IAPAC Releases Guidelines for Improving Entry into and Retention in Care

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Earlier this month the International Association of Physicians in AIDS Care (IAPAC) released new guidelines for improving entry into and retention in care for people with HIV, as well as optimizing adherence to antiretroviral therapy. The recommendations were published in the March 5, 2012, advance online edition of Annals of Internal Medicine to coincide with the 19th Conference on Retroviruses and Opportunistic Infections (CROI 2012) in Seattle.

The guidelines include recommendations in several areas including monitoring of and interventions to improve ART, adherence tools for patients, education and counseling, and health system and service delivery interventions.

The IAPAC panel covered the needs of several special populations including pregnant women, people with mental health and substance use issues, homeless and marginally housed people, incarcerated individuals, and children and adolescents.

"Over the last 15 years, we have made astounding progress in HIV treatment, resulting in longer and healthier lives for people living with HIV. Yet many people are unable to optimally benefit from these advances because of delayed diagnosis and multiple challenges to entering and staying in medical care," said panel co-chair Melanie Thompson in a press release issued by IAPAC. "Once receiving potent treatment for HIV, many struggle to take their drugs consistently. Unfortunately, missed doses and drug holidays lead to resistant virus and, often, to treatment failure. Ultimately, both individual and public health depend on helping patients to successfully negotiate all of the steps of this treatment cascade."

The Centers for Disease Control and Prevention (CDC) recently reported that 69% of HIV positive persons in the U.S. enter care, 59% stay in care, and only 28% achieve and maintain undetectable HIV viral load.

"We have known for some time that much more attention is required to optimize the way in which HIV-positive patients are linked to and retained on HIV treatment so that they derive the full benefit of existing care, treatment, and support," said IAPAC President José Zuniga. "These guidelines are an important step in that direction."

One key element throughout the guidelines is the need for close monitoring and individualized care. For example, the panel advises that clinicians should ask patients about adherence and potential difficulties at each visit, rather than waiting until viral load goes up.

"As the global economy contracts, the identification and implementation of evidence-based strategies to maximize the individuals and societal benefits of HIV treatment will become increasingly important," the panel members concluded. "With proper research and resources, the tools are at hand for substantially decreasing -- and perhaps ending -- the global HIV epidemic."

A summary of the 37 recommendations is available as a PDF.

The free full text of the guidelines is available online here.

3/23/12

Reference

MA Thompson, MJ Mugavero, KR Amico, et al. Guidelines for Improving Entry Into and Retention in Care and Antiretroviral Adherence for Persons With HIV: Evidence-Based Recommendations From an International Association of Physicians in AIDS Care Panel. Annals of Internal Medicine. March 5, 2012 (Epub ahead of print).

Other Source

International Association of Physicians in AIDS Care. IAPAC Guidelines Offer Recommendations to Optimize Entry into and Retention in HIV Care, and Treatment Adherence. Press release. March 5, 2012.