• New York State Department of Health. How to integrate prevention into primary care. New York (NY): New York State Department of Health; 2005 Nov. 11 p. [16 references]

This is the current release of the guideline.

Human immunodeficiency virus (HIV) infection

Counseling
Prevention
Screening

Allergy and Immunology
Family Practice
Infectious Diseases
Internal Medicine
Preventive Medicine

Advanced Practice Nurses
Health Care Providers
Nurses
Physician Assistants
Physicians
Public Health Departments

To help clinicians to integrate prevention into primary care of human immunodeficiency virus (HIV)-infected patients

Human immunodeficiency virus (HIV)-infected patients

1. Addressing prevention during routine clinical encounters including assessment of patient's readiness to think about prevention and discussing specific harm-reduction strategies
2. Using a spectrum of prevention interventions including
   • Structural interventions, such as displaying posters, educational brochures, and videotaped programs
   • Availability of condoms and instructions about proper use
   • Routine assessment for behaviors associated with HIV transmission
   • Individualized counseling with prevention messages
   • Referral to both internal and external resources
   • Medical screening for sexually transmitted diseases (STDs)
3. Clinical staff education and training about HIV prevention

Not stated

Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases

Not stated

Not stated

Expert Consensus (Committee)

Not applicable

Review

Not stated

Expert Consensus

AIDS Institute clinical guidelines are developed by distinguished committees of clinicians and others with extensive experience providing care to people with HIV infection. Committees* meet regularly to assess current recommendations and to write and update guidelines in accordance with newly emerging clinical and research developments.

The Committees* rely on evidence to the extent possible in formulating recommendations. When data from randomized clinical trials are not available, Committees rely on developing guidelines based on consensus, balancing the use of new information with sound clinical judgment that results in recommendations that are in the best interest of patients.

* Current committees include:

• Medical Care Criteria Committee
• Committee for the Care of Children and Adolescents with HIV Infection
• Dental Standards of Care Committee
• Mental Health Committee
• Women's Health Committee
• Substance Use Committee
• Physician's Prevention Advisory Committee
• Pharmacy Committee

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

External Peer Review

All guidelines developed by the Committee are externally peer reviewed by at least two experts in that particular area of patient care, which ensures depth and quality of the guidelines.

Clinicians should address prevention during routine clinical encounters for all patients, regardless of race, age, gender, sexual orientation, or antiretroviral (ARV) status, in one or more of the following ways:

• Assessing the patient's current level of risk or willingness to address specific sexual or drug-using risk behaviors
• Assessing the patient's readiness to think about prevention
• Discussing specific goal-oriented harm-reduction strategies

Clinicians should frame prevention messages within the context of maintaining the patient's health. Consistent messages should be reinforced by members of the healthcare team.

Clinicians should encourage human immunodeficiency virus (HIV)-infected patients to assume personal responsibility to maintain their health and to prevent HIV transmission to others. Patients should also be encouraged to carry out their responsibility to inform sexual and needle-sharing partners of their HIV infection.

Key Points:

• Prevention messages should be brief and should be tailored specifically to each patient's situation and lifestyle.
• Ensuring that prevention messages are consistently delivered by different members of the healthcare team is a key element of delivering effective prevention counseling.

Models for Prevention Counseling According to the Clinical Environment

In addition to directly discussing prevention issues with patients, clinicians should establish alliances with others who can also deliver these messages as part of the healthcare team.

At institutions where staff members other than the clinician provide the bulk of risk-reduction counseling, regular communication is imperative so that both the clinician and counselor are providing the same message.

Spectrum of Interventions

Clinicians should use a spectrum of prevention interventions in the clinical setting, including education, assessment, counseling, medical screening, and referral to both internal and external resources.

Materials and Tools to Augment Preventive Messages

Prevention messages, including printed materials and posters, should be visible and part of the clinical environment. Condoms should also be readily accessible.

The Role of Referrals

Clinicians should be familiar with community prevention resources, including peer education and support, and should make this information readily available in the clinical setting.

Clinicians should refer substance-using patients to treatment programs or other substance use services that best meet the patient's needs.

Clinician Education

All clinical staff should be educated about HIV prevention and trained to effectively deliver prevention messages to patients.

None provided

The type of evidence supporting the recommendations is not specifically stated.

Appropriate integration of prevention into primary care of human immunodeficiency virus (HIV)-infected patients

Not stated

The AIDS Institute's Office of the Medical Director directly oversees the development, publication, dissemination and implementation of clinical practice guidelines, in collaboration with The Johns Hopkins University, Division of Infectious Diseases. These guidelines address the medical management of adults, adolescents and children with HIV infection; primary and secondary prevention in medical settings; and include informational brochures for care providers and the public.

Guidelines Dissemination

Guidelines are disseminated to clinicians, support service providers and consumers through mass mailings and numerous AIDS Institute-sponsored educational programs. Distribution methods include the HIV Clinical Resource website, the Clinical Education Initiative, the AIDS Educational Training Centers (AETC) and the HIV/AIDS Materials Initiative. Printed copies of clinical guidelines are available for order from the NYSDOH Distribution Center for providers who lack internet access.

Guidelines Implementation

The HIV Clinical Guidelines Program works with other programs in the AIDS Institute to promote adoption of guidelines. Clinicians, for example, are targeted through the Clinical Education Initiative (CEI) and the AIDS Education and Training Centers (AETC). The CEI provides tailored educational programming on site for health care providers on important topics in HIV care, including those addressed by the HIV Clinical Guidelines Program. The AETC provides conferences, grand rounds and other programs that cover topics contained in AIDS Institute guidelines.

Support service providers are targeted through the HIV Education and Training initiative which provides training on important HIV topics to non-physician health and human services providers. Education is carried out across the State as well as through video conferencing and audio conferencing.

The HIV Clinical Guidelines Program also works in a coordinated manner with the HIV Quality of Care Program to promote implementation of HIV guidelines in New York State. By developing quality indicators based on the guidelines, the AIDS Institute has created a mechanism for measurement of performance that allows providers and consumers to know to what extent specific guidelines have been implemented.

Finally, best practices booklets are developed through the HIV Clinical Guidelines Program. These contain practical solutions to common problems related to access, delivery or coordination of care, in an effort to ensure that HIV guidelines are implemented and that patients receive the highest level of HIV care possible.

Living with Illness
Staying Healthy

Effectiveness
Patient-centeredness

• New York State Department of Health. How to integrate prevention into primary care. New York (NY): New York State Department of Health; 2005 Nov. 11 p. [16 references]

Not applicable: The guideline was not adapted from another source.

2005 Nov

New York State Department of Health - State/Local Government Agency [U.S.]

New York State Department of Health

Not stated

Not stated

Not stated

This is the current release of the guideline.

None available

This NGC summary was completed by ECRI Institute on September 12, 2007.