XIX International AIDS Conference


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THPE626 - Poster Exhibition

Social network analysis of health care agency referrals to HIV/AIDS medical services in New York, 2007-2011

S. Kim1,2, V. Pinho1,3, K. McKinnon1,3

1Columbia University, College of Physicians and Surgeons, New York, United States, 2Teachers College, Columbia University, New York, United States, 3New York State Psychiatric Institute, Washington Heights Community Service, New York, United States

Background: People with HIV/AIDS often need various medical services, and few studies have investigated network structures of HIV-related care. In order to address this gap, we examined referral practices of NYS healthcare agencies to illustrate the extent to which geographic region and agency type were related to collaboration between providers to deliver comprehensive care for HIV patients.
Methods: We collected needs assessment data by survey from 176 agencies seeking HIV mental health training between August 2007 and October 2011. Mental health, HIV, and primary care agencies throughout NYS reported up to 8 agencies to which referrals for HIV services were made. Among them, 151 agencies referred patients to 86 other agencies. Social network analysis was used to determine the characteristics of referrals. Kruskal-Wallis test and exponential-family random graph models were fitted to investigate statistical significance by agency type and geographic location.
Results: Designated AIDS Centers (DACs, i.e., state-certified, hospital-based programs) accounted for only 30% of agencies to whom referrals were made, though DACs provided 51% of all referrals. The remaining referrals were predominantly to Community Based Organization/Community Based Clinic (CBO/CBCs). Geographic factors (i.e. distance and region) were more salient than agency types to referral networks. Different patterns among regions were observed in terms of the distance between referral agencies and network centrality (see Figures).
Conclusions: NYS is considered a highly specialized HIV-care environment, and even outside of major metropolitan areas a high volume of patients requires HIV care and collaboration. Disconnection between NYC metropolitan and other cities and relatively low utilization of DACs might imply a) lack of collaboration and of utilizing specialized care or b) well-established collaborations and specialization within the local area care providers and CBO/CBCs (not DACs). Further investigation would be appropriate to test these hypotheses. Meanwhile, promotion of service integration through training, policy, and other means of network-building is needed.

1. Distribution of Referral Distance
[1. Distribution of Referral Distance]

2. HIV Referrals by Geographic Region
[2. HIV Referrals by Geographic Region]

3. Centrality by Regions
[3. Centrality by Regions]

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