General principles and background
Sustained high quality care for people living with HIV is necessary to reduce morbidity and mortality among people living with HIV, prerequisite to a good health-related quality of life and a better integration in active life. Uptake of ART also reduces onward transmission of HIV and hence supports control of the epidemic. Therefore, high quality care is considered a cost-efficient investment. Nowadays, the indicators on clinical care for HIV infection in Belgium are excellent. The current efforts should, however, be further supported to maintain the high-level clinical care and ensure those high standards for all people living with HIV, including hard-to-reach and vulnerable populations by lowering barriers to accessing care. Enhanced attention to psychosocial support is important to reach similar standards of excellence.
The objectives of the third pillar are to guarantee high-quality multidisciplinary care for all people living with HIV and thereby to ensure better health and health-related quality of life for all people living with HIV and contribute to the control of the HIV epidemic in Belgium.
The specific objectives are :
- to contribute to the improvement of the cascade of care by optimizing the steps related to the care of HIV, namely :
- Ensure timely access to HIV care for all diagnosed people living with HIV
- Ensure retention in care for all those entered in HIV care
- Ensure prompt access to ART for all those in care
- Ensure achievement of an undetectable VL for all those on ART
- to provide all people living with HIV the support to reach the best quality of life possible in terms of medical and psychosocial aspects.
In addition to the priorities for care listed below, an efficient national epidemiological and surveillance of clinical and psycho-social HIV activities should be supported as it is necessary to monitor the HIV care and health-related quality of life, as well as operational and clinical research to improve it.
This pillar on HIV care aims to cover medical and psychosocial care for people living with HIV from the diagnosis of the HIV infection to the achievement of an undetectable VL, with an additional focus on health-related quality of life along the continuum of care.
The responsibilities and competencies involved to ensure medical treatment and care in HIV reference centres or other medical structures are mainly located within the federal authorities.
For HIV patients with who benefit from the national health insurance, the expenses for medical care are covered by RIZIV/INAMI. CPAS-OCMW and Fedasil cover the costs for non-insured HIV patients. The Federal Public Services of Interior Affairs & Public Health finances the medical care for incarcerated patients.
Through a participatory process, relevant stakeholders in the HIV care domain agreed on the following priority areas and actions.
Priority area 1: Guarantee access to high quality care and ART for all the people living with HIV living in Belgium, independent of administrative status
1.1 Ensure that all diagnosed people living with HIV receive adequate information on HIV care and multidisciplinary support
1.2 Ensure that all diagnosed people living with HIV are timely referred to HIV care specialized practitioners for full assessment
1.3 Ensure that all people living with HIV living in Belgium benefit of prompt access to the most adequate ART
1.4 Substantially reduce the administrative barriers to access ART for people living with HIV in an asylum procedure or depending of urgent medical care
1.5 Provide access to HIV quality care for people living with HIV in prisons or other detention facilities
1.6 Provide access to HIV quality care for people living with HIV in centres for asylum seekers
1.7 Provide access to HIV quality care for people living with HIV in psychiatric centres, nursing homes, retirement homes or other long-term inpatient settings
1.8 Inform people living with HIV about the availability of peer support via patient organisations
Priority area 2: Guarantee retention in HIV care of all people living with HIV through patient empowerment and a collaborative approach with general practitioners and patient organisations
2.1 Ensure a systematic tracing of patients lost to follow up
2.2 Systematically assess with each new HIV patient how they can be reached in the event of missed appointments
2.3 Identify patients at higher risk of disengagement who should benefit of targeted support to be retained in care
2.4 Support (peer) education and empowerment of people living with HIV about their (HIV) care and the use of eHealth
2.5 Increase the knowledge and awareness of general practitioners on the HIV epidemic in Belgium, TasP, U=U and UNAIDS 95-95-95 targets and health related quality of life
2.6 Ensure clear channels of communication between HRCs and general practitioners and inform them on the multidisciplinary HIV care offer that is available within the HRCs
Priority area 3: Provide to all people living with HIV the most adequate and efficient ART tailored to their clinical situation and expectations in order to reach an undetectable viral load
3.1 Ensure that ART is prescribed in line with European guidelines (EACS), in partnership with each patient
3.2 Inform and train HIV care specialised practitioners on the best available evidence on ART prescription in order to develop and maintain excellent care for people living with HIV
3.3 Monitor the participation of the HRCs to the national HIV surveillance
3.4 Support operational and clinical research
Priority area 4: Guarantee optimal quality of care for people living with HIV within a holistic approach, including prevention and management of complications and comorbidities
4.1 Ensure the complementarity of the care provided by general practitioners and HRCs (for example vaccination, STI screening and treatment, drug interactions) by clarifying the tasks of general practitioners in HIV care
4.2 Ensure the availability and accessibility, including reimbursement, of vaccines for people living with HIV as recommended by the European guidelines (EACS)
4.3 Improve collaboration between HRCs and other specialists and ensure the coordination of multidisciplinary care for patients with comorbidities, with a special attention for ageing patients and their specific needs
4.4 Increase access to multidisciplinary support, in particular for partner notification, STI screening and treatment, sexual and reproductive health, mental health, drug addiction including chemsex, dietary requirements, smoking cessation and social support
4.5 Integrate measures of health-related quality of life and well-being in the HRC practice with the aim to identify, in collaboration with people living with HIV, potential areas for care improvement