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

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.

SUBMITTER: Leff JA

PROVIDER: S-EPMC5364616 | biostudies-literature | 2017 Mar

REPOSITORIES: biostudies-literature

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

Leff Jared A JA Hernández Diana D Teixeira Paul A PA Castellón Pedro C PC Feaster Daniel J DJ Rodriguez Allan E AE Santana-Bagur Jorge L JL De León Sandra Miranda SM Vidot José Vargas JV Metsch Lisa R LR Schackman Bruce R BR

BMC health services research 20170323 1

<h4>Background</h4>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 J ...[more]

PMID: 28335754

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Project description:BackgroundThe southern cattle fever tick (SCFT), Rhipicephalus (Boophilus) microplus, remains endemic in Puerto Rico. Systematic treatment programmes greatly reduced and even eradicated temporarily this tick from the island. However, a systemic treatment programme that includes integrated management practices for livestock against SCFT remains to be established in the island. We describe a spatially-explicit, individual-based model that simulates climate-livestock-SCFT-landscape interactions. This model was developed as an investigative tool to aid in a research project on integrated management of the SCFT that took place in Puerto Rico between 2014 and 2017. We used the model to assess the efficacy of tick suppression and probability of tick elimination when applying safer acaricides at 3-week intervals to different proportions of a herd of non-lactating dairy cattle.ResultsProbabilities of eliminating host-seeking larvae from the simulated system decreased from ≈ 1 to ≈ 0 as the percentage of cattle treated decreased from 65 to 45, with elimination probabilities ≈ 1 at higher treatment percentages and ≈ 0 at lower treatment percentages. For treatment percentages between 65% and 45%, a more rapid decline in elimination probabilities was predicted by the version of the model that produced higher densities of host-seeking larvae. Number of weeks after the first acaricide application to elimination of host-seeking larvae was variable among replicate simulations within treatment percentages, with within-treatment variation increasing markedly at treatment percentages ≤ 65. Number of weeks after first application to elimination generally varied between 30 and 40 weeks for those treatment percentages with elimination probabilities ≈ 1.ConclusionsExplicit simulation of the spatial and temporal dynamics of off-host (host-seeking) larvae in response to control methods should be an essential element of research that involves the evaluation of integrated SCFT management programmes. This approach could provide the basis to evaluate novel control technologies and to develop protocols for their cost-effective use with other treatment methods.

Dataset Information

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

Publications

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

Similar Datasets

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