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

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A Guide to Primary Care of People with HIV/AIDS Chapter 4: Prevention of HIV in the Clinical Care Setting 4 How can HIV prevention be made a part of routine clinic practice? HIV prevention, often neglected as a component of HIV clinical care, is more likely to be a part of routine clinic practice if it is part of the clinical continuous quality improvement activities (see Chapter 17: Quality Improvement). While the most effective indicators for prevention practice in the clinical setting are not known, considerations include medical record documentation of risk assessment history, prevention counseling, medical/laboratory examination for STDs, establishment of a prevention plan, and completion of referrals. There should be regular assessment of whether such tasks are completed and regular feedback to staff members regarding the success rates of completing these interventions. Finally, training interventions should be guided by data from these quality improvement activities (see Chapter 18). KEY POINTS The HIV clinical care setting offers an ongoing opportunity to work with patients to reduce their risk of transmitting HIV to others. Common elements of behavioral interventions to reduce HIV risktaking include establishing rapport with the patient, addressing immediate patient needs (eg, mental health problems, substance abuse, housing), and working in small steps to build motivation and skills for change. A brief history of patient risk behaviors and HIV prevention counseling should be parts of each patient visit. Besides HIV prevention counseling, the following are important components of HIV prevention in the clinical setting: contact notification, drug abuse treatment, screening for STDs, decreasing the patient’s viral load through ART, and nPEP. Structural interventions for HIV prevention include making available educational materials and condoms, establishing strong referral relationships with social service and substance abuse services, and incorporating prevention indicators into quality improvement activities. SUGGESTED RESOURCES Institute of Medicine/Committee on HIV Prevention Strategies in the United States. No time to lose: getting more from HIV prevention. Ruiz MS, Gable AR, Kaplan EH, Stoto MA, Fineberg HV, Trussell J, eds. Washington DC: National Academy Press. 2001. Centers for Disease Control and Prevention. Advancing HIV prevention: New strategies for a changing epidemic – U.S. 2003. MMWR. 2003;52:329-332. Available at http://www.cdc.gov/hiv/pubs/mmwr.htm. Centers for Disease Control and Prevention. Incorporating HIV prevention into the medical care of persons living with HIV. MMWR. 52(RR12):1-24. July 18, 2003. Available at: http://www.cdc.gov/hiv/ pubs/guidelines.htm#prevention. WEBSITES AIDSInfo: http://www.AIDSInfo.nih.gov Accessed 11/03. HIVInsite: http://www.hivinsite.org?InSite?p age=Prevention Accessed 11/03. STD/HIV Prevention Training Centers (PTCs): http://depts.washington.edu/nnptc Accessed 10/03. 26 U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau
A Guide to Primary Care of People with HIV/AIDS Chapter 4: Prevention of HIV in the Clinical Care Setting REFERENCES Ball JK, Curran R, Irving WL, Dearden AA. HIV-1 in semen: determination of proviral and viral titres compared to blood, and quantification of semen leukocyte populations. J Med Virol. 1999;59:356-363. Centers for Disease Control and Prevention. Revised guidelines for HIV counseling, testing and referral. MMWR. 2001;50 (RR-19):1-57. Dukers NH, Goudsmit J, de Wit JB, Prins M, Weverling GJ, Coutinho RA. Sexual risk behavior relates to the virological and immunological improvements during highly active antiretroviral therapy in HIV-1 infection. AIDS. 2001;15:369-378. Kalichman SC, Rompa D, Luke W, Austin J. HIV transmission risk behaviors among HIV positive persons in serodiscordant relationships. Int J STD/AIDS. 2002;13:677- 682. Kamb ML, Fishbein M, Douglas JM, et al. Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases; a randomized, controlled trial. Project RESPECT Study Group. JAMA. 1998;280:1161-1167. Marks G, Richardson JL, Crepaz N, et al. Are HIV care providers talking with patients about safer sex and disclosure?: A multiclinic assessment. AIDS. 2002;16:1953-1957. Natter J, Fiano T, Gamble B, Wood RW. Integrating HIV prevention and care services: the Seattle “Collaboration Project.” J Public Health Manag Pract. 2002 Nov;8:15-23. Quinn TC, Wawer MJ, Sewankambo N, et al. Viral load and heterosexual transmission of human immunodeficiency virus type 1. N Engl J Med. 2000;342:921-929. Scheer S, Chu PL, Klausner JD, Katz MH, Schwarcz SK. Effect of highly active antiretroviral therapy on diagnoses of sexually transmitted diseases in people with AIDS. Lancet. 2001;357:432-435. Wilson TE, Barron Y, Cohen M, et al. The Women’s Interagency HIV Study. Adherence to antiretroviral therapy and its association with sexual behavior in a national sample of women with human immunodeficiency virus. Clin Infect Dis. 2002;34:529-534. 4 U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau 27
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