Specialist or generic community nursing care for HIV/AIDS patients?

Improved management of HIV-related illness means that patients spend over 80% of their time in non-institutional settings. Most community-based health care in the United Kingdom is provided by primary health care teams: general practitioners and community nurses, with support from social workers. However, in many areas specialist HIV services have assumed responsibility for the care of HIV/AIDS patients, and primary health care teams have only played a marginal role. Our study examined patterns of community nursing for HIV/AIDS patients in one regional health authority, North-East Thames (NETRHA). Interviews with 77 people in seven health districts included community nurse managers, clinical nurse specialists (CNS) HIV/AIDS and palliative care nurses. The appropriateness of different nursing models was assessed, taking into account the changing epidemiological and demographic profile of the disease, the influence of dedicated HIV funding, and the effect of recent British National Health Service reforms. Three models of care have developed in NETRHA: specialist HIV teams, individual CNS HIV/AIDS acting as a resource to generic staff, and care given by generic community nurses. Our work suggests that both generic community nurses and patients benefit from specialist input, and that this should be provided using CNSs HIV/AIDS in an advisory and facilitative capacity.