title: Developing new models of shared primary and specialist HIV care in the UK: a survey of current practice.
abstract: HIV care in the UK is led by hospital-based specialists with limited general practitioner (GP) involvement. As GPs have expertise in some non-microbial HIV-associated co-morbidities (e.g. cardiovascular disease), and more people are disclosing their HIV status to their GPs, there could be benefits in sharing HIV care. We describe contemporary models of shared HIV care in relevant developed world settings to inform future shared HIV care in the UK. An interview survey of key informants was used to explore experiences and models of shared care, and identify promoting and inhibiting factors. We interviewed ten key informants from six shared care models. There were three broad categories of shared care, with varying degrees of GP involvement. Strong clinical leadership in primary care, good professional relationships and communication, and tailored GP training were facilitators. Barriers included stigma, confidentiality concerns, and low prevalence of HIV outside major conurbations. Contemporary shared HIV care models have emerged organically and seem to work when grounded in good collaboration between a small number of dedicated GPs and specialist units. We propose two models for further study which may only be feasible in high HIV caseload practices. User acceptability, clinical and cost effectiveness must be considered.
authors.affiliation: Barts Health NHS Trust, Ambrose King Centre, Royal London Hospital, Whitechapel, London, UK Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK jane.hutchinson@bartshealth.nhs.uk.
authors.forename: Jane
authors.initials: J
authors.lastname: Hutchinson
authors.affiliation: Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Loma J
authors.initials: LJ
authors.lastname: Sutcliffe
authors.affiliation: Barts Health NHS Trust, Ambrose King Centre, Royal London Hospital, Whitechapel, London, UK.
authors.forename: Andy J
authors.initials: AJ
authors.lastname: Williams
authors.affiliation: Barts Health NHS Trust, Ambrose King Centre, Royal London Hospital, Whitechapel, London, UK Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Claudia S
authors.initials: CS
authors.lastname: Estcourt
mesh_terms: D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005194:Family Practice / Q000379:methods; D058005:General Practitioners / Q000523:psychology*; D015658:HIV Infections / Q000628:therapy*; D006801:Humans; D010348:Patient Care Team; D011320:Primary Health Care / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D006113:United Kingdom
keywords: AIDS; HIV; models; primary care; shared care