Strategies for dealing with problems associated with use of services for HIV infection and AIDS out of region: views of providers and users

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Abstract
OBJECTIVES —To identify reasons why people with HIV infection and AIDS living within the former South West Thames Regional Health Authority use HIV and AIDS services outside the region, and to identify strategies for dealing with theproblems associated with such use. DESIGN —Qualitative study consisting of interviews with individual subjects and focus groups. SETTING —Providers of services for patients with HIV infection and AIDS in South West Thames, central London, and Brighton. Users of such servicesresident in South West Thames. SUBJECTS —Thirty four South West Thames residents with HIV infection and AIDS who use or usedservices outside theformer region; and 70 providers of services within and beyond South West Thames. RESULTS —Principal reasons for use of services out of the region were accessibility (15) and negative appraisals of local services (14). Three main strategies for dealing with the problems of such use were suggested by providers. These entailed introducing users of services outside the region to services in their locality (16); sharing the responsibility for care between providers in specialist centres and in the person's locality (10); and involving the person's general practitioner in their care (12). These strategies were deemed acceptable by 29, 30, and 20 service users respectively. CONCLUSION —The reasons underlying use of services for patients with HIV infection and AIDS outside the region offer suggestions for developing services in areas with a high incidence of such use. The suggestions advanced by service providers offer an acceptable framework for dealing with the problems. Various problems in provision of services can arise when a person with HIV infection or AIDS travels long distances for HIV and AIDS services The main reasons for use of HIV and AIDS services outside the region identified by a sample of South Thames (West) residents with HIV infection or AIDS were service accessibility and negative appraisals of local services To overcome the problems of such use service providers advocated encouraging people with HIV infection or AIDS to transfer their care wholly or partly to their local area Strategies for transferring and sharing care were rated as broadly acceptable -with certain provisos -by service users