Models of care and delivery

Marked regional differences in HIV‐related clinical outcomes exist across Europe. Models of outpatient HIV care, including HIV testing, linkage and retention for positive persons, also differ across the continent, including examples of sub‐optimal care. Even in settings with reasonably good outcomes, existing models are scrutinized for simplification and/or reduced cost. Outpatient HIV care models across Europe may be centralized to specialized clinics only, primarily handled by general practitioners (GP), or a mixture of the two, depending on the setting. Key factors explaining this diversity include differences in health policy, health insurance structures, case load and the prevalence of HIV‐related morbidity. In clinical stable populations, the current trend is to gradually extend intervals between HIV‐specific visits in a shared care model with GPs. A similar shared‐model approach with community clinics for injecting drug‐dependent persons is also being implemented. Shared care models require oversight to ensure that primary responsibility is defined for the persons overall health situation, for screening of co‐morbidities, defining indication to treat comorbidities, prescription of non‐HIV medicines, etc. Intelligent bioinformatics platforms (i.e. generation of alerts if course of care deviates from a prior defined normality) are being developed to assist in providing this oversight and to provide measure of quality. Although consensus exists to assess basic quality indicators of care, a comprehensive set of harmonized indicators are urgently needed to define best practise standards via benchmarking. Such a tool will be central to guide ongoing discussions on restructuring of models, as quality of care should not be compromised in this process.