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A literature review and analysis of organizational frameworks and systems-level outcomes of HIV primary care integration

Shedlock, Gregory (2017) A literature review and analysis of organizational frameworks and systems-level outcomes of HIV primary care integration. Master Essay, University of Pittsburgh.

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Background: Human Immunodeficiency Virus (HIV) continues to be a major public health concern in the United States. The Health Resources and Service Administration has identified HIV care integration including screening, prevention, treatment, support services, and linkage to care, as an area of priority interest. HIV Primary Care Integration (HPCI) focuses on the integration of HIV primary, specialty, and ancillary care services into a single setting to improve health system efficiency and health outcomes. HPCI is of great public health significance in the treatment and care of PLWHA, but also for preventing future infections by improving adherence, linkage to care, and retention in care and reducing community viral load. HPCI also promotes HIV prevention and testing among those at-risk for HIV. Evidence and evaluation of service integration at a health systems level is sparse, particularly for HPCI. This essay aimed to review the current evidence-base for 1) frameworks and models of integration and how these may best be applied and 2) systems-level outcomes as a direct result of HPCI. Methods: A comprehensive literature review was conducted in databases: Google Scholar, Medline, Embase, and PubMed to compile and analyze current literature for frameworks, models, and outcomes of HIV primary care integration. Results: A tiered framework of HIV primary care integration is described. Findings from the literature review were organized into four domains of models of care and case studies presented as examples. Five systems-level outcomes were consistent across the literature: 1) provider knowledge 2) patient satisfaction 3) linkage to care 4) retention in care 5) HIV-related stigma. All five outcomes presented a strong argument for HPCI. Conclusions: Primary care has an important role in the care of the diagnosis, treatment, and management of people living with HIV and those at-risk for HIV. With paradigms and politics ever changing, health care must evolve and adapt. An integrated, multidisciplinary approach to care should be considered to improve quality of care for patients and to improve health outcomes for communities and populations.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Shedlock, Gregory
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairMatthews, Derrickderrick.matthews@pitt.eduUNSPECIFIEDUNSPECIFIED
Committee MemberEgan, Jamesjee48@pitt.eduUNSPECIFIEDUNSPECIFIED
Committee MemberKinsky, Suzannekinskys@upmc.eduUNSPECIFIEDUNSPECIFIED
Date: 30 March 2017
Date Type: Submission
Publisher: University of Pittsburgh
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Infectious Diseases and Microbiology
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Date Deposited: 08 Aug 2017 14:49
Last Modified: 20 Dec 2018 00:56


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