Ryan White CARE Act Title IV: building networks to improve healthcare delivery to the HIV infected.
There has been little evaluation of the implementation of HIV consortia that were created under Title IV of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. In 1993, Mor and colleagues reported that the effectiveness of networks established by the Robert Wood Johnson Foundation had been compromised by the inability of the participating agencies to work together, given their competing goals and varied institutional cultures. In a study published in 1995, Roy and colleagues identified the following as determinants of successful project implementation: federal and local government support, management-level support and technical assistance, and linkages between participating agencies. This article describes the role that network infrastructure can play in developing interagency collaboration, and the importance of network infrastructure in coordinating the delivery of care at the service-delivery level. The authors describe the efforts of the Lower New York Consortium for Families with HIV (hereafter, "the Consortium") to develop integrative mechanisms at both the network level and the program level. As the number of infected women grows, so does the need to improve the delivery of services and to reduce barriers to the receipt of care. In itself, the support of individual agencies that provide case-management services may not be enough to improve service delivery and reduce barriers; the experiences of networks such as the Consortium may help inform the development of guidelines for creating and enhancing the coordination of services to assure improvements in care. Systematic studies are needed to evaluate different models of collaboration and of coordinating care to determine whether the effort to develop consortia is justified by improved access to care and improved health.