title: Factors Influencing the Delivery of HIV-Related Services to Severely Mentally Ill Individuals: The Provider's Perspective.
abstract: BACKGROUND
  Individuals with severe mental illnesses (SMI) are disproportionately vulnerable to HIV infection but are not consistently engaged in HIV-related services.
  
  
  OBJECTIVE
  To understand factors influencing implementation of HIV-related services to individuals with SMI, we conducted a series of focus groups with multidisciplinary clinicians and staff serving individuals with SMI in outpatient, emergency, acute inpatient, and chronic inpatient levels of care.
  
  
  METHODS
  Six focus groups with 30 participants were conducted, audiotaped, and transcribed. Our qualitative analysis drew on Grounded Theory. Using NVivo Version 9, coding was conducted by the first and senior authors; interrater reliability was verified by running Coding Comparison queries.
  
  
  RESULTS
  The providers' narratives highlighted (1) patient-related factors, (2) stigma, and (3) administrative factors as themes particularly relevant to the delivery of HIV-related services to individuals with SMI. The reported relevance of these factors ranged across levels of care, from creating multiple barriers in the outpatient care to relatively seamless and effective delivery of full continuum of HIV-related services in the chronic inpatient environment, where adequate structural support is provided.
  
  
  CONCLUSIONS
  Providers' narratives suggest that effective delivery of HIV-related services for individuals with SMI requires sustained structural support that is coordinated across levels of psychiatric care and tailored to individual patient's needs. The narratives also suggest that such support is currently not available.
authors.affiliation: Department of Sociology, American University, Washington, DC.
authors.forename: Monica
authors.initials: M
authors.lastname: Biradavolu
authors.affiliation: Washington DC HIV/AIDS, Hepatitis, STD and TB Administration, Washington, DC.
authors.forename: Yujiang
authors.initials: Y
authors.lastname: Jia
authors.affiliation: National Institutes of Health, National Institute of Mental Health, Bethesda, MD.
authors.forename: Keenan
authors.initials: K
authors.lastname: Withers
authors.affiliation: National Institutes of Health, National Institute of Mental Health, Bethesda, MD; Department of Psychiatry and The Behavioral Sciences, University of Southern California Keck School of Medicine, Los Angeles, CA. Electronic address: kapetano@usc.edu.
authors.forename: Suad
authors.initials: S
authors.lastname: Kapetanovic
mesh_terms: D000553:Ambulatory Care; D001291:Attitude of Health Personnel; D000071959:Case Managers; D003153:Community Health Services; D003156:Community Mental Health Services; D015897:Comorbidity; D003695:Delivery of Health Care; D004637:Emergency Services, Psychiatric; D017144:Focus Groups; D066296:Grounded Theory; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006778:Hospitals, Psychiatric; D006801:Humans; D055552:Infectious Disease Medicine; D008403:Mass Screening; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy*; D009722:Nurse Practitioners; D009726:Nurses; D010820:Physicians; D011570:Psychiatry; D036301:Qualitative Research; D057545:Social Stigma; D000068217:Social Workers