A holistic perspective on providing care for HIV: An individual-focused approach to supporting those with HIV
In the last four decades, significant advancements have transformed HIV from a fatal illness to a controllable disease. With consistent treatment, individuals with HIV can now lead fulfilling lives and age successfully. The revolutionary creation of effective HIV medications has allowed many to reduce the virus to undetectable levels, leading to an impossibility of transmission (U=U). Coupled with access to preventative measures and resources, this has resulted in a gradual decrease in new cases and fatalities related to HIV and AIDS.i
“We must not become complacent if we want to completely eradicate it.”ii.
In 2016, member countries of the United Nations pledged to eliminate the AIDS epidemic by 2030.iii
Around 100,000 individuals are diagnosed with this condition annually in Europe.iv
The battle against HIV is not yet won as addressing it requires more than just controlling the spread of the virus. With this in mind, UNAIDS has introduced a new approach in 2021 that focuses on bridging the gap of inequality that is driving the HIV and AIDS crisis.v.
To meet the U.N.’s global targets for HIV, a comprehensive approach is necessary that addresses issues of social inequality and unmet needs within the HIV community. This approach should not only focus on individualized testing, prevention, and treatment, but also strive for inclusivity and a reduction of stigma in addressing the underlying factors driving HIV. Ultimately, this will improve the overall well-being of those living with HIV.
Focus on the individual, not just the infection.
Achieving undetectable levels of HIV is crucial, but it is also necessary to consider more than just the virus. It is essential to have discussions that can educate and improve routine HIV treatment. By actively listening, appreciating, and incorporating the perspectives of patients, we can ensure a personalized approach to HIV care that goes beyond their diagnosis. Through listening, we have discovered that 56% of individuals with HIV are not completely satisfied with their current medication.vi.
Achieving undetectable levels is crucial, but it is also essential to address more than just the virus. It is necessary to initiate discussions that can educate and improve regular HIV treatment.
Individuals who have been diagnosed with HIV are at a higher risk for developing other health conditions, are often subject to negative attitudes and prejudice, and may have a decreased overall well-being.vii
For certain individuals, the thought of having to take their medication every day brings up concerns about revealing their HIV status, causes them to feel tired of the treatment, or serves as a constant reminder of their illness. As a result, this can lead to difficulties in following the treatment regimen and can also have a detrimental effect on their emotional well-being and overall satisfaction with life.viii.
patients
Reducing the number of pills taken annually to a less frequent schedule could potentially address the remaining needs of certain patients.ix
This aligns with a healthcare setting that properly recognizes and implements these innovative treatments to provide options and optimal care.
This initiative, guided by the desires, choices, and necessities of patients, must also acknowledge the importance of tools for preventing HIV.x
Investing in both person-centered approaches to HIV prevention and treatment can provide a great benefit to those living with HIV and those who could benefit from PrEP. This can lead to better continuity of care and strengthen overall health systems, ultimately benefiting the public beyond just the healthcare sector.
Looking for multiple paths to move forward by giving importance to personalized treatment.
We must look beyond just achieving viral suppression and consider the unique needs and desires of those living with HIV in all areas of their lives. It’s important to recognize that there is no one-size-fits-all solution, and instead, we must customize our approach to measuring treatment success and implementing healthcare systems for individuals who are living and growing older with HIV.
In order to achieve the 2030 targets for elimination, it is necessary to create specialized resources for prevention, treatment, and care that address the specific needs of marginalized communities and the changing nature of HIV over time.
One way to evaluate the effectiveness of treatment is to look beyond just reducing the presence of a virus and also consider the outcomes reported by the patient.xi
National clinical guidelines and health technology assessment processes have an important role in promoting a collaborative decision-making process for disease management. This approach would prioritize clinical research and practice based on the experiences of individuals living with HIV, as well as inform decision-making regarding access to treatment.
In order to achieve the 2030 elimination objectives, it is necessary to create specialized prevention and treatment methods and healthcare systems that cater to the specific needs of marginalized communities.
At the edges. Ensuring inclusion for all.
In Europe, certain groups of people, such as migrants, sex workers, individuals who use drugs, transgender individuals, men who have sex with men, and women, are particularly impacted by HIV and are at a higher risk for facing stigma and discrimination. These populations also face restrictive social and legal conditions that have historically contributed to the spread of HIV. As a result, there is a disparity in access to healthcare and resources for HIV prevention and treatment.xii.
A comprehensive strategy involving all levels of government and society is necessary to tackle the underlying social and economic factors contributing to these disparities. This includes working towards meeting the UNAIDS goal of 10-10-10, which aims to combat harmful legal and policy environments, stigma, discrimination, and gender inequality and violence.xiii
“In the context of the health sector, this entails including communities in the decision-making process, in accordance with the GIPA principles.”xiv
Rewording: Investing in novel approaches to delivering services and empowering community-based services that prioritize care for and by the communities.
