HIV clinics are no longer funded to provide or coordinate non-HIV care, meaning care for people with HIV has become fragmented, according to a new policy briefing by The National Aids Trust entitled Providing coordinated care for people living with HIV.
This can leave patients with multiple morbidities struggling with numerous appointments at different locations, having tests repeated, repeating their history multiple times to different providers, and receiving conflicting medical advice. However, there are signs that new policies are leaning towards reintegrating care.
All healthcare providers must think about how to integrate care for people living with HIV, the report stresses. This means maintaining good communication and interaction with other providers, and developing models of collaborative provision – for all patients, not just those considered as ‘complex’.
Managing multimorbidity is a significant concern for people living with HIV and for those who treat and care for them. Poorly integrated care can cause inconvenience and unnecessary cost, and also risks suboptimal or even potentially dangerous treatment. As the cohort of people living with HIV in the UK ages, needs related to multimorbidity are likely to increase.
Given variability of need and the requirement for flexibility, it is not possible to prescribe a system that suits everyone, the report concludes. It identifies 15 principles that should underpin provision of integrated, coordinated care for people living with HIV. These include:
- A holistic approach that encompasses non-clinical (e.g. social care, social services, counselling, drug and alcohol services) as well as clinical needs.
- Recognition that the principle of ‘patient-centred care’ requires a fundamental change in how knowledge is shared, decisions made, and outcomes evaluated.
- Commissioning that follows the patient: avoiding fragmentation and duplication of care provision can result in efficiencies.
