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Primary Care Guidance for Persons With HIV - 2021

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Key Points 2 ➤ This guidance from an expert panel of the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA) updates the 2013 HIV primary care guidelines. ➤ These recommendations encompass the comprehensive care of persons with HIV, including comorbidity management. I. OPTIMIZING CARE ENGAGEMENT, MEDICATION ADHERENCE, AND VIRAL SUPPRESSION 1. All persons with HIV should be provided timely access to routine and urgent primary medical care, including approaches to expand access such as extended/weekend hours or telehealth. 2. HIV care sites should make every effort to provide care in a way that is linguistically and culturally appropriate. 3. HIV care sites should implement programs incorporating evidence- based and evidence-informed interventions shown to improve HIV care engagement and viral suppression. 4. HIV care sites should utilize a multidisciplinary model but identify a primary clinician for each patient and support the development of trusting, long-term, patient-clinician relationships. Diagnosis II. INITIAL EVALUATION AND IMMEDIATE FOLLOW-UP FOR PERSONS WITH HIV 5. A comprehensive present and past medical history including HIV- related information, medication/social/family history (Tables 1 and 2), review of systems, and physical examination (Table 3) should be obtained for all patients upon initiation of care, ideally at the first visit but, if not feasible, then as soon as possible thereafter. In particular, in settings of rapid ART initiation, clinicians may initially truncate parts of the comprehensive history and physical, providing a more targeted exam but with close follow-up to complete the essential and more comprehensive assessment. Since many patients will not be able to recall details of prior treatments and labs, medical records should be requested and reviewed, and the current medical record updated accordingly. Baseline laboratory assessments should be obtained at the initial visit. (See Table 4)

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