Extending The Continuum of Care—HIV Primary Care By The Infectious Disease Physician

Abstract

Background. HIV infected (HIV+) patients are increasingly affected by HIV associated non-AIDS conditions. Infectious diseases (ID) physicians are now faced with the task of providing primary care in addition to HIV services to HIV+ patients. The objective of this study is to assess ID physician's practices and barriers to delivery of primary care services to the HIV+ population. Methods. IDSA's Emerging Infections Network (EIN) is a provider-based emerging infections sentinel network of ID physicians who provide clinical care. A 6-item survey was used to assess practice patterns and barriers to providing primary care for HIV+ patients. The survey was distributed to EIN members in January 2016. Results. Of the 1248 active members, 644 (52%) responded to the survey. Among the 644 respondents, 431 (67%) routinely treat HIV patients in outpatient settings. Of these 431 respondents, a majority (326, 75%) acted as primary care physicians for atleast some of their HIV+ patients. Responders who reported always or mostly performing a screening assessment as recommended per guidelines were: (1) Primary care related screening (fasting lipids 94%, colonoscopy 94%, mammogram 89%, cervical pap smears 87%, depression screening 57%, osteoporosis for postmenopausal women 55% and men >50 years 23% prostate cancer 37%); (2) Screening specific to HIV (latent tuberculosis 95%, genital chlamydia/gonorrhea 77%, hepatitis C 67%, extra genital chlamydia/gon-orrhea 47%, baseline anal pap smear for men 33% and women 36%); (3) Vaccination related (influenza 99%, PPSV23 96%, PCV13 94%, Tdap 84%, HPV 61% and zoster 39%). The most common barriers to primary care preventive services were: non adherence to HIV medications (43%), having other health priorities (44%), not enough time for clinic visit (43%) and financial or insurance limitations (40%). Conclusion. Most ID/HIV providers act as primary care providers for their HIV infected patients. Provision of primary care screening services and vaccination for HIV+ patients is suboptimal based on current guidelines, and multiple patient and health systems barriers are common. Interventions to increase screening practices and vaccinations; and to decrease barriers are urgently needed to address the needs of the HIV+ population.