Is there a role for primary care clinicians in providing shared care in HIV treatment? A systematic literature review

Wong, Wai-Man; Luk, C W; Kidd, Michael

doi:10.1136/sextrans-2011-050170

Cited by 19 publications

(19 citation statements)

References 21 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: 92%

“…Given that task shifting has not been widely implemented in locations with poor linkage to care [60, 61, 66], implementation research on how best to facilitate task shifting is needed, especially in settings with poor linkage to care. Second, research on linkage to care among women, adolescents, and children should be a priority given their under-representation in linkage to care research [3, 5, 63, 65–67]. Third, as task shifting expands HIV service delivery into a wider range of settings, research on maintaining confidentiality and privacy will be important.…”

Section: Discussionmentioning

confidence: 99%

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Facilitators and barriers in HIV linkage to care interventions

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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: 92%

Section: Discussionmentioning

confidence: 99%

Facilitators and barriers in HIV linkage to care interventions

Tso

Best

Beanland

et al. 2016

Aids

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“…Although national guidance recommends involvement of primary care in the management of people with HIV, 13,27 there is no accepted scope or model for its delivery. For the purposes of this review, we used a broad definition of shared care 15,16 and applied it to the HIV setting.…”

Section: Discussionmentioning

confidence: 99%

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

2015

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HIV shared care is uncommon in the UK although shared care could be a beneficial model of care. We review the literature on HIV shared care to determine current practice and clinical, economic and patient satisfaction outcomes. We searched MEDLINE, EMBASE, NICE Evidence, Cochrane collaboration, Google and websites of the British HIV Association, Aidsmap, Public Health England, World Health Organization and Terrence Higgins Trust using relevant search terms in August 2014. Studies published after 2000, from healthcare settings comparable to the UK that described links between primary care and specialised HIV services were included and compared using principles of the Critical Appraisal Skills Programme and Authority, Accuracy, Coverage, Objectivity, Date, Significance frameworks. Three of the nine included models reported clinical or patient satisfaction outcomes but data collection and analyses were inadequate. None reported economic outcomes although some provided financial costings. Facilitators of shared care included robust clinical protocols, training and timely communication. Few published examples of HIV shared care exist and quality of evidence is poor. There is no consistent association with improved clinical outcomes, cost effectiveness or acceptability. Models are context specific, driven by local need, although some generalisable features could inform novel service delivery. Further evaluative research is needed to determine optimal components of shared HIV care.

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“…Prior studies have shown that generalists provide equivalent care with regards to HIV outcomes[49, 50]; however, our sample did not classify providers by levels of experience, previously shown to impact HIV outcomes[26, 44–46]. Our sample size for generalists is less than 6% of the overall sample, however, and reflects clinical practice patterns of many fewer providers compared with the ID and ID plus generalist groups.…”

Section: Discussionmentioning

confidence: 96%

“…Increased experience caring for PLWHA or HIV patient volume has been shown to affect the rate of incorporating new literature into practice[42–46], HIV outcomes[47, 48], and mortality[49, 50]. Yet relatively few studies have assessed the optimal HIV care model—whether comprised of ID, generalist, or both—in terms of NCD screening in the current era of HIV care[24–26], when prevention and management of chronic disease complications are key clinical priorities.…”

Section: Discussionmentioning

confidence: 99%

Non-Communicable Disease Preventive Screening by HIV Care Model

et al. 2017

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ImportanceThe Human Immunodeficiency Virus (HIV) epidemic has evolved, with an increasing non-communicable disease (NCD) burden emerging and need for long-term management, yet there are limited data to help delineate the optimal care model to screen for NCDs for this patient population.ObjectiveThe primary aim was to compare rates of NCD preventive screening in persons living with HIV/AIDS (PLWHA) by type of HIV care model, focusing on metabolic/cardiovascular disease (CVD) and cancer screening. We hypothesized that primary care models that included generalists would have higher preventive screening rates.DesignProspective observational cohort study.SettingPartners HealthCare System (PHS) encompassing Brigham & Women’s Hospital, Massachusetts General Hospital, and affiliated community health centers.ParticipantsPLWHA age >18 engaged in active primary care at PHS.ExposureHIV care model categorized as infectious disease (ID) providers only, generalist providers only, or ID plus generalist providers.Main Outcome(s) and Measures(s)Odds of screening for metabolic/CVD outcomes including hypertension (HTN), obesity, hyperlipidemia (HL), and diabetes (DM) and cancer including colorectal cancer (CRC), cervical cancer, and breast cancer.ResultsIn a cohort of 1565 PLWHA, distribution by HIV care model was 875 ID (56%), 90 generalists (6%), and 600 ID plus generalists (38%). Patients in the generalist group had lower odds of viral suppression but similar CD4 counts and ART exposure as compared with ID and ID plus generalist groups. In analyses adjusting for sociodemographic and clinical covariates and clustering within provider, there were no significant differences in metabolic/CVD or cancer screening rates among the three HIV care models.ConclusionsThere were no notable differences in metabolic/CVD or cancer screening rates by HIV care model after adjusting for sociodemographic and clinical factors. These findings suggest that HIV patients receive similar preventive health care for NCDs independent of HIV care model.

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Is there a role for primary care clinicians in providing shared care in HIV treatment? A systematic literature review

Abstract: Primary care has an important role in the shared care of the diagnosis and management of people with HIV. Some improvements with current guidelines on the management in primary care of people with HIV in developing countries should be considered.

Cited by 19 publications

References 21 publications

Facilitators and barriers in HIV linkage to care interventions

Facilitators and barriers in HIV linkage to care interventions

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

Non-Communicable Disease Preventive Screening by HIV Care Model

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