By Sarah Garland

How can we better care for people living with HIV as they age? Antiretroviral therapies – treatments for people with HIV – are easier to access and more effective than ever before. This improvement in care means that people with HIV are living longer, and as they age, they face other chronic conditions associated with aging. People living with HIV also have an increased risk of complications with long-term antiretroviral therapies.

Currently, people living with HIV typically access care through HIV or infectious disease specialists, which are usually located in larger urban centres. However, the number of HIV specialist physicians is declining, and fewer physicians are entering this specialty. There is a need, and in fact has been a recent shift, to caring for people with HIV through primary care. Is it possible for primary care physicians to balance HIV care with other chronic conditions? What are the outcomes for people living with HIV when they receive care from primary care physicians?

CADTH — an independent agency that finds, assesses, and summarizes the research on drugs, medical devices, tests, and procedures — recently published a report on the management of HIV care in primary care settings. The report highlights current Canadian guidelines on HIV management and provides a summary of the relevant literature that describes the models for HIV management and the outcomes for people with HIV.

The CADTH report found 4 studies that identified patient outcomes associated with different HIV models of care. Based on the information in those studies, there was generally no difference in outcomes for people living with HIV whether they were seen by specialists or by primary care doctors. This is the case for most HIV-related outcomes as well as outcomes related to other chronic conditions. These studies looked at integrating HIV-specific care within primary care, embedding primary care within HIV clinics, or delivering HIV care at the same location as other health care services. Overall, the frequency of screening for chronic diseases, like cancer or diabetes, was also similar, regardless of type of clinician seen.

There are some unique challenges facing people with HIV who also have other chronic health conditions. Medication fatigue, due to having to take numerous drugs, can make it difficult to be consistent and adhere to all the medications a person may need to take. Increased medical costs can also be stressful and impact daily life and relationships. There can also be increased stigma associated with having both HIV and a chronic condition, but positive coping strategies can help with the stress of having multiple chronic conditions.

There were some limitations and gaps in the literature. Most of these studies looked at urban centres, so it is uncertain how people living with HIV in rural areas experience care. This is particularly important for a geographically large country like Canada, where even primary care may be limited in rural or remote areas.

Primary care doctors may need training to increase their knowledge of HIV-specific care and to increase their confidence in providing care. A consult service – where primary care doctors can virtually connect with HIV specialists – may be an option for improving care and building capacity in the primary care setting. Clinicians providing care for people with HIV should familiarize themselves with current guidelines – this includes screening for chronic conditions like cancer and diabetes as well keeping up to date with vaccinations. Some routine screening may be different compared with people without HIV, for example, current recommendations are to screen people with HIV for syphilis every 3 to 6 months.

As people living with HIV age, it is important to consider the range of care they might need. Shifting to primary care, or more fully integrating primary care into HIV care settings, may ensure that people living with HIV receive care that is inclusive of other chronic conditions.

The full report on HIV management in primary care, can be found at canjhealthtechnol.ca/index.php/cjht/article/view/hc0028. To learn more about CADTH, visit us at www.cadth.ca, follow us on Twitter @CADTH_ACMTS, or speak to a Liaison Officer in your region: cadth.ca/contact-us/liaison-officers.

Sarah Garland is  Knowledge Mobilization Officer at CADTH.