Coordinated HIV Prevention across Domestic Jurisdictional Borders

Abstract

Problem: Urban HIV epidemics often span State and County jurisdictional borders; evidence suggests that borders create barriers to coordinated approaches to HIV prevention and treatment. No systematic assessment has been conducted to understand domestic borders and how they are perceived and navigated by HIV prevention stakeholders.

Objective: The specific aims of this investigation are to:

Examine the extent to which there are disconnects between services available to vulnerable populations and expertise of HIV Prevention Organizations (HPOs).

Describe collaboration between HPOs across a jurisdictional border.

Determine whether the Health Services Research Utilization Model (HSUM) explains organizational barriers to coordinated HIV prevention across jurisdictional borders.

Methods: Data from a survey of HPOs were analyzed to explore populations served by HPOs, organizational expertise with vulnerable populations, HPOs perceived benefits and barriers to cross-jurisdictional collaboration, past and current cross-jurisdictional collaboration, and efficacy for cross-jurisdictional grant-writing. Correlations between these constructs were assessed with Spearman’s Rho and jurisdictional differences were analyzed with the Mann-Whitney U test statistic. The matrix method of literature review (MMLR) explored organizational barriers to coordinated HIV prevention across jurisdictional borders and the HSUM as a framework.

Results: While 13 of 15 HIV-vulnerable populations were served by over 50% of the HPOs in the study, only 2 of these 13 populations were served with high expertise by more than half of the HPOs in the sample - giving credence to community leader’s concerns regarding misalliance between whom HPOs serve and with whom they have high expertise. For a majority of HPOs, inadequate staffing and resources prevented cross-jurisdictional grant applications. Cross-jurisdiction grant-writing efficacy was associated with fewer perceived barriers (r = -0.642, p<0.01). The HSUM captured all of the organizational barriers to cross-jurisdictional collaboration for HIV prevention, and the MMLR added 14 sub-constructs to the HSUM and operationalized the model for addressing organizational barriers to HIV prevention across jurisdictional borders.

Conclusions: The identification of barriers to cross-jurisdictional collaboration and the validation of a framework for addressing these barriers may aid researchers and healthcare professionals in resolving inefficiencies in HIV prevention services in metropolitan areas that cross jurisdictional borders.