Barriers and facilitators to integrated mental health and HIV care: administrator and provider perspectives

Since the 1980s when the HIV epidemic began, HIV and substance use have been intricately linked. A promising area for improving access to care and treatment for people living and aging with HIV and substance use is through integrated care (i.e., "the systematic coordination of general and behavioral healthcare"). There is a recognized need to increase collaboration and integration of mental health, substance use, and primary care providers, including infectious disease specialties. We conducted in-depth interviews with 15 administrators (e.g., clinic managers and care coordinators) and 21 providers (e.g., Physicians, Advanced Practice Providers (APPs), nurses) across Georgia between January 2021 and November 2022. Interviews explored administrator and provider perceptions of clinic integration and their desire to increase integration. Data were analyzed using inductive and deductive thematic analysis guided by the Consolidated Framework for Implementation Research. Overall, study participants in a variety of public, private, and community healthcare settings across the state recognized the benefits of integrated behavioral and physical healthcare and noted some facilitators. However, they reported significant individual-, organizational-, and community-level barriers to implementing it in practice. Our findings highlight opportunities for improvement at the provider, organization, and policy/system levels.