GPs' perceived barriers to their involvement in caring for patients with HIV: a questionnaire-based study

Background Since the introduction of highly active antiretroviral therapy (HAART) in the late 1990s, individuals with HIV are living longer and beginning to experience the chronic diseases of ageing. Alongside side effects of HAART therapy, these may be better managed in the community by generalists rather than by HIV specialists. Aim. To explore GPs' current perceptions of barriers to their involvement in managing patients with HIV. Design of study Postal questionnaire. Setting Practices within a primary care trust in the south of England. Method The questionnaire included 24 statements relating to potential structural and attitudinal barriers to GPs' involvement in the care of patients with HIV. Results Seventy-one per cent (124/174) of GPs responded; 93% (n = 115) of responders were comfortable managing other illness in HIV patients, and 60% (n = 74) agreed that GPs rather than specialists should manage common chronic problems such as hypertension or diabetes. Specialist prescribing was commonly identified as a barrier, specifically: difficulty keeping up to date, knowledge of HAART side effects,. and drug interactions. The majority of responders (67% [83]) viewed patients as preferring their HIV illness to be managed by specialists. Conclusion There is now the opportunity and potential to relocate the management of chronic disease in patients with HIV to GPs. Factors such as lack of time, experience, and training were identified as barriers to caring for patient with HIV in the pre-HAART era; these factors continue to challenge some GPs. Additional barriers are the complexity of HAART regimes and inadequate reimbursement. Addressing these barriers is necessary if services are to be reconfigured for people with HIV.