HomeHome

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

Jared A. Leff; Diana Hernandez; Paul A. Teixeira; Pedro Castellon; Daniel J. Feaster; Allan E. Rodriguez; Jorge L. Santana-Bagur; Sandra M. De León; José V. Vidot; Lisa Metsch; Bruce R. Schackman

Title:
The structural and health policy environment for delivering integrated HIV and substance use disorder treatments in Puerto Rico
Author(s):
Leff, Jared A.
Hernandez, Diana
Teixeira, Paul A.
Castellon, Pedro
Feaster, Daniel J.
Rodriguez, Allan E.
Santana-Bagur, Jorge L.
De León, Sandra M.
Vidot, José V.
Metsch, Lisa
Schackman, Bruce R.
Date:
Type:
Articles
Department(s):
Sociomedical Sciences
Volume:
17
Persistent URL:
Book/Journal Title:
BMC Health Services Research
Geographic Area:
Puerto Rico
Notes:
Keywords: AIDS, HIV, Injection drug use, Mental health, Qualitative analysis
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.
Subject(s):
Intravenous drug abuse--Health aspects
Drug abuse--Treatment
HIV infections--Treatment
Mental health policy
Publisher DOI:
https://doi.org/10.1186/s12913-017-2174-7
Item views
9
Metadata:
text | xml
Suggested Citation:
Jared A. Leff, Diana Hernandez, Paul A. Teixeira, Pedro Castellon, Daniel J. Feaster, Allan E. Rodriguez, Jorge L. Santana-Bagur, Sandra M. De León, José V. Vidot, Lisa Metsch, Bruce R. Schackman, , The structural and health policy environment for delivering integrated HIV and substance use disorder treatments in Puerto Rico, Columbia University Academic Commons, .

Columbia University Libraries | Policies | FAQ