Primary Care HIVNet

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Primary Care HIV-Net

• GPs contribution
• 14.09.2007

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GPs work in Belgium. Features

• Individual doctors vs group-setting
• GP acts as a first step and refers to specialist
  if necessary (multidisciplinary)
• Preventive and curative care
• Highly confidential relationship
• Individual anonymous counseling
• Homevisits possible
• Working hours 24/24 hrs

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GPs work. Finances

• Most patients pay cash per visit and get ¾ paid
  back by mutuality
• 3th payment rule by OCMW or mutuality possible
  for migrants patient pays nothing, doctor is
  reimbursed later
• Other payment systems health centres (few),
  Artsen zonder grenzen, and Medicine for the
  people

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GPs and STDs/HIV

• Every GP can offer and do a test for hiv/stds
• Lab tests are to be paid by patient (bloodtest,
  urinetest) partly reimbursed by insurance
  (mutuality/OCMW)
• Follow-up and treatment can be done by GP in
  strict confidentiality

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GP and HIV/STD test

• GPs detect 60 of hiv cases in Belgium
• Screeningstest via private lab or via IMT
• Hiv test STD test (blood and urine sample)
• Informed consent
• Pre- and postcounseling (VCT)

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GPs-HIV-Network

• Horizontaly (general practitioners Antwerp)
• Verticaly (patients/ sensoa/ ITM-ARC/ hospital/
  university/ helpcenter/ ...)
• Peer review
• Productinfo
• Update hiv/std

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GPs and HIV-Net

• Since 1999 GPs (15) in Antwerp meet 3x/yr for
  updating/ intervision
• Speakers from all levels are invited at regular
  bases
• Different groups of society are highlighted
• Hiv an std knowledge is updated
• Only a small amount of GPs is interested!

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HIV-Net and HIV-SAM

• In 12/2003 the HIV-SAM project has been
  introduced in Hiv-Net meeting
• Leaflets were made and explained to GPs of the
  network
• GPs went back to their practices with open
  attitude for counseling and testing
• Few patients consulted hiv-net members

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Conclusion

• To pay cash at the GPs office is a barrier
• To pay the lab separately is a barrier
• GPs have good knowledge on prevention and VCT
  but people ask more for curative care

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Suggestions

• Distribute (anthropological) knowledge of African
  culture and health beliefs among GPs in their
  magazines/updating circuit
• Administration of 3th payment rule asks more
  time, but can be encouraged
• Private labs to be sponsered for hiv-tests to
  reduce the cost for the patient?

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Precounseling

• Open questions, not convicting, discrete
• Clearing up fear(s), in dialogue!
• Listening in an active way (reflecting, making
  feelings and thoughts clear, summarize
• Make an inventary of barriers, intentions and
  choices, with respect for the proces of the
  patient

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Postcounseling

• Prepare yourself timing!, own fear ?
• Introduce with I message
• Tell the bad news shortly and immediately. Give
  time and space !!
• React/reflect on emotions (I see that...),
  reflect, mirror,... . Take time!
• Give more explication on the result if necessary
  (shortly)
• Make a summary and a plan (24 hrs)
  confidential/professional persons to inform?