Interface between primary and specialized care in a context of decentralization of services for HIV/AIDS

Abstract

The interaction between Primary Health Care (PHC) and specialized care is as relevant as it is critical. The care for people living with HIV/AIDS (PLWHA), carried out in specialized outpatient clinics, was implemented in PHC for its potential to expand access. Based on a case study conducted in a municipal region of Rio de Janeiro between 2018 and 2019, we examine the issue and highlight the following results: lack of knowledge and/or doubts of specialty care professionals about the effective delivery of services to PLWHA in primary care; prioritization of material, symbolic, and political investment in primary care; limited channels for dialogue between services, among others. In this study, we found the interface between PHC and specialized care to emphasize a binary logic that favors isolation instead of interaction and shared
management principles expected in an integrated healthcare system. Despite the potential gains in access
and ‘rationalization’ justifying the use of the specialist (infectious disease specialist), these results indicate the need to strengthen processes of communication and interaction between professionals from different
types of services, in addition to strategies to reinforce the coordination of care, such as matrix support and integrated electronic medical records.