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Integrating HIV healthcare: before and after COVID-19


By Cheryl Gowar, Policy & Campaigns Manager

The delivery of healthcare is perhaps one of the most obvious ways that COVID-19 has changed how we now do things. Face-to-face appointments have been replaced by telephone calls and some people living with HIV have asked for their blood tests to be done at their GP instead of having to take long journeys on public transport to their HIV clinics. In some ways, COVID-19 has resulted in the unplanned piloting of innovations in care delivery that can be learnt from, adapted, and built on to ensure optimal future care delivery.

However, to get this right, we have to focus not just on the opportunities that, perversely, this pandemic has thrown up, but also on the underlying issues around fragmentation of service provision and the push for integration that existed long before anyone imagined needing to respond to COVID-19. These issues have not gone away, even if our attention has been deflected.

Today, National AIDS Trust (NAT) is publishing a briefing on Improving and integrating HIV care in South East London. The recommendations were worked out before COVID-19 had taken hold, with people living with HIV, GPs, HIV clinicians, and Clinical Commissioning Group (CCG) and Integrated Care System (ICS) representatives who all deliver, receive, or provide support for services across the South East London ICS footprint.

The recommendations reflect the good ideas that emerge when you get people together who come from different sides of a problem.

Some recommendations are ‘quick wins’, like the suggestion GP practices could have a pop-up alert to prompt GPs to offer vaccinations according to BHIVA guidelines, or that HIV clinicians send requests for vaccinations directly to the practice nurses who deliver them. Others focus on more substantial, systemic change, such as how care can be shared between the HIV service and the GP clinic. Across the piece, implementing the recommendations will require collaboration between different healthcare providers and commissioners, plus financial and logistical support from the ICS.

An issue that was made abundantly clear during our discussions is that population characteristics, plus demand and capacity for change are not uniform across the different boroughs making up the South East London ICS area.

The footprint includes Lambeth and Southwark, which have the highest HIV prevalence in the country, but also outer boroughs where late diagnosis among heterosexuals is the especially pressing priority.

Therefore, while some recommendations are universally applicable, others pinpoint the partnerships and protocols that need to be in place and supported by the ICS, to deliver place-specific models of care delivery. Although the recommendations were always intended to be specific to South East London, and won’t provide an exact model for change in all ICSs, the project participants hope their work can be built on, adapted and interpreted to meet place-specific needs across the country.

Integrated Care Systems are replacing Sustainability and Transformation Partnerships (STPs) and will take on extended powers. This process is being ramped up because of the demands of COVID-19 but must also respond to the needs that existed before it arrived. This is the perfect time for integration of HIV care to be on the agenda. NAT’s briefing sets a blueprint for how HIV care can be improved and integrated in South East London, and beyond. We will now be working to see that blueprint implemented.

This work sits alongside our work on care coordination published earlier this year, which specifically considers service integration and long-term condition management for people living with HIV and multimorbidity.

Cheryl Gowar is Policy & Campaigns Manager at NAT (National AIDS Trust). Follow her on Twitter at @cherylgowar

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