State of HIV Primary Care Integration: Results of a National Provider Survey

The HIV landscape has changed dramatically with the Affordable Care Act (ACA), National HIV/AIDS Strategy, and the HIV Care Continuum Initiative. In order to understand this changing environment, our team conducted the Third Annual State of HIV Primary Care Survey.  The online instrument consisted of 56 questions.  Recruitment included targeted email lists, monthly newsletters and website postings.  Data were collected between March and June 2013.  Survey was convenience sampled and no incentive was provided for participation.  Findings highlight an aging workforce struggling to meet the demand for HIV services and the migration of HIV specialists into primary care.  PCPs saw increases in various co-morbidities including obesity, hepatitis C (HCV) and depression.  PCPs cited retention in care as their biggest challenge and cited a strong patient-provider relationship as a best practice for retaining patients. PCPs faced structural barriers to providing HIV care, cited a lack of readiness to implement ACA, and believed an increase in access to care would not necessarily translate to an increase in quality care for HIV patients. Common educational needs cited were HCV, retention in care, antiretroviral therapy, and PrEP.  PCPs face workforce challenges will exacerbate as more HIV patients enter care.  Findings indicate a need to recruit and educate PCPs on HIV as well as leverage HIV specialists as mentors. Furthermore, results highlight the co-occurrence of conditions related to mental health and aging. PCPs need to be educated on addressing these challenges and implementing the ACA in order to provide quality care for HIV patients.