relevant as the current economic crisis in Puerto Rico affects funding, and may be relevant for other settings with substance use-driven epidemics.
Zusatzmaterial
Additional file 1: The open-ended interview guide used during data collection is available as a supplemental file entitled Interview Guide_Community Members_v1.0_ENG.doc. (DOC 54 kb)
12913_2017_2174_MOESM1_ESM.doc
Literatur
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