Qualifications for Physicians Who Care for Patients with HIV Infection

[Guest guest]

Qualifications for Physicians Who Care for Patients with HIV Infection

Background

The onslaught of the HIV/AIDS epidemic in the early 1980s brought

with it major challenges to the nation's health care system. In

those early years, internists and family practice physicians and

others from a variety of medical disciplines joined those with

specialized training in infectious diseases to use the limited tools

then available in medicine to care for individuals with HIV disease.

Many of these physicians from the ranks of general medicine remain

leaders in the clinical care of people living with HIV disease. Any

effort to identify and/or credential physicians who are experts in

the treatment of HIV disease must acknowledge the historical and

ongoing contributions of these physicians as well as those who come

from the specialty ranks of infectious diseases.

In the last five years dramatic progress has been made in the

development of treatments to extend health and life for people with

HIV disease. Scientific and medical developments have made treating

HIV disease vastly more sophisticated and complex than it once was.

Physician education and training related to new developments in the

field and ongoing experience working with patients with HIV disease

are essential to ensure that these patients get optimal care. The

changing health care system, with its myriad delivery and financing

mechanisms, has highlighted the importance of access to specialized

care.

The HIV Medicine Association (HIVMA) of the Infectious Diseases

Society of America (IDSA) offers the following guidance to public and

private health care payors and institutions to identify and recruit

health care professionals with expertise in HIV disease. Our goal is

to assist these organizations in ensuring that patients with HIV

disease receive the highest quality of care that reflects the most

current medical research at the hands of those who have demonstrated

experience and commitment to treating this disease. The guidance we

offer is intended to allow flexibility, based on the special

circumstances of any given community or institution relative to the

prevalence of HIV disease and the availability of physicians to treat

patients with HIV disease. In addition, this guidance may be viewed

and implemented in the context of existing state or other

institutional guidelines related to continuing medical education.

Qualifications

HIVMA believes that an HIV-qualified physician should manage the care

of patients with HIV disease. There is ample evidence in the

research literature that care by experienced HIV providers translates

into improved clinical outcomes. In defining HIV-qualified

physicians, one must take into account both the training and

expertise of infectious disease specialists and pediatric infectious

diseases specialists, as well as the expertise and experience of

physicians from a variety of medical disciplines who have made a

significant professional commitment to HIV/AIDS care and who care for

tens of thousands of patients with HIV disease.

HIVMA believes that an additional certification examination process

is not necessary to identify the expertise of an HIV-qualified

physician and to ensure access to high quality HIV care for HIV-

infected patients. Rather, we propose that any credentialing process

to identify HIV- qualified physicians be based on a combination of

patient experience and the demonstration of ongoing education and

training in HIV care, especially in the area of antiretroviral

therapy. In the case of communities or geographic areas where no

physicians meeting these criteria are available, a primary care

physician should have an established consultative relationship with

at least one physician meeting the criteria outlined below.

To be an HIV-qualified physician, an individual should be able to

show continuous professional development through:

Clinical management of at least 25 HIV- infected patients within the

last year (Numbers of patients may vary depending upon the

concentration of HIV-infected patients in a given community).

A minimum of 15 hours of HIV-specific CME (including a minimum of 5

hours related to antiretroviral therapy per year).

Recently trained infectious diseases (ID) fellows or those recently

certified or recertified in infectious diseases should be considered

qualified providers of patients with HIV/AIDS. However, given the

rapid pace of change in HIV medicine, board certification in

infectious diseases and pediatric infectious diseases does not

guarantee sufficient knowledge to assure that an ID specialist will

remain an expert in HIV disease over time. Therefore, all physicians

(including ID and pediatric ID physicians) should meet the experience

and education based criteria outlined above to retain their HIV-

qualified status.

Relationship between HIV Provider Experience and

Patient Outcomes

Selected References

AIDS mortality rates lower at sites with HIV experience. AIDS Alert

1999:14(11): 129-30.

Bach PB, Calhoun EA, CL. The relation between physician

experience and patterns of care for patients with AIDS-related

Pneumocystis carnii pneumonia: results from a survey of 1,500

physicians in the United States. Chest 1999; 115(6): 1563-9.

Brosgart C et al. Community patterns of care for HIV disease:

experience makes a difference. Int Conf AIDS 1998; 12:1143-44.

Brosgart CL et al. Clinical experience and choice of drug therapy

for human immunodeficiency virus disease. Clin Infect Dis 1999; 28

(1): 14-22.

Hecht FM et al. Optimizing care for persons with HIV infection.

Society of General Internal Medicine AIDS Task Force. Ann Intern Med

1999; 131(2): 136-43.

