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

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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 speciality and primary health‐care professionals efficiently and effectively co‐operate.