Chapter 5: Organizational Issues: Are You Ready to Replicate?



Before taking action to replicate and implement one or more of the models of care described in this manual to engage hard-to-reach populations into care, providers are asked to review the following list of issues and concerns:

  • What are the agency’s clinical measures and how does it define being engaged in HIV care? Are these different from those used by their colleagues at other local agencies? Are they consistent with those set forth by HRSA? Are their activities aligned with the goals of the NHAS?
  • Self-reporting. Providers may need to question how much they can trust self-reports regarding HIV care reported by clients. Some clients may define “ being in care” as visiting a doctor several years before, while others would consider themselves “ out of care” in that situation.
  • Data disconnect. HIV providers often collect data differently. Some still use paper records, while others create unique EMRs for each patient that can be updated through secure online portals. Relatively few patients have the ability to share patient information online due to limitations on their electronic data infrastructures and concerns for client privacy. For these reasons, clients may seek care from different clinics without the providers’ knowledge.
  • Readiness and health status. Research suggests that regardless of the intervention, the success of PLWHA in care depends in large part on whether or not they are already ill, and if they are willing to engage in HIV care.
  • Provider relationships and adaptability. Is your agency ready to engage in new approaches to care? If you work with partners, are you able to accommodate their requests? If you do not offer services, can you refer clients to colocated or nearby ancillary care and support services, such as transportation, dental care, and mental health?
  • Skill sets. Does your staff have the training necessary to engage in new approaches to care? Does your site have the capacity to train staff? Does the model you are selecting really fit the needs of your clients?
  • Are you really able to reach the population(s) you wish to target?  If you and your staff find you are unable to engage your original target population, do you have a contingency plan?
  • Is your agency ready to receive vulnerable PLWHA? Is it in a discrete location? Is the facility inviting and the staff linguistically and culturally competent? Are you able to secure patient privacy in the waiting room by conducting universal screenings for stigmatizing conditions, such as HIV, mental illness, and SUDs? Does your agency’s workflow allow it to be responsive to patients’ needs and ensure shorter wait times and longer visits with providers?
  • Do you have the infrastructure to track patients and easily update their EMRs? Is it set up to flag clinicians when appointments, blood work, and tests are required? Can it track patients across inpatient/ outpatient settings, agencies, and States/borders to avoid duplicating services and losing them to care?
  • Do you listen to your patients? Does your clinic incorporate input from PLWHA representatives on HIV Planning Councils and other public bodies?