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Background: Individuals living with HIV/AIDS are at greater risk for developing chronic conditions, such as diabetes, cardiovascular diseases, hypertension, and cognitive impairment. These individuals are also more likely to present with complex social and mental health needs. Unstable housing, lack of transportation, unemployment, substance abuse, depression, anxiety, and other psychiatric disorders are disproportionately experienced by HIV/AIDS patients. The confluence of these conditions result in high usage of Emergency Department (ED) services for non-urgent needs.

Methods: We conducted a preliminary landscape analysis to explore factors that influence patient access and adherence to care pathways. Medical records of 28 Leeway Residential Care Home (RCH) residents up to May 2021 were extracted and analyzed. Of these 28 residents, 12 were selected for participation in semi-structured, in-depth qualitative interviews. Additionally, 6 RCH staff members participated in qualitative interviews.

Results: Staff support, barriers to care utilization, substance use treatment and management, community-building at Leeway, building resident self-efficacy, and navigating mental health and social needs were major themes that emerged from Leeway RCH staff and resident interviews. 89.3% of residents had at least one mental health condition diagnosis and 64.3% of residents had a history of substance use. The most common comorbidities among residents were neurological disorders (82.1%), complications of the lungs (64.3%), and cardiovascular disease (60.7%). The most common mental health conditions among residents were depression (46.4%), suicide (32.1%), and schizophrenia/schizoaffective disorder (28.6%). The highest number of ER visits per year among RCH residents was 22. The most common ER diagnoses were other, pain, and lung issues.

Conclusion: Residents reported having medical and basic needs met through services at Leeway. Residents’ complex psychosocial and emotional needs as well as difficulties managing substance use could contribute to poor utilization of care pathways. Identifying and leveraging community assets to meet residents’ psychosocial and emotional needs and implementing peer-support and/or community health worker models to build resident self-efficacy could improve care pathway utilization.

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Community Health and Preventive Medicine

Improving Care Pathway Access and Utilization in an HIV/AIDS Skilled Nursing Center in New Haven, CT