Stakeholders' perceptions of barriers and facilitators for dental and mental health referrals of HIV/AIDS clinic patients.

Abstract

Persons living with HIV/AIDS (PLWHA) are understudied and underserved with respect to both dental and mental health services. The coexistence of psychiatric and dental problems in PLWHA leads to more complex diagnostic assessments and treatments compared to the general population. The aim of the present study was to identify relevant themes from the perspectives of important stakeholders regarding the barriers to and facilitators of patient referral to these services. Semi-structured Key Informant Interviews (KIIs) were conducted with nine program directors and other key staff from New York State HIV clinics to examine barriers to and facilitators of successful dental and mental health referrals and factors that affect patient motivation. Primary themes crystalized around dental and mental health referral, subject knowledge and perspective, patient barriers, and strategies to overcome barriers. Identified barriers included mental health and HIV status stigma, social determinants of health, fear, disconnectedness, and inconsistent access for dental care. Facilitators identified included case management, integrated one-stop-shop care, and interprofessional awareness and collaboration. Potential patient motivators included process improvement strategies such as transportation support, case management, incentives, and building trust. Specific strategies to facilitate patient motivation such as care coordination and interprofessional collaboration is useful for improving dental and mental health referrals.