With the awareness of HIV, screening tests are being able to detect newer cases. The need of the hour even in India is how to involve patients in their treatment. Here is information on the guidelines issued.

Team@CMHF

Leading AIDS experts at Johns Hopkins and other institutions around the world have issued new guidelines to promote entry into and retention in HIV care, as well as adherence to HIV treatment, drawn from the results of 325 studies conducted with tens of thousands of people infected with HIV, the virus that causes AIDS.

The guidelines are believed to be the first ever to focus exclusively on how best to get those newly diagnosed with HIV into treatment plans and help them adhere to lifelong drug and check-up regimens.

Some 50,000 Americans each year are diagnosed with the potentially deadly, but now treatable, infection, and more than a million Americans already are known to be HIV-positive.
“Clearly, there is lots of room for improvement in how we, as care providers, can get new patients into treatment and help them adhere to the often strict drug regimens needed to suppress the viral disease and prevent drug resistance,” said infectious disease specialist Larry W. Chang, a co-author of the guidelines. The need is urgent, he says, because other research has shown that patients who miss follow-up medical visits within the first year after they begin outpatient drug treatment for HIV infection tend to be out of compliance with regimens and, over the long term, die at twice the rate of those who keep their appointments.

The guidelines were published online in the Annals of Internal Medicine March 5, coinciding with the 19th annual Conference on Retroviruses and Opportunistic Infections being held in Seattle.

The 37 recommendations that make up the guidelines were crafted by an international team co-chaired by Jean B. Nachega, senior author of the guidelines and an associate scientist at the Johns Hopkins University Bloomberg School of Public Health, as well as a professor of medicine and director of the Centre for Infectious Diseases at Stellenbosch University in Cape Town, South Africa.

Key among the guidelines is the need for systematic monitoring and tracking of people newly diagnosed with HIV, and those already under care for the disease, to make sure they are actively involved in treatment decisions and properly following their regimens.

Possible strategies to help newly diagnosed people include using patient “navigators,” or personal guides, to help them sort through the hospital and community services available, and assist them with paperwork for drug discounts or government aid.

Chang says that once people have kept their first clinic appointment, another system needs to be in place to keep them “engaged” (or personally involved in their care) and make sure they never “lose touch” with their care team. He says that this could be as simple as periodic follow-up calls from a nurse or case manager, or direct questions from physicians during clinic visits asking about adherence to medication.

More elaborate tracking systems, Chang adds, could include automated systems that alert the pharmacist or physician to missed drug refills or to lapses longer than six months in booking check-ups. What is key, he emphasizes, is physicians’ tracking their patients’ visits and compliance with drug therapy, and working more closely with pharmacies to keep track.

The expert panel notably calls for stopping practices that have proved ineffective or not feasible in routine clinical practice, The experts say that streamlining therapies wherever possible to include drugs that need to be taken only once daily, as opposed to two or three times, would help simplify drug taking for people and improve ART adherence.
Patient counseling was found effective in keeping patients engaged in their care and ART compliant.

Other recommendations were specific to people and groups disproportionately affected by HIV, including pregnant women, children, homeless people and prisoners. Worldwide, an estimated 10 million of the 34 million people infected with HIV receive drug treatment for their infection.

Chang says that the group plans to launch an accredited online medical education program to promote the new guidelines to other physicians and health care providers. The international team also has plans for further research into the value of patient navigators, peer support networks and other tactics to foster rapid entry into care for newly infected people or for those who have never entered treatment.

Ref: http://gazette.jhu.edu/2012/03/12/hiv-guidelines-issued-for-care-of-those-newly-diagnosed/