Primary care providers need further training on HIV
The introduction of pre-exposure prophylaxis (PrEP) for people at an increased risk of HIV is challenging healthcare providers. People newly infected with HIV will normally seek care from a doctor specialised in HIV, but for people who protect themselves from HIV through the use of antiretroviral medication (PrEP), they will normally engage with a primary care provider, and not a specialist. The lack of knowledge among primary care providers about HIV medications is making it difficult for people at risk for HIV infection to get a prescription for Truvada, the antiretroviral drug used for PrEP.
Primary care providers who are not familiar with antiretroviral medications, may not feel comfortable prescribing it, thus making it difficult for people belonging to high risk populations to access PrEP. Not only is knowledge about PrEP essential for primary care providers, they also need more general knowledge about HIV treatment. As HIV treatment has improved, the virus can be more easily kept under control, meaning people living with HIV (PLHIV) are becoming older. This requires a change of focus for HIV care providers – from providing HIV treatment, to the inclusion of other chronic diseases, related to lifestyle and ageing. It also requires increased knowledge on the part of primary care providers about HIV and HIV medication, as more PLHIV will present themselves with diseases related to ageing to primary care providers.
For this reason, new guidelines released last year by the HIV Medicine Association (HIVMA) addressed the importance for HIV treatment providers to also focus on the patient's long-term health, and better linking with primary care providers. This is because not all primary care providers have in-depth HIV knowledge, nor are they familiar with specific therapies for HIV, the associated drug interactions, and specific guidelines for care. The same is true that not all HIV experts are familiar with all aspects of primary care and prefer to manage only HIV.
This change in care needs for PLHIV calls for a change in the education of primary care providers, as HIV patients are not often suffering of life-threatening opportunistic infections, but are facing a heighted risk for cancers, heart disease, and other issues related to inflammation. Primary care providers have to address these risk factors and be aware of the increased risk for PLHIV.