Acceptability of shared care for asymptomatic HIV-positive patients

In Britain, Human Immunodeficiency Virus (HIV) disease has been seen as an illness requiring specialist hospital care at all times. However, as its chronic nature has become apparent, the possibiliity that it could be managed more cost effectively in primary care has been raised. This has led to increasing interest in 'shared care', that is, care which is shared between a general practitioner and a specialist according to clear protocols, for this group of patients. However, for 'shared care' to be a success, it must be acceptable to all concerned: patients, GPs and specialists. This paper presents our experience of recruiting asymptomatic HIV-positive patients into a shared care programme: after 10 months' recruitment only 19 of 128 eligible patients had accepted the offer of shared care. The reasons for this, and alternative strategies for increasing GP involvement, are discussed.