Comprehensive Care Programs

Some hospitals, clinics, and managed care organizations or HMOs, es­pecially those in large urban areas, have comprehensive programs of care tailored to the specific needs of people with HIV infection.

In the United States, the type and extent of services provided, and the type of specialists available, vary from one program to another and from one HIV center to another. The people and programs in compre­hensive care programs can include HIV counselors, medical specialists, support groups, home therapy programs, dietitians, psychologists and psychiatrists, social workers, case managers, hospice care programs, drug rehabilitation programs, and dental care. Most comprehensive care programs will have some but not all of these services.

HIV counselors are specifically trained to provide information about HIV infection, especially information about the progress of the disease, the meaning of a positive blood test, and preventing transmis­sion. These counselors also give advice on where, in a local community, to go for legal advice, for financial advice, and for personal planning ser­vices.

Medical specialists associated with a comprehensive care program are the same experts a primary care physician or AIDS physician is likely to consult about some of the complications of HIV infection that require specialized knowledge or a specialized procedure.

Support groups offer a person with HIV infection emotional sup­port and help with adherence to the drug regimens in the company of people facing similar problems (see chapter 11). The support groups are ideally made up of no more than five to eight people affected by HIV in­fection who have common interests and concerns. The groups are often led by a mental health professional. The benefit of a support group is sharing experiences and problems—medical and nonmedical—that are not easily shared with others.

Home therapy programs extend comprehensive services to the per­son’s home. These services are most useful to the person whose physical condition is stable and who may be staying in the hospital only to re­ceive certain types of treatment, like intravenous drugs. Nurses working in home therapy programs can give intravenous drug treatments, draw blood for necessary laboratory tests, and do general nursing care—all at home, and all much less expensively than in the hospital. In most in­stances, the person with HIV infection or the caregiver is taught how to administer the drugs intravenously by himself or herself, so that visits by a trained professional are few. This style of giving intravenous drugs may sound somewhat risky, but it has now become commonplace in medical practice.

A dietitian’s job is to help people with HIV infection solve the eat­ing problems that can interfere with proper nourishment and complicate the proper use of HAART.

Psychologists and psychiatrists treat the array of emotional difficul­ties that face people with HIV infection. Some of these difficulties are se­rious, some short-lived; some are treatable with medications, some are best treated by talking them out. Psychological social workers, mental health nurses, psychologists, and psychiatrists—four kinds of mental health professionals who provide somewhat different services—can de­termine the severity of the emotional difficulty and can decide on the best course of treatment (see chapter 11, under “Mental Health Profession­als”).

Social workers and case managers help sort out many of the non­medical problems people with HIV infection face: dealing with hospitals and insurance companies, keeping finances straight, sorting out living arrangements, and much more (see the sections in this chapter on case management and on social workers).

The services offered in comprehensive care programs are more likely to be extensive in metropolitan areas and in hospitals or clinics that serve large numbers of people with HIV infection. Some people, especially those in the early stages of the infection, have no need for such a com­plex network of services. Some AIDS physicians work in private offices but have established a network of referrals that is comparable to a com­prehensive care program. Some people with HIV infection prefer the simplicity of a single physician; others prefer the availability of many specialized services. The people who most benefit from the advantages of a comprehensive care program are either those who need more com­plicated and specialized care or those whose primary care physicians are uncomfortable treating many of the complications of HIV infection.