The Prevention and Access to Care and Treatment project (PACT) is a community-based program located in inner-city Boston. PACT targets disenfranchised and high-risk inner-city HIV patients using a health promotion and harm reduction model to reach patients failing treatment in traditional modes of care. PACT is collaborating with the Brigham and Women's Hospital in Boston to build an improved model of HIV care on provider and systems levels. We aimed to determine the strengths and potential weaknesses of the existing care system to offer targeted solutions. Our methods include a needs assessment based on focus groups, patient interviews, and site analysis. We found that providers recognized many of the personal challenges that patients face, such as barriers to keeping appointments, issues related to disclosure, and substance abuse problems. Providers also acknowledge their own limitations when it comes to assessing patient literacy. Patients stated that they generally like the care they received at the clinic, citing physicians and staff as helpful and friendly. Amid this health care goodwill, they also face a variety of barriers in getting their care. Examples of obstacles that patients noted but providers did not emphasize include obtaining medications, maintaining privacy, disclosure, and issues of employment. The clinic site itself is functional but can be streamlined to better deliver information to patients. Recommendations include increasing patient access to health care information and decreasing HIV stigma by reorganizing the clinic's physical space and improving educational materials, making use of patients' trust of their providers to deliver focused and pertinent messages, and designing a comprehensive framework for patients to discuss their HIV status with loved ones based on past patient experiences. Based on the findings of this initial needs assessment, further exploration should be done to more precisely identify barriers and potential solutions.
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