A systematic review of contemporary models of shared HIV care and HIV in primary care in high-income settings

Mapp, Fiona; Hutchinson, Jane; Estcourt, Claudia

doi:10.1177/0956462415577496

Cited by 20 publications

(33 citation statements)

References 23 publications

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“…This finding is consistent with a small quantitative literature on HIV and primary care integration [64, 65] and found effective in high income settings [66, 67]. Several themes supported this finding (cessation support services for substance users, active referrals, and case management team counseling), highlighting the many ways in which integration could be effectively implemented [14, 17, 33–36, 39, 40, 43, 44–46, 48, 52].…”

Section: Discussionsupporting

confidence: 93%

Facilitators and barriers in HIV linkage to care interventions

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Best

Beanland

et al. 2016

Aids

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Objective To synthesize qualitative evidence on linkage to care interventions for people living with HIV. Design Systematic literature review. Methods We searched nineteen databases for studies reporting qualitative evidence on linkage interventions. Data extraction and thematic analysis were used to synthesize findings. Quality was assessed using the CASP tool and certainty of evidence was evaluated using the CERQual approach. Results Twenty-five studies from eleven countries focused on adults (24 studies), adolescents (8 studies), and pregnant women (4 studies). Facilitators included community-level factors (i.e. task-shifting, mobile outreach, integrated HIV and primary services, supportive cessation programs for substance users, active referrals, and dedicated case management teams) and individual-level factors (encouragement of peers/family and positive interactions with healthcare providers in transitioning into care). One key barrier for people living with HIV was perceived inability of providers to ensure confidentiality as part of linkage to care interventions. Providers reported difficulties navigating procedures across disparate facilities and having limited resources for linkage to care interventions. Conclusions Our findings extend the literature by highlighting the importance of task-shifting, mobile outreach, and integrated HIV and primary services. Both community and individual level factors may increase the feasibility and acceptability of HIV linkage to care interventions. These findings may inform policies to increase the reach of HIV services available in communities .

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Section: Discussionsupporting

confidence: 93%

Facilitators and barriers in HIV linkage to care interventions

Tso

Best

Beanland

et al. 2016

Aids

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“…The need for greater involvement and the integration of primary care into the care of people living with HIV is well established,[ 15 – 17 , 41 ] but HIV shared care remains a fluid concept without a universally accepted definition. [ 32 ] Our findings support the need to advance our understanding of how shared care models can ensure comprehensive, timely, and accessible care for people living with HIV.…”

Section: Discussionsupporting

confidence: 55%

“…All settings were very team oriented, likely reflecting the needs of the evolving epidemic. [ 32 ] Team work has been identified to be important to an HIV care settings’ ability to provide comprehensive services for people living with HIV in both primary and specialist care settings. [ 33 ] Settings further performed well on critical HIV care measures, such as the ability to conduct HIV-related blood tests.…”

Section: Discussionmentioning

confidence: 99%

The organizational attributes of HIV care delivery models in Canada: A cross-sectional study

et al. 2018

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HIV treatment in Canada has rapidly progressed with the advent of new drug therapies and approaches to care. With this evolution, there is increasing interest in Canada in understanding the current delivery of HIV care, specifically where care is delivered, how, and by whom, to inform the design of care models required to meet the evolving needs of the population. We conducted a cross-sectional survey of Canadian care settings identified as delivering HIV care between June 2015 and January 2016. Given known potential differences in delivery approaches, we stratified settings as primary care or specialist settings, and described their structure, geographic location, populations served, health human resources, technological resources, and available clinical services. We received responses from 22 of 43 contacted care settings located in seven Canadian provinces (51.2% response rate). The total number of patients and HIV patients served by the participating settings was 38,060 and 17,678, respectively (mean number of HIV patients in primary care settings = 1,005, mean number of HIV patients in specialist care settings = 562). Settings were urban for 20 of the 22 (90.9%) clinics and 14 (63.6%) were entirely HIV focused. Primary care settings were more likely to offer preventative services (e.g., cervical smear, needle exchange, IUD insertion, chronic disease self-management program) than specialist settings. The study illustrates diversity in Canadian HIV care settings. All settings were team based, but primary care settings offered a broader range of preventative services and comprehensive access to mental health services, including addictions and peer support.

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“…A systematic review of shared care in HIV medicine found no consistent association with improved clinical outcomes, cost effectiveness, or acceptability, but the quality of studies was again judged to be poor [25]. A study of patients in care for HIV infection in Ontario, Canada found colorectal cancer screening was more common among patients receiving care from both generalists and specialists, compared with only HIV specialists [26].…”

Section: Discussionmentioning

confidence: 99%

Should Human Immunodeficiency Virus Specialty Clinics Treat Patients With Hypertension or Refer to Primary Care? An Analysis of Treatment Outcomes

Appenheimer

Bokhour

McInnes

et al. 2017

Open Forum Infectious Diseases

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Background.Care for people with human immunodeficiency virus (HIV) increasingly focuses on comorbidities, including hypertension. Evidence indicates that antiretroviral therapy and opportunistic infections are best managed by providers experienced in HIV medicine, but it is unclear how to structure comorbidity care. Approaches include providing comorbidity care in HIV clinics (“consolidated care”) or combining HIV care with comorbidity management in primary care clinics (“shared care”). We compared blood pressure (BP) control in HIV clinics practicing consolidated care versus shared care.Methods.We created a national cohort of Veterans with HIV and hypertension receiving care in HIV clinics in Veterans Administration facilities and merged these data with a survey asking HIV providers how they delivered hypertension care (5794 Veterans in 73 clinics). We defined BP control as BP ≤140/90 mmHg on the most recent measure. We compared patients’ likelihood of experiencing BP control in clinics offering consolidated versus shared care, adjusting for patient and clinic characteristics.Results.Forty-two of 73 clinics (57.5%) practiced consolidated care for hypertension. These clinics were larger and more likely to use multidisciplinary teams. The unadjusted frequency of BP control was 65.6% in consolidated care clinics vs 59.4% in shared care clinics (P < .01). The likelihood of BP control remained higher for patients in consolidated care clinics after adjusting for patient and clinic characteristics (odds ratio, 1.32; 95% confidence interval, 1.04–1.68).Conclusions.Patients were more likely to experience BP control in clinics reporting consolidated care compared with clinics reporting shared care. For shared-care clinics, improving care coordination between HIV and primary care clinics may improve outcomes.

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A systematic review of contemporary models of shared HIV care and HIV in primary care in high-income settings

Cited by 20 publications

References 23 publications

Facilitators and barriers in HIV linkage to care interventions

Facilitators and barriers in HIV linkage to care interventions

The organizational attributes of HIV care delivery models in Canada: A cross-sectional study

Should Human Immunodeficiency Virus Specialty Clinics Treat Patients With Hypertension or Refer to Primary Care? An Analysis of Treatment Outcomes

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