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HIV Testing and Prevention Services in Behavioral Health Organizations: A Multi-method Study Using the Consolidated

Lydia A Chwastiak1, Mira Reichman2, Laurie Sylla3

  • 1Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 Ninth Avenue, Box 359911, Seattle, WA, 98104, USA. lchwast@uw.edu.

AIDS and Behavior
|December 3, 2025
PubMed
Summary

Implementing HIV testing and prevention for individuals with serious mental illness in behavioral health settings is crucial. Key facilitators include supportive organizational culture, while barriers involve resource limitations and staff training needs.

Keywords:
Behavioral health organizationsHIV testingPrEPSerious mental illness

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Area of Science:

  • Public Health
  • Implementation Science
  • Mental Health Services Research

Background:

  • Increasing access to HIV testing and prevention services for individuals with serious mental illness (SMI) is a public health priority.
  • Limited understanding exists regarding the factors influencing the implementation of these services within behavioral health organizations.

Purpose of the Study:

  • To identify barriers and facilitators to implementing on-site HIV testing and Pre-exposure prophylaxis (PrEP) services in behavioral health organizations.
  • To explore organizational determinants influencing service delivery for HIV prevention among clients with SMI.

Main Methods:

  • A multi-method study combining quantitative surveys and qualitative interviews in King County, Washington.
  • Utilized the Consolidated Framework for Implementation Research (CFIR) 2.0 for deductive qualitative analysis.
  • Surveyed 16 organizations; conducted in-depth interviews with 21 staff, providers, and leaders from 3 organizations.

Main Results:

  • Facilitators included positive organizational culture, non-judgmental care, long-term client relationships, and holistic care missions.
  • Barriers comprised resource shortages, insufficient trained staff, infrastructure issues (billing, referrals), competing service priorities, and knowledge gaps.
  • Providing on-site PrEP faced greater challenges (staff training, service complexity) than HIV testing.

Conclusions:

  • Behavioral health organizations face significant barriers to implementing HIV testing and PrEP services.
  • Leveraging existing strengths like organizational culture and client relationships can facilitate service integration.
  • Capacity-building strategies, including training and partnerships, are essential for improving HIV prevention service delivery.