Is HIV/AIDS a primary-care disease? Appropriate levels of outpatient care for patients with HIV/AIDS.
OBJECTIVE
To estimate the proportion of outpatient visits that could be managed at a primary-care level, by World Health Organization (WHO) clinical staging.


METHODS
Prospective, descriptive study. Six medical doctors in a tertiary hospital HIV ambulatory clinic recorded clinical diagnoses, WHO clinical staging and their recommendation regarding the appropriate level of care for each outpatient seen.


METHODS
All HIV-infected patients attending a public-sector, urban, South African, referral and teaching hospital HIV outpatient clinic between September and November 1992.


METHODS
There were 238 visits by 148 patients during the study period.


RESULTS
Of 238 visits, 165 (69.3%) were deemed suitable for treatment at the primary-care level. After allowing for contradictory responses, at least 141 visits (59.2%) could be appropriately treated at the primary-care level. Although all six doctors assessed more than half of their visits as suitable for primary care, there were significant differences among them. In total, 83 visits (34.8%) needed a medical specialist, and 45 (18.9%) required tertiary-care facilities. Of all the visits, 58 (24.9%), 51 (21.9%), 60 (25.8%) and 64 (27.4%) were classified as WHO stages 1, 2, 3 and 4, respectively. For these stages, 55 (94.8%), 38 (74.5%), 42 (70.0%) and 26 (40.5%) visits, respectively, were suitable for treatment at a primary-care facility.


CONCLUSIONS
Many of the outpatient visits to this outpatient specialist clinic could have been safely cared for at a primary-care level. As the severity of the disease increases, there is a decrease in the proportion of patients that can be treated at a primary-care level.
Metrikin
A S
AS
Health Systems Division, Centre for Epidemiological Research in South Africa (CERSA), Cape Town.
Zwarenstein
M
M
Steinberg
M H
MH
Van Der Vyver
E
E
Maartens
G
G
Wood
R
R
D000163:Acquired Immunodeficiency Syndrome / Q000628:therapy*; D000553:Ambulatory Care; D005500:Follow-Up Studies; D015658:HIV Infections / Q000628:therapy*; D006801:Humans; D011320:Primary Health Care; D011446:Prospective Studies; D013019:South Africa