2023-12-13 14:06:57
The majority of practicing physicians specializing in HIV/AIDS fear that there will be major gaps in care in the future in the treatment of these patients. This emerges from a survey by the German Association of Outpatient Doctors for Infectious Diseases and HIV Medicine (dagnä) on the occasion of World AIDS Day on December 1, 2023 [1]. One fear was that a shortage of skilled workers and an aging population might lead to many HIV-focused practices closing within the next 15 years.
There is great concern regarding a decline in HIV care structures
Almost 80% of those surveyed expect that the shortage of doctors and skilled workers might lead to a decline in HIV care structures. 43.9% tended to agree with this statement, while 34.6% even fully agreed with it. Around half of the participants stated that they were over 55 years old and would therefore be leaving the pension system in ten to 15 years, usually with no prospect of a successor.
“We have to expect that in 10 years there will be significantly fewer HIV-focused practices than today, with the corresponding consequences for the care of our patients,” says dagnä board member Heiko Karcher. Many colleagues report that they have difficulty selling their practices as they age. Karcher expects divestitures to become even more difficult in the future.
Supply gaps mostly in rural areas
Especially outside the big cities, there might soon be entire areas of the country without a single HIV practice, and therefore no low-threshold access to life-sustaining medication or preventive measures such as the highly effective PrEP-HIV prophylaxis, according to dagnä.
Is a branch still worth it?
The reason for the reluctance of young doctors in particular to take on an HIV-focused practice is, among other things, that “there is always a fight to finance important services,” emphasized Karcher. The question arises as to whether the services can still be offered in their current quality in the future.
Thanks to nationwide outpatient care, Germany was able to achieve the so-called “90-90-90” milestone set by UNAIDS in 2020: 90% of people with HIV know regarding their infection, 90% of them are being treated, and 90% of them are Thanks to the treatment, the virus is neither detectable nor transmissible.
On the other hand, according to dagnä, the number of recorded first HIV diagnoses stagnates at around 2,500 cases per year. “HIV is still a highly contagious and incurable infectious disease with serious health consequences,” said Karcher. This underlines the importance of effective HIV care, as is offered throughout Germany by the outpatient HIV focus centers.
Politics must create incentives
The dagnä board chairman demands that the tried and tested care structures be maintained and that doctors be appropriately remunerated – with the aim of avoiding gaps in care before they arise. At the same time, the new specialist title “infectious diseases” must definitely be embedded in outpatient care. “This is the only way our successors will know where they stand,” says Karcher.
In Germany, established HIV specialists are mostly general practitioners or internists; around half have the additional title of infectious disease specialist following 12 months of further training. In addition to HIV care, almost all of them also offer infectious disease services, such as the treatment of hepatitis B and C and other sexually transmitted infections, explains dagnä. What is new, however, is that in addition to the additional title, a specialist in infectious diseases is now being introduced in Germany, with 72 months of training.
The article was originally published on Univadis.de.
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