Assuntos
Atenção à Saúde/legislação & jurisprudência , Acesso à Internet , Saúde Sexual/legislação & jurisprudência , Confidencialidade , Humanos , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/legislação & jurisprudência , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/legislação & jurisprudência , Saúde Sexual/economiaRESUMO
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.