Healthcare in Context: Neighborhood and Organizational Network Effects on HIV Service Provision

Cornell University, Ithaca NY

Investigators

Linked publications, trials & patents

Abstract

? DESCRIPTION (provided by applicant): Within the United States, community based organizations and local clinics are responsible for distributing the lion's share of HIV prevention and treatment services. However, little is known about how the neighborhood and network contexts in which these organizations operate influences their ability to provide services. Prior literature on organizations demonstrates that inter-organizational linkages, such as relationships formed through collaboration, play integral roles in organizational survival and performance. For HIV service organizations, these connections are critical for providing comprehensive care to clients given the specialization of organizations within this field. Inter-organizational linkages re also beneficial to clients, who experience increased access to services that are funneled through these ties. However, inter-organizational ties are most likely to be formed among organizations within the same neighborhood. Despite their higher rates of HIV, disadvantaged neighborhoods are the least likely to host and sustain organizations. In turn, this paucity of organizations in disadvantaged neighborhoods may influence those organizations' connectedness to the broader network of care, ultimately jeopardizing the range of services they can provide to clients. This study investigates how neighborhood context and inter-organizational networks influence healthcare provision and access through three aims. Aim 1 is to establish how neighborhood context, measured through disadvantage and racial composition, influences organizations' connectedness within the inter-organizational network. Aim 2 is to investigate how embeddedness within the network influences the provision of healthcare services. Aim 3 is to examine how an individual's affiliations with organizations are linked with differential access to and utilization of healthcare services. I utilize novel data from the Young Men's Affiliation Project (YMAP) to investigate these relationships. YMAP is a mixed method, longitudinal study of men who have sex with men (MSM) and the social and health venues they frequent in Chicago and Houston. Included in this data are interviews with organizational staff describing the services their organization provides, the clientele they serve and their connections with other local organizations, as well as survey data on MSM's healthcare utilization patterns, risk behaviors and affiliations with local venues. MSM account for 50% of the individuals living with HIV and 63% of new infections, representing a critical population in need of HIV services (CDC 2014). This project advances the AHRQ's mission of improving healthcare access and equitability by studying the organizations and contextual structures that underpin service delivery to this at-risk population.