The Massachusetts HIV, Hepatitis, Addiction Services Integration (HHASI) Experience: Responding to the Comprehensive Needs of Individuals with Co-Occurring Risks and Conditions

Abstract

Categorical funding mechanisms traditionally used to fund public health programs are a challenge to providers serving individuals with complex needs that often span multiple service areas. Integration--a formalized, collaborative process among service systems--responds to the challenge by decreasing fragmentation of care and improving coordination. In 2000, the Massachusetts Department of Public Health (MDPH) received a one-year planning grant from the federal Substance Abuse and Mental Health Services Administration (SAMHSA) to evaluate opportunities for integrating HIV/AIDS programs and substance abuse treatment programs. The project was later expanded to include viral hepatitis programming. Outcomes include the development of a strategic plan, joint procurement initiatives, and an ongoing commitment to sustain inter-bureau integration efforts, even in the face of substantial budget reductions. Integrated approaches can promote greater efficiency, improving communication and coordination among clients, providers, and government funding agencies.

Inability to access health and social services associated with mental health among people who inject drugs in a Canadian setting

“…The low self-reported inability to access services among HCV-positive PWID may be partially explained by the long latency period for the disease, poor tolerability of pegylated interferon-based regimens, and low perceived need for treatment (Doab et al, 2005, Jordan et al, 2013, Mehta et al, 2008 and Swan et al, 2010). Poor coordination between services (Harris and Rhodes, 2013, Hoffman et al, 2004, Krusi et al, 2010 and Nosyk et al, 2014), however, largely compromised access to care among PWID, especially when managing comorbid health conditions. The improved engagement in HIV treatment provides an important opportunity to seek and treat mental health conditions and HCV among HIV-positive PWID on ART.…”

Integrating HIV and substance use services: a systematic review

“…Similarly, within substance use facilities, the majority of studies were micro level integrations (n =1 2 ) [40,41,44,47,51,58,59,66,68,76,77,79,80,82], with three meso level integrations [46,56,65]. In other facilities, three studies described micro level integration [38,39,53], two described meso level integration [42,43] and two described macro level integration [55,78].…”

Community stakeholders’ perspectives on the impact of the minority AIDS initiative in strengthening HIV prevention capacity in four communities1 The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

“…Collaborations, especially formal ones, have been found to be effective in other prevention efforts, such as substance abuse (Substance Abuse and Mental Health Services Administration 2000). Furthermore, collaborations may allow providers to be more responsive to clients with multiple and complex needs, and may result in better access to a more comprehensive range of services for these clients and others at risk (Hoffman et al 2004). As previous research has noted, the influx of independent and autonomous HIV/AIDS-related services has led to a sense of frustration among providers and clients (Kwait et al 2001).…”