9.4 Service delivery
Consolidated ARV guidelines, June 2013
9.4.1 Good practices in providing chronic care
See reference (63)
In many countries, health services are organized primarily to provide episodic acute care. As HIV begins to become a manageable, chronic condition, programme managers and care providers need to consider how current health delivery systems can be reorganized to provide chronic care.
Once people are diagnosed and enrolled in chronic care, follow-up visits should be scheduled and planned. Waiting until people present with symptoms or preventable complications is costly and inefficient. People living with HIV require care that anticipates their needs at different stages of the care continuum. Compared with the acute care model, planned chronic care models provide opportunities for prevention, early identification of issues and timely intervention.
Chronic care requires broad support for people living with HIV from their communities and health care teams to stay in care, adhere to treatment and cope with stigma. People living with HIV and their families need to be informed about HIV infection and the anticipated side effects of medicines and supported to adhere to treatment. Health care teams play an important role in linking people living with HIV with community-level interventions, resources and support.
A system to keep information on the people receiving care at health facilities is critical for ensuring the continuity of chronic care. A patient registry serves a reminder function for follow-up services. Health care teams can use it to identify people’s needs, to follow-up and plan care, to monitor responses to treatment and to assess outcomes for both individuals and for the overall treatment cohort. Information systems can be paper-based or based on an electronic registry, depending on local context. Programmes should develop a systematic strategy for collecting and aggregating key information that supports better management of the patient and ensures high-quality care. A robust patient information system is also critical for high-quality monitoring and evaluation of programmes and for supply management systems.
When effective operational solutions such as successful service delivery models and processes of care are identified in existing systems, programmes need to consider scaling up such models of care.