Medical team
HIV specialists
The HIV competencies required for genitourinary medicine (GUM) specialty trainees to complete training are outlined in the syllabus of the Joint Royal Colleges Postgraduate Training Board (JRCPTB) GUM curriculum (2016) (www.jrcptb.org.uk). For infectious disease (ID) specialists, the 2014 ID curriculum (www.jrcptb.org.uk) details the competencies required to manage patients with HIV.
The Diplomas of GU medicine (Dip GU Med) and HIV Medicine (Dip HIV Med) are compulsory for GUM trainees to complete specialist training and to enter the General Medical Council register of specialists. The Dip HIV Med exam is also highly recommended for ID trainees although it is not compulsory. In order for ID trainees to complete specialist training it is required that they pass the Fellow of the Royal College of Pathology (FRCPath) Part 1 and Combined Infection Certificate Examination (CICE) which includes assessment of HIV medicine. The details of this exam, can be viewed at www.rcpath.org.
Personal development plans should include educational or training activities that relate directly to HIV care. This should include either attendance at a national or international meeting at least once every 2 years, or alternatively online access to conference proceedings and/or attendance or online access to conference feedback meetings. For specialists undertaking inpatient care of people living with HIV, or who undertake care of people with complex comorbidities or co-infections, it is critical that the appraisal process includes these areas and also addresses the need to keep up to date in general medicine. Suitable CPD-approved general medicine courses are widely available.
Non-HIV specialists, general practitioners and other community-based practitioners
People living with HIV access all areas of the health service and it is critical that all doctors (both specialists and general practitioners) have a core knowledge of HIV including the following:
Who and how to test for HIV including screening, opt-out testing, and testing those with HIV-indicator conditions
Prognosis of people living with HIV in the ART era
HIV transmission – including that having an undetectable viral load prevents transmission
Role of ART in preventing and reducing ill health
Management of relevant (non-HIV related) conditions in people living with HIV
Importance of drug–drug interactions (DDIs) between ART and other agents and how to access the information on DDIs
High incidence of anxiety and depression in people living with HIV
Nursing team
Specialist HIV nursing should be provided by registered nurses, within primary and secondary care with support from health support workers as appropriate. The knowledge and skills required for specialist HIV nursing care are outlined in the National HIV Nurses Association (NHIVNA) ‘National HIV Nursing Competencies’ (October 2013) and nurses working in advance practice are supported by ‘Advanced Nursing Practice in HIV care: Guidelines for Nurses, Doctors, Service Providers and Commissioners’ (August 2016).
Registered nurses should demonstrate competence to the appropriate level in the four core areas:
and additionally, where relevant, the specialist competencies for outpatients, inpatients, adolescents and research. The competency levels required relate not only to job banding and job specification but also the level of specialist HIV care that is required. This level will differ for an HIV specialist nurse in an HIV clinical area compared to a generalist nurse providing some HIV care within their role (e.g. a district nurse).
The process of assessment of competence (based on the NHIVNA competency framework) will be locally determined and should be multi-faceted including (e.g. direct observation and reflective practice). Learning opportunities for specialist nurses are: NHIVNA online training and CPD articles (www.nhivna.org), NHIVNA conference and study days, some HIVspecific modules at diploma and degree level. Nurses working in advanced practice should undertake non-medical prescribing and preferably undertake master’s-level education, although this is only locally determined by health trusts.
Competency to prescribe ART
Nurse independent prescribers are nurses who have successfully completed an NMC independent nurse prescribing course. Those who have successfully completed the supplementary part of the prescribing course are also able to prescribe against a clinical management plan.
Pharmacy team
Specialist pharmacy support should be provided by registered pharmacists and pharmacy technicians who are competent in the pharmaceutical care issues of people living with HIV. For example, drug–drug interaction management of ART and other medicines including over-the-counter, herbal and recreational drugs. They should have current appropriate knowledge and skills and be appraised annually.
Competency to prescribe ART
Pharmacists carrying out advanced practice roles such as independent prescribing should fulfil the requirements of the Royal Pharmaceutical Society Competency Framework for all Prescribers. They should have shared access to the patient care record and prescribe within their scope of practice according to local and national guidelines.
Peer-support team
Peer support can be delivered by paid staff and volunteers who are living with HIV in both one-to-one and group settings. There are many approaches to providing peer support, this can be informal or a formal structured approach such as peer mentoring. These Standards are primarily concerned with the delivery of structured support as set out in the ‘National Standards of Peer Support in HIV’ (2017).
Peer support works best when facilitated by trained peers from the community they support. The breadth of knowledge and skills involved in providing peer support means it is important that the people providing it should have access to structured training, linked to a professional qualification, where appropriate and possible. Core competencies should include knowledge and understanding of HIV and treatments, ability to recognise and work with diversity, effective listening and communication skills, understanding of confidentiality and safeguarding for vulnerable adults. Organisations or groups providing peer support should provide peer supporters with regular structured support and supervision, as well as ongoing professional development.
Rehabilitation team
Physiotherapists, occupational therapists and other rehabilitation specialists should be registered with the Health and Care Professionals Council (HCPC). Physiotherapists working in any setting should have advanced skills in neurological, respiratory and musculoskeletal practice, while occupational therapists and speech and language therapists should have advanced skills in neurological practice and, in particular, neurocognitive assessment and treatment.
Dietetics team
Specialist dietetic input should be provided by registered dietitians and dietetic assistants competent in the dietetic care of people living with HIV. The knowledge and skills required for specialist HIV dietetic care are outlined in the Dietitians in HIV/AIDS (DHIVA) ‘Dietetic Competency Framework’. They should demonstrate competence to the level appropriate for the level of specialist HIV care that is required, reflected in their job banding and job specification. The process of assessment of competence will be locally determined and should be part of appraisal, objective-setting and personal development planning. Dietitians are required by the HCPC to maintain an accurate record of their CPD activities.