Kitahata MM, Van Rompaey SE, Shields AW. Physician experience in the

care of HIV-infected persons is associated with earlier adoption of

new antiretroviral therapy. J Acquir Immune Defic Syndr 2000; 24(2):

106-14.

Kitahata MM et al. Physicians experience with the acquired

immunodeficiency syndrome as a factor in patients' survival. NEJM

1996; 334(11): 701-706.

Laine C et al. The relationship of clinic experience with advanced

HIV and survival of women. AIDS 1998; 12(4): 417-424.

Markson LE et al. Repeated emergency department use by HIV-infected

persons: effect of clinic accessibility and expertise in HIV care.

J Acquir Immune Defic Syndr & Human Retrovirology 1998; 17(1): 35-41.

Shapiro M et al. Variations in the care of HIV-infected adults in the

United States. JAMA 1999; 281:2305-2315.

Willard CL, Liljestrand P, Goldschmidt RH, Grumbach K. Is experience

with human immunodeficiency virus disease related to clinical

practice? A survey of rural primary care physicians. Arch of Fam

Med 1999; 8(6): 502-8.

http://www.hivma.org/HIV/HIVMA/HIVProviderDef.htm

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HIV Medicine Association (HIVMA)

66 Canal Center Plaza, Suite 600

andria, VA 22314

Phone: (703) 299-1215

Fax: (703) 299-0473

hivma@...

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[Guest guest]

Dear Dr Naik,

I fully agree with you that India needs trained HIV physicians. It is high

time our unversities rise to the need for diploma and MD degree courses in

HIV Medicine. When Leprosy was given its special due, much attention was

focussed on various aspects of the disease and National Leprosy programmes

were successfully implemented.

Dr HR Jerajani

Mumbai

E-mail: <jerajani@...>

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[Guest guest]

Dear colleagues,

I fully agree with Prof. Maniar, particularly the second paragraph. Since

there is no specialised MD degree for HIV/ADS, as of now all doctors who are

having AIDS management experience are qualified to manage the patients n

future too. I being a medical doctor and MD in Medical Microbiology managing

several AIDS patients (for which I am legtimized y Medical Council of

India/Delhi) beter than hundreds of MDs in medicine in rural India who, for

whatsoever reason, do not know even basics of AIDS management and refer

patients to AIIMS or other tertiary care hospitals. Why?, if MD medicine

degree is the only criteria?.

Dr. Sarman Singh, MD. MNAMS

Head, Division of Clinical Microbiology

Department of Laboratory Medicine

All India Institute of Medical Sciences

P.O. Box. 4938, Ansari Nagar, New Delhi-110 029

India, Phone: 659 4764, 659 4977, 652 8484

Fax: 686-2663, 652 1041

E-mail: <ssingh56@...>

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[Guest guest]

Respected All memebers of the community,

To add further to the discussion -

I think we need 2 category of professionals to manage the AIDS epidemic

A) professionals with trg included in the MBBS & MD curriculum (as part

of Inf diseases) who are expected to recognise OI and other routine

infections in the community and may treat/refer them to the nearest

specialised centres or even Appex Hospitals designated for the purpose.

HAART/PMTCT may be started in the specialised centres where

APs/Registrars and others senior people in the unit take care of the

neccessity of when and what to start HAART and also possibly decide when

to stop the HAART. The follow up and maintainence phase is back in the

community

More MDs trained in Public Health to manage and adminster the

programme in the community where the componenet of

i) treatment of OIs and other infections is taken care of

ii) continuation and follow up of HAART

iii) counselling and VCT

iv) Linkages thru the SACS, NGOs and the referral hospital for tracking

the HIV+/AIDS patients

V) IEC activities, and other TI/programms aimed at prevention of spread

of HIV in the community

If proper, adequate and complete information is given to an HIV+ and his

carers/family members as to what to do incase of illness and whom/where

to approach, then even the pvt practictioner/RMP and other people

claiming themselves as HIV specialists in a village/small town can be

bypassed.

One time counselling contact is insufficent to expect the carers/HIV+ to

adopt safe practices and alos to remember other aspects of care. Regular

and repaeted counselling sessions are required to ensure that HIV+ and

his family understand that we mean the best for him

In any new and emerging diseases, it is always that certains

professional memebers do recognise it as an future opportunity and do

gain early expertise in management of the disease without a formal

degree. However, these very professionals as they age with disease, must

help in formalising the capacity build in an adequate and appropriate

manner. Thus the role of such 'peers' is extremely crucial and should

not be ingnored, rather utilised benefically for future development of

response. So is the case HIV+/AIDS

This will ensure a uniformity of treatment, follw up, continuim of care

and support to the family. Other componenets of drugs availabilty and

supply could be built into the process

Thank you all for patient reading

Dr HS Ratti, MD

E-mail: <ratti2@...>

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