HIV clinical consultation to low-volume inexperienced providers: It works

ISSUES: HIV-positive patients in a rural California community were not connected to HIV specialty care. Patients received medication refills without consistent clinical or laboratory follow-up; received no HIV specialty care; or traveled long distances for HIV specialty care. In 2001, a local physician unfamiliar with HIV care agreed to treat local HIV-positive patients.

DESCRIPTION: The physician sought individual clinical consultation from a credentialed HIV Specialist. The collaboration focused on providing specialized training to a low-volume HIV provider to improve consistency between practices and current HIV recommendations and treatment guidelines; build greater provider and clinic service capacity for the local underserved HIV patient population; and improve the quality of care and successful HIV management among patients.

LESSONS LEARNED: Training and clinical consultation occurred between April 2001 and November 2007. Chart reviews were conducted. Flow sheets and individualized summaries were created for each HIV-positive patient. Clinical consultation focused on recognizing subtle physical findings of symptomatic HIV/AIDS and modeling HIV history-taking, safer sex discussion, and medication adherence counseling. Between 2001 and 2007, the total number of patients seen increased almost sevenfold (13 and 90, respectively). The total number of patients in active care increased fourfold (12 and 48, respectively). Eighty percent of patients were on antiretroviral therapy, and 95% had an undetectable viral load.

RECOMMENDATIONS: Individualized HIV clinical consultation to low-volume HIV providers was shown to be effective. Expanding services to low-volume and inexperienced HIV providers is essential in reaching geographically isolated and underserved HIV-infected populations.