HIV Education and Welfare Services in Primary Care: An Empirical Model of Integration in Brazil's Unified Health System.

Rahbel Rahman,Rogério Pinto,Melanie Wall

doi:10.3390/ijerph14030294

Abstract

Integration of health education and welfare services in primary care systems is a key strategy to solve the multiple determinants of chronic diseases, such as Human Immunodeficiency Virus Infection and Acquired Immune Deficiency Syndrome (HIV/AIDS). However, there is a scarcity of conceptual models from which to build integration strategies. We provide a model based on cross-sectional data from 168 Community Health Agents, 62 nurses, and 32 physicians in two municipalities in Brazil’s Unified Health System (UHS). The outcome, service integration, comprised HIV education, community activities (e.g., health walks and workshops), and documentation services (e.g., obtainment of working papers and birth certificates). Predictors included individual factors (provider confidence, knowledge/skills, perseverance, efficacy); job characteristics (interprofessional collaboration, work-autonomy, decision-making autonomy, skill variety); and organizational factors (work conditions and work resources). Structural equation modeling was used to identify factors associated with service integration. Knowledge and skills, skill variety, confidence, and perseverance predicted greater integration of HIV education alongside community activities and documentation services. Job characteristics and organizational factors did not predict integration. Our study offers an explanatory model that can be adapted to examine other variables that may influence integration of different services in global primary healthcare systems. Findings suggest that practitioner trainings to improve integration should focus on cognitive constructs—confidence, perseverance, knowledge, and skills.

Highlights

Across the globe, Human Immunodeficiency Virus Infection and Acquired Immune DeficiencySyndrome (HIV/AIDS) continues to disproportionately burden low-income ethnic/racial groups and sexual minorities who face myriad other chronic diseases [1,2,3]
In 2015, 830,000 people were living with HIV in Brazil, the prevalence for adults aged 15 to 49 was 0.6%, with the highest rates in populations facing low educational attainment and economic inequality [4]
We investigated influences on FHS teams’ provision of HIV/AIDS education along with their involvement of consumers in community-level activities and helping them to obtain documentation/registration, “service integration,” as a latent variable underlying three measures: HIV/AIDS education; community activities; and documentation services (Figure 1)

Summary

Introduction

Human Immunodeficiency Virus Infection and Acquired Immune Deficiency. Syndrome (HIV/AIDS) continues to disproportionately burden low-income ethnic/racial groups and sexual minorities who face myriad other chronic diseases [1,2,3]. In 2015, 830,000 people were living with HIV in Brazil, the prevalence for adults aged 15 to 49 was 0.6%, with the highest rates in populations facing low educational attainment and economic inequality [4]. HIV risk behaviors arise within the context of socioeconomic determinants of health, such as the physical, familial, cultural, organizational, economic, policy/legal, and social environments in which those affected live [5,6]. Given the scope of these determinants of health, governments worldwide, including Brazil, have. Res. Public Health 2017, 14, 294; doi:10.3390/ijerph14030294 www.mdpi.com/journal/ijerph

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