A Guide to Primary Care of People with HIV/AIDS - Canadian Public ...

A Guide to Primary Care of People with HIV/AIDS
Chapter 1: Primary Care as Chronic Care
Chapter 1:
Primary Care as Chronic Care
John G. Bartlett, MD
Laura W. Cheever, MD, ScM
Michael P. Johnson, MD, MPH
Douglas S. Paauw, MD, FACP
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What is a primary care approach to the
treatment of HIV/AIDS,
and why is it important?
People with HIV/AIDS can live longer, healthier lives
because of advances in treatment of HIV infection.
However, longer lives are associated with increased
prevalence of 1) adverse effects of HIV infection,
2) adverse effects of the drugs used to treat HIV, and
3) concurrent medical conditions that would occur in
the absence of HIV. These long-term complications have
put HIV infection in the realm of chronic diseases
rather than of infectious diseases, which usually
respond to short-term clinical interventions.
Effective management of chronic diseases in the
primary care setting requires the coordination of
interventions that occur at the level of the clinical
services, the community supports for those clinical
services, and the individual patient. While clinical
services begin in the primary care clinic, community
supports are needed, and the patient must be engaged
to enhance self-management. The coordinated
interventions together contribute to the desired
clinical outcomes. The Chronic Care Model, which is
used in the design and quality improvement activities
of clinical services, conceptualizes how these factors
impact the clinical outcome of chronic disease
management (see Figure 1-1).
What is the purpose of this guide?
This book addresses several important aspects of
HIV/AIDS care and treatment in a concise, accessible
format; it is not meant to be a comprehensive reference
book. Recommended references and citations are
provided for the reader to be able to access in-depth
information on topics that are particularly important
and/or controversial. Appropriate use of antiretroviral
drugs, treatment of opportunistic infections, symptom
management, treatment of concurrent medical
conditions, and other specific interventions to treat HIV
disease and its complications are addressed.
The format of this guide is designed to provide practical
information for the common questions that arise in
the care of patients with HIV infection. Recognizing
the broader array of best practices that contribute
to effective clinical outcomes among patients with
a complex array of service needs, the authors also
address patient evaluation, adherence, mental health,
substance abuse, overall clinic management, and
other factors that lead to improved patient outcomes
according to the Chronic Care Model. Last, because the
authors recognize the challenges of maintaining clinical
practices in the face of rapidly changing and ever
more complex treatment interventions, a chapter on
sources for updated and in-depth clinical information is
provided. Pediatric HIV/AIDS treatment is not addressed
in this book.
U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau
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