Time to read
Advances in HIV treatment and care have led to improved health outcomes, meaning that people living with HIV can now live long and healthy lives. HIV is now a manageable long-term condition, but in many ways our health system is often playing catch-up in how it recognises and delivers HIV care and treatment.
A new discussion paper from HIV Outcomes UK, a coalition convened by the National AIDS Trust, sets out how collaborative care frameworks can improve experiences of people living with HIV in primary and secondary care. The paper is being launched today at the Ageing & HIV Conference, which is bringing together multi-sectoral stakeholders to collaborate, exchange knowledge and enhance care for people ageing with HIV.
HIV is increasingly characterised by ageing, multimorbidity, polypharmacy and complex social needs. The paper argues that the current division between specialist HIV care and other healthcare can result in fragmented care and poorer access to support. It notes that while some people living with HIV are increasingly receiving enhanced, HIV-informed care from their GP in certain practices, both access to this in England and the framework used remain inconsistent
The paper proposes the development of a collaborative care framework between primary care and specialist HIV services. Under this model, specialist HIV services would retain overall responsibility for HIV treatment and monitoring, while it would strengthen primary care’s role in holistic health, prevention and management of long-term conditions, with rapid specialist back-up. Any arrangement would be based on informed consent and agreed by the person living with HIV, the GP and the specialist service.
The paper highlights that with HIV currently not formally recognised as a long-term condition within the NHS, people living with HIV may not be receiving the best options and opportunities of care available to people living with other long-term conditions. Alongside the development of collaborative care frameworks, the paper calls for formal recognition of HIV as a long-term condition.
Delivering collaborative care at scale will require coordinated action across the health system and co-creation with people living with HIV. The paper recommends the establishment of a multi-stakeholder implementation group to co-produce the template collaborative care framework and implementation programme. When this is established, the Department of Health & Social Care, Integrated Care Boards and Primary Care Networks should promote the local adoption of collaborative care frameworks.
James Cole, Senior Policy, Research & Influencing Manager at National AIDS Trust, who will be presenting the findings of the paper at the Ageing & HIV Conference, said:
“People living with HIV should be able to benefit from the same coordinated, person-centred care available to people living with other long-term conditions. Better collaboration between HIV clinics and primary care would improve experiences of care, reduce fragmentation and help ensure people receive the right support at the right time.
Our discussion paper comes at a pivotal moment for both the HIV response and NHS reforms. As the NHS seeks to shift more care into communities and place greater emphasis on prevention, we have an opportunity to rethink how care is delivered for people living with HIV. The importance of strong links between primary and specialist care is also already recognised in the Government’s HIV Action Plan. Collaborative care frameworks provide a practical way to turn these Government ambitions into reality, helping deliver more joined-up, person-centred care.”
Dr Nicoletta Policek, Co-Chair of HIV Outcomes UK, and John Jaquiss, BHIVA Community Trustee and UK-CAB Steering Group member, said:
“People living with HIV should not be expected to hold a fragmented health system together during the process of aging. All people, but especially those facing racism, poverty and disability, are too often expected to navigate gaps in care.
Collaborative care must be properly funded, designed and shaped by us, with a named care coordinator, who has clear responsibilities across services and specialist support when needed. Recognising HIV as a long-term condition has the potential to strengthen our ability to work more closely with the professionals to support and drive our care. If the NHS calls this integration while leaving us to coordinate services ourselves, nothing will change.”
Dr Tristan Barber, BHIVA Chair said:
“As an HIV clinician, I welcome this timely report. With an ageing, multimorbid population, managing everything within HIV services is becoming increasingly difficult, as specialists are not trained to provide all aspects of medical care. Collaboration could also bring practical benefits: for example, care closer to home, with fewer duplicated tests and appointments. For GPs, to have a clear framework and named specialist contact, will build confidence. For clinics, shared care preserves a holistic approach while freeing-up capacity for specialist care.
“This collaborative approach is not intended to replace specialist HIV care, but to support it. Above all, co-production of shared care approaches must always include people living with HIV to underpin and support implementation.”
If you would like to share your reflections on the discussion paper, highlight examples of good practice, or explore opportunities to work with us, please contact us at [email protected]