When I traditionally conceive of effectively combating the global HIV epidemic, my mind turns immediately to the infectious disease doctors who dominated the early response to the crisis. After doing this set of readings, I am increasingly aware of the rising and essential role in primary care in HIV treatment and management.
Obvious evidence for this increasing role of primary care in HIV control can be seen from the Truvada study by Mera et. al which noted that the population of PrEP users of TVD users in the US is “more be treated by primary care clinicians.” This study indicated that uninfected PrEP users are almost four times as likely to be treated by a non-ID physician compared to HIV positive patients. The literature reinforces this naming “internists, family physicians… nurse practitioners” and “physicians’ assistants” as key players. Looking to the Global Progress report this shift becomes still less-surprising. After initial pathological diagnosis, the primary care system would be responsible for tracking viral load at regular intervals, be the primary point of contact for reproductive health and family-planning, and to check for treatment adherence and comorbidities. The role of PCP’s in enacting interventions is likely particularly vital in nations with less robust health infrastructures by necessity given the lack of specially-trained physicians in many high-need regions. The increasing roles for PCP extend beyond management of AIDS itself. If interventions succeed, people with HIV/AIDS can live longer, healthier lives which. With this longevity comes increased prevalence of “adverse effects of HIV infection, adverse effects of the drugs used to treat HIV, and concurrent medical conditions that would occur in the absence of HIV.” If we cure someone’s HIV/AIDS only to leave their diabetes or heart disease unchecked have we truly improved their quality of life?
I am not alone in coming to the realization asserted in this response some of the world’s leading HIV doctors agree. The HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA) holds that moving forward “HIV specialists need to be familiar with primary care issues, and primary care physicians need to be familiar with HIV care recommendations” and has produced a new set of guidelines to accomplish this.