While increasing numbers of HIV-positive people are living longer and changes have occurred in the duration and type of care they require, both HIV specialised and generalist general practitioners continue to play a wide role in care, with the majority of people living with HIV seeing a Section100 GP for their HIV care. Increasingly, HIV can be managed as a chronic disease using a team-based interdisciplinary approach, including general practitioners, specialists, nurses, Aboriginal Health Workers, pharmacists and other primary care providers.
Models of care review and analysis should be further developed to address increased access to testing, shared care provision, and the needs of the ageing population of people living with HIV. This work will also focus on describing ways to avoid system barriers to care and loss of follow-up in specific populations.
A range of models will ensure that all people living with HIV have equitable access to primary care services with general HIV awareness combined with, or in addition to, specialist HIV general practice and tertiary care. Models will be promoted that address the need for patient-centred, coordinated and integrated care; self-management; continuum of care; and effective management of the acute-chronic interface with electronic records and other clinical management initiatives.
During the life of this strategy, implementation of the recommendations of the Models of Access and Clinical Service Delivery for HIV Positive People Living in Australia should be considered a priority. It will also be important to identify links between this strategy and other health reform initiatives that can support the development of an integrated approach to HIV specialised care in parallel with chronic illness management approaches.
Exploration of dispensing options to make access to Section100 medications in the context of long-term care more optimal and efficient is increasingly important, and is being considered within a broader context through a separate Australian Government Department of Health and Ageing review.
Measures will include:
- supporting HIV-diagnosing GPs, linked to the testing process
- supporting mainstream services (particularly mental health, ageing, oral health and drug and alcohol services) to provide quality services to people living with HIV, particularly in partnership with HIV service agencies and primary healthcare teams
- addressing national counselling guidelines and standards of care for HIV positive women and their children, for use by GPs and specialists-including supporting appropriate choices regarding fertility, family planning and antiretroviral therapy during pregnancy and birth.