Quality of generalist vs. specialty care for people with HIV on antiretroviral treatment: a prospective cohort study

Abstract

Objectives: To describe health-care use by persons with HIV in an urban area of Switzerland (Zurich). Further, to compare the different health-care settings.

Design: A 1-year prospective cohort study recruiting 60 patients at general practices and 60 patients at a specialized university outpatient clinic.

Methods: Patients and their treating physicians were interviewed or answered questionnaires, respectively, at baseline, month 6 and 12.

Results: During the study period, five patient groups were identified among the 106 enrolled patients, of whom (i) 42% saw a general practitioner exclusively, (ii) 31% were treated at the specialized outpatient clinic, (iii) 8% were in shared care, (iv) 10% changed health-care model, and (v) 9% were lost to follow-up. Baseline demographic, psychosocial and clinical data were similar among patient groups. At study end, the proportion of patients with HIV-1 RNA < 400 copies/mL was 72%, 74%, 88%, 55% among groups (i) to (iv), respectively (ns), and 22% at month 6 among those lost to follow-up. Indicators for quality of care were similarly good among all patient groups.

Conclusions: A well-working system offers high-quality healthcare to persons living with HIV, where existing teams of specialty and primary health-care professionals efficiently and effectively co-operate.