HIV / AIDS Course CEUS - Chapter 5 - Starting HIV Care

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Chapter 5: Starting HIV Care A. Find a Provider 1. Locate an HIV Care Provider How Do You Find an HIV Health Care Provider? You can find an HIV health care provider by using our HIV Testing Sites and Care Services Locator. Just enter your Zip code to be connected to HIV medical care and other services such as HIV testing locations, housing assistance, and substance abuse and mental health services. There are other ways to find HIV providers and services too: Ask your primary care provider—If you have a primary care provider (someone who manages your regular medical care), that person may have the medical knowledge to treat your HIV. If not, he or she can refer you to a provider who specializes in providing HIV care and treatment. Call your state HIV/AIDS hotline—State HIV/AIDS toll-free hotlines are available to help connect you to agencies that can help determine what services you are eligible for and help you get them. Search the Referral Link directory—The American Academy of HIV Medicine's Referral Link is a directory of healthcare providers specializing in HIV management and prevention across the country. The doctors and clinicians represented in this database practice in a variety of care settings including health centers, Ryan White clinics, and private practices. Use your home HIV test hotline—If you received an HIV diagnosis by using an HIV home test kit, it is important that you take the next steps to make sure your test result is correct. Home test manufacturers provide confidential counseling to answer questions and provide local referrals for follow-up testing and care. Why Do You Need to Find an HIV Health Care Provider? After you're diagnosed with HIV, it's important to see a health care provider who can help you start HIV medication (called antiretroviral therapy or ART) as soon as possible. ART is recommended for all people with HIV, regardless of how long they've had the virus or how healthy they are. ART can't cure HIV, but it can control the virus. If taken as every day, exactly as prescribed, ART can reduce the amount of HIV in your body (also called the viral load) to a very low level. This is called viral suppression. Viral suppression helps to keep you healthy and prevents illness. If your viral load is so low that it doesn't show up in a standard lab text, this is called having an undetectable viral load. There are important health benefits to having a suppressed or undetectable viral load. People living with HIV who know their status, take HIV medication daily as prescribed, and get and keep an undetectable viral load can live long and healthy lives. There is also a major prevention benefit. People living with HIV who take HIV medication daily as prescribed and get and keep an undetectable viral load have effectively no risk of transmitting HIV to their HIV-negative sexual partners. This is often called treatment as prevention. How Soon Do You Need to Find an HIV Health Care Provider? The U.S. Department of Health and Human Services (HHS) guidelines on the use of HIV medicines in adults and adolescents recommend that people with HIV start medical care and begin HIV treatment as soon as possible. If you have the following conditions, it's especially important to start ART right away: pregnancy, AIDS, certain HIV-related illnesses and coinfections, and early HIV infection. (Early HIV infection is the period up to 6 months after infection with HIV.) Learn more about when to start ART. Content Source: HIV.gov Date last updated: April 29, 2019 2. Types of Providers Who Should Be on My Health Care Team? Finding a health care team that is knowledgeable about HIV care is an important step in managing your care and treatment. If you are able to choose your provider, you should look for someone who has a great deal of experience treating HIV. This matters because the more HIV experience your provider has, the more familiar he or she will be with the full range of treatment options that exist today, as well as the unique issues that can come up in HIV care over time. Who is on your HIV health care team will depend on your health care needs and the way that the health care system, clinic, or office you will get your care from is set up. It should also be based on your preferences and what will work best for you. Don't get hung up on finding the perfect provider the first week after you are diagnosed. The most important thing you can do now for your health is to meet with an HIV provider who can order your first lab tests and start HIV treatment as soon as possible. Don't let the search for the perfect doctor slow you down on this. You can change doctors later if you need to. Your HIV health care provider should lead your health care team. That person will help you determine which HIV medicines are best for you, prescribe antiretroviral therapy (ART), monitor your progress, and partner with you in managing your health. He or she can also help put you in touch with other types of providers who can address your needs. Your primary HIV health care provider may be a doctor of medicine (MD) or doctor of osteopathic medicine (DO), nurse practitioner (NP), or a physician assistant (PA). Some women may prefer to see an OB-GYN provider who has expertise in HIV/AIDS. On the whole, the patients of providers with more experience in HIV care tend to do better than those who see a provider who only has limited HIV care experience. In addition to your HIV health care provider, your health care team may include other health care providers, allied health care professionals, and social service providers who are experts in taking care of people living with HIV. The types of professionals who may be involved in your HIV care include: Health care providers Medical doctors (MD or DO): Health care professionals who are licensed to practice medicine. Nurse practitioners (NP): Registered nurses, with specialized graduate education, who can diagnose and treat illnesses independently, or as part of a health care team. Physician assistants (PA): Health care professionals who are trained to examine patients, diagnose injuries and illnesses, and provide treatment to patients under the supervision of physicians and surgeons. Allied health care professionals: Nurses: Health care professionals who provide and coordinate patient care as part of a health care team. Mental health providers: Professionals, such as a counselor, psychologist, or psychiatrist, who provide mental health care in the form of counselling or other types of therapy. Pharmacists: Health care professionals who provide preblockedion medicines to patients and offer expertise in the safe use of preblockedions. Pharmacists may also provide advice on how to lead a healthy life; conduct health and wellness screenings; provide immunizations; and oversee medicines given to patients. Nutritionists/dietitians: Experts in food and nutrition who advise people on what to eat in order to lead a healthy lifestyle or achieve a specific health-related goal. Dentists: Health care professionals who diagnose and treat problems with a person's teeth, gums, and related parts of the mouth. Dentists also provide advice and instruction on taking care of teeth and gums and on diet choices that affect oral health. Social service providers: Social workers: Professionals who help people solve and cope with problems in their everyday lives. Case managers: