Interorganizational relationships among HIV/AIDS service organizations in Baltimore: A network analysis

A wide variey of organizations has become involved in providing medical and social services to people living with human immunodeficiency virus/acquire d immunodeficiency syndrome (HIV/AIDS). Although there is much interest amo ng policymakers, service providers, and clients in coordination among HIV/A IDS service organizations, few studies have used network analytic tools to examine existing systems of HIV-related care. In an effort to fill this gap , this study used network analysis methods to describe several aspects of t he interorganizational relationships among 30 HIV/AIDS service agencies in Baltimore, Maryland. Client referrals to other organizations, client referr als from other organizations, exchange of information about shared clients, formal written linkage agreements for client referrals, and joint programs were each examined as a distinct type of network tie, with each the basis of a separate network among these 30 organizations. All of the networks exc ept the one based on joint programs were relatively well connected, with mo st organizations either directly or indirectly linked. Most of the interorg anizational collaboration occurred on a rather ad hoc basis for the purpose s of meeting the more immediate needs presented by clients. Highly structur ed coordination involving substantial investment of resources and ongoing i nteragency activities appeared to be less common. The findings from this st udy also suggest that the providers in Baltimore tend to work directly with others as client needs arise rather than negotiating through "clearinghous e" types of organizations. Of the 30 HIV/AIDS service organizations, 5 were highly central in at least four of the five different types of networks. T hese five organizations-each having a critical role in the continuum of car e-may be considered the most central core of the HIV/AIDS service delivery network in Baltimore. These organizations tend to be those that have been c reated specifically to provide HIV-related services or that specialize in H IV/AIDS care. This research can help policymakers understand how an HIV-rel ated service delivery network may function and delineate key features of a network. In all communities, this type of assessment is critical to designi ng interventions to promote collaboration that are feasible within the cont ext of existing interorganizational relationships. This type of data also h as implications for informing activities to build the capacity of HIV/AIDS service organizations.