Outpatient care for people living with HIV should be person-centred and follow current national guidelines for support, monitoring and treatment to maximise the benefits of ART, to allow early detection of treatment- and HIV-related complications and to promote a good quality of life.
As increasing numbers of people live with HIV, services should facilitate living well with HIV by working within the local health and social care system, and engaging particularly with other sectors such as primary care. There is an established relationship between HIV and an increased risk of other health problems, ranging from some cancers through to mental health and sexual health. In these, as well as other areas such as pregnancy, there are specific HIV-related issues ranging from medical management through to the patient’s experience of stigma and difficulties in communication with partners and family. The interfaces between HIV care and other health and social care services are particularly important and should be as smooth and seamless as possible.
People living with HIV who have complex care needs should have their care delivered in settings with the appropriate range of specialist knowledge, skills and services and there should be local arrangements, such as care pathways, to allow equity of access to this expertise. ‘Virtual’ arrangements, such as access to specialist advice via email or by phone, should be used where direct contact is not feasible. On the other hand, people living with HIV who are well and do not currently have significant health-related needs may also appreciate virtual care arrangements in order to minimise the requirement for time spent attending clinics.
Access to important aspects of healthcare is best achieved through primary care, particularly as patients age and become more likely to develop comorbidities. Services should communicate well with other specialties and primary care with respect to HIV, specific comorbidities and drug–drug interactions. There should be clear protocols and pathways for care across the primary and secondary sectors to maximise patient safety and clinical effectiveness. Regular communication between these services should take place, unless the patient specifically withholds consent. When patients withhold consent, HIV services have a responsibility to understand, explore and discuss any concerns, while primary care services have a duty to ensure that all clinical and non-clinical staff understand the particular issues experienced by people living with HIV with respect to stigma and discrimination.