Professionals who help people find the support and services they need, develop a services plan, and follow up to make sure that services are provided. Substance use/abuse specialists: Counselors who provide advice, treatment, and support to people who have problems with substance use. Patient navigators: There are a number of different types of navigators who are trained and culturally sensitive workers who provide support and guidance to people by helping them "navigate" through the health care system. For example, navigators could be health care workers, social workers, those who work for community-based organizations, or peers. Content Source: CDC's HIV Treatment Works Date last updated: May 21, 2018 3. Take Charge of Your Care How Can You Work Best with Your Health Care Team? HIV treatment is most successful when you actively take part in your medical care. That means taking your HIV medications every time, at the right time, and in the right way; keeping your medical appointments; and communicating honestly with your health care provider. This can be achieved when you: Keep all of your medical appointments. There are many tools you can use to help you remember and prepare for your appointments. You can: Use a calendar to mark your appointment days. Set reminders on your phone. Download a free app from the Internet to your computer or smartphone that can help remind you of your medical appointments. Search for “reminder apps” and you will find many choices. Keep your appointment card reminder in a place where you will see it often, such as on a mirror, or on your refrigerator. Ask a family member or friend to help you remember your appointment. Be prepared for your medical appointments. Before an appointment, write down questions or concerns you want to discuss with your health care provider. Be prepared to write down the answers you receive during your visit. If you can't keep a scheduled appointment, contact your provider to let them know, and make a new appointment as soon as possible. Communicate openly and honestly with your health care providers. Your health care provider needs to have the most accurate information to manage your care and treatment. Keep track of your medical services. You may have multiple health care providers working on your health care team. Keep records of your lab results, medical visits, appointment dates and times, medicines and medicine schedules, and care and treatment plans. Update your contact information. Make sure your health care providers have your correct contact information (telephone number, address, and e-mail address) and let them know if any contact information changes. Need inspiration? You can view stories and testimonials of people living with HIV who are working with their health care team to stay in care and on treatment by visiting Positive Spin or by visiting CDC's HIV Treatment Works campaign. Content Source: CDC's HIV Treatment Works Date last updated: May 15, 2017 B. Getting Ready for Your First Visit 1. What to Expect at Your First HIV Care Visit What Can You Expect at Your Medical Visits? Living with HIV can be challenging at times. Partnering with your health care provider will help you manage your health and HIV care. During your medical appointments, your health care provider may: Conduct medical exams to see how HIV is affecting your body. Ask you questions about your health history. Take a blood sample to check your CD4 count and viral load. Look for other kinds of infections or health problems that may weaken your body, make your HIV infection worse, or prevent your treatment from working as well as possible. Give you immunizations, if you need them. Discuss, prescribe, and monitor your HIV medicines, including when and how to take them, possible side effects, and continued effectiveness. Discuss strategies that will help you follow your HIV treatment plan and maintain your treatment. Help identify additional support you may need, such as: finding a social worker, case manager or patient navigator; finding an HIV support group; finding support services for mental health or substance use issues; or finding support services for transportation or housing. Ask you about your sex partner(s) and discuss ways to protect them from getting HIV. Ask you about your plans, or your partner's plans, for getting pregnant. Talk regularly with your health care provider about how you are feeling and communicate openly and honestly. Tell your health care provider about any health problems you are having so that you can get proper treatment. Discuss how often you should expect to attend medical visits. Staying informed about HIV care and treatment advances and partnering with your health care provider are important steps in managing your health and HIV care. What Tests Can Help Monitor Your HIV Infection? Your health care provider will use blood tests to monitor your HIV infection. The results of these blood tests, which measure the amount of HIV virus and the number of CD4 cells in your blood, will help you and your health care provider understand how well your HIV treatment is working to control your HIV infection. These test results will also help your health care provider decide whether he or she should make changes to your treatment. These blood tests include regular CD4 counts and viral load tests. Read about these tests below. CD4 Count CD4 cells, also called T-cells, play an important role in your body's ability to fight infections. Your CD4 count is the number of CD4 cells you have in your blood. When you are living with HIV, the virus attacks and lowers the number of CD4 cells in your blood. This makes it difficult for your body to fight infections. Typically, your health care provider will check your CD4 count every 3 to 6 months. A normal range for a CD4 cell count is 500 cells to 1,600 cells per cubic millimeter of blood (you may see this written as “cells/mm3”). A low CD4 cell count means you are at higher risk of developing opportunistic infections. These infections take advantage of your body's weakened immune system and can cause life-threatening illnesses. A higher CD4 cell count means that your HIV treatment is working and controlling the virus. As your CD4 count increases, your body is better able to fight infection. If you have a CD4 count of fewer than 200 cells per cubic millimeter of blood, you will be diagnosed as having AIDS. Viral Load Test Your viral load is the amount of HIV in your blood. When your viral load is high, you have more HIV in your body, and your immune system is not fighting HIV as well. When you take a viral load test, your health care provider looks for the number of HIV virus particles in a milliliter of your blood. These particles are called "copies." The goal of HIV treatment is to help move your viral load down to undetectable levels. In general, your viral load will be declared "undetectable" if it is under 40 to 75 copies in a sample of your blood. The exact number depends on the lab that analyzes your test. Your health care provider will use a viral load test to determine your viral load. A viral load test will: Show how well your HIV treatment is controlling the virus, and Provide information on your health status. You should have a viral load test every 3 to 6 months, before you start taking a new HIV medicine, and 2 to 8 weeks after starting or changing medicines. Content Source: CDC's HIV Treatment Works Date last updated: May 15, 2017

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