The European Union must take charge
This upcoming term of the EU Commission will be the final one before 2030, providing a crucial chance to guarantee that Europe meets the global HIV goals set by the United Nations. It is imperative that the EU and its member nations do not allow any setbacks or regression in progress. Now is the moment for us to renew our commitment to a fresh HIV Action Plan together.xv
This guarantees that HIV remains a key concern in Europe. The strategy should incorporate the objectives of UNAIDS into the EU’s policy agenda and establish appropriate guidance and resources to ensure that member countries are making progress towards meeting the 2030 elimination goals.
The upcoming EU Commission term will be the final one before 2030, providing a valuable chance to guarantee that Europe meets the United Nations’ HIV goals on a global scale.
The entire HIV community must support this approach and the revitalization of a European Union Action Plan for HIV using a comprehensive and inclusive approach that addresses both the medical and social aspects of the HIV and AIDS crisis.
At ViiV Healthcare, we are prepared to collaborate and support this goal, ensuring that no one is left behind. The time for action is currently.
References:
“The Joint United Nations Programme on HIV/AIDS (UNAIDS) released a press release and statement on the Prevention Gap Report
UNAIDS recently published a press release and statement regarding the Prevention Gap Report.
[ii] WHO. (2017). HIV: from a devastating epidemic to a manageable chronic disease. Available from: https://reliefweb.int/report/world/hiv-devastating-epidemic-manageable-chronic-disease. Last accessed: August 2023.
[iii] https://www.un.org/pga/70/2016/06/10/press-release-bold-commitments-to-action-made-at-the-united-nations-general-assembly-high-level-meeting-on-ending-aids/
[iv] https://www.ecdc.europa.eu/sites/default/files/documents/2022-Annual_HIV_Report_final.pdf
[v] https://www.unaids.org/sites/default/files/media_asset/global-AIDS-strategy-2021-2026_en.pdf
The study conducted by Rios et al. (2020) examined the treatment goals and opinions on new medications among individuals with HIV in 25 different countries. The results were published in the Population Medicine journal and revealed that there is a diverse range of views and aspirations towards innovative treatments for HIV.
The study by den Daas et al. (2019) examines the health-related quality of life of adult patients with HIV, exploring various themes and their interconnected relationships. The research is available on the Quality of Life Research website and was accessed in August 2023.
[viii] Safreed-Harmon K et al. (2019). Reorienting health systems to care for PLHIV beyond viral suppression. Available from: https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(19)30334-0/fulltext. Last accessed: August 2023.
[viii] ViiV Healthcare. (2020). Optimising quality of life for all people living with HIV: Recognising the 4th 90.
[viii] Claborn, K., Meier, E., Miller, M. and Leffingwell, T. (2014). A systematic review of treatment fatigue among HIV-infected patients prescribed antiretroviral therapy. Available from:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4315727/. Last accessed: August 2023.
Colliver (2023) discusses the possibility of eliminating HIV with the use of monthly injections. These injections could potentially offer hope for controlling the virus without the burden of daily medication. This information is available at https://www.ucsf.edu/news/2023/07/425781/can-we-stamp-out-hiv-new-monthly-injections-could-offer-hope#:~:text=Remembering%20to%20take%20medications%20each,to%20get%20it%20under%20control.. It was last accessed in August 2023.
[x] Mitchell, K. et. Al. (2023). Estimating the impact of HIV PrEP regimens containing long-acting injectable cabotegravir or oral tenofovir disoproxil fumurate / emtricitabine among men who have sex with men in the Unites States. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9950652/. Last accessed: August 2023.
[xi] Mott, F. (2017). Patient reported outcomes (PROs) as part of value-based care can shape therapy guidelines. Available from: https://link.springer.com/article/10.1007/s40487-016-0038-7. Last accessed: August 2023.
[xii] HIV and transgender and other gender-diverse people. Available from: https://www.unaids.org/sites/default/files/media_asset/04-hiv-human-rights-factsheet-transgender-gender-diverse_en.pdf. Last accessed: June 2023.
[xii] UNAIDS Fact Sheet 2022. Available from: https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf. Last accessed: June 2023.
This source is the 2021 report on HIV/AIDS surveillance in Europe by ECDC. It can be found at the link provided and was last accessed in June 2023.
The HIV prevention roadmap for 2025 aims to put us on the right path to eliminate AIDS as a public health threat by 2030.
“The UNAIDS Policy Brief (2007) [1] titled “The Greater Involvement of People Living with HIV (GIPA)” focuses on the impact of HIV/AIDS, hepatitis, and tuberculosis and was published on the europa.eu website.”
[xv] HIV/AIDS, hepatitis and tuberculosis (europa.eu)
