PLWH who are receiving effective and durable anti-retroviral therapy (ART) have similar
life expectancy as the general population, but the patients do suffer from two-fold
higher burden of disability associated with chronic comorbidities as compared with people
without HIV infection. The screening and management of these chronic comorbidities are
gaining attention in both high-income and low- and middle-income settings.
There are at present different models of care to deliver healthcare for the screening and
management of comorbidities for PLWH. Fully integrated care of both HIV and comorbidities
in a one-stop clinic brings numerous benefits, including optimal utilization of
resources, provision of holistic care, and de-stigmatization; but also encounters various
challenges, such as placing burden on human and spatial resources in HIV clinics, and the
limited availability of co-medications in HIV clinics. In high-income settings,
traditional models of care are often physician-centred, thus more innovative models have
been explored, involving integrated care in the primary care setting, or consultations by
multiple specialists in an integrated clinic, but these require a high magnitude of
coordination and have resource implications, limiting feasibility universally. On the
other hand, a "differentiated service delivery (DSD)" model is an adaptive model of care
that aims to tailor healthcare delivery services according to patients' individual
clinical needs and preferences, while taking into consideration resource availability in
the local context. This model of care is successful in the delivery of HIV care and
management of ART, and is patient-centred, offering patients a mode of care most optimal
for their lifestyle and needs without imposing unmanageable burden on the healthcare
system. DSD is advocated to be developed for the aging population of PLWH to provide
patient-centred healthcare service for management of their comorbidities and other
age-related issues, but has not been well studied.
The rising use of telemedicine since the Coronavirus disease 2019 (COVID-19) pandemic in
the management of HIV and other chronic diseases would facilitate the incorporation of
more patient-centred options in healthcare service delivery according to patients' needs
and preferences. Telemedicine interventions improve access to care, control of disease,
and quality of life in people with chronic non-communicable diseases. In particular,
telemonitoring interventions and synchronous video teleconsultations are found to be
beneficial in disease control and enhancing patient-physician interaction.
The currently proposed DSD model of care has the following benefits: (1) patient-centred
care with individualized care delivery options according to patients' preference, such as
offering teleconsultation as an alternative, options of different drug delivery modes,
and personalized management plans according to individual clinical needs; (2) shared care
between HIV care providers and internal medicine specialists, with close communication
regarding clinical data and treatment plans, while avoiding duplication of resources; (3)
draws on the availability of telemedicine tools in public healthcare services in Hong
Kong; (4) patient empowerment by educating patients on treatment goals, performing
selfmonitoring of disease, and scheduling appointments according to clinical indications;
and (5) optimizing care of complex comorbidities by providing specialist care, and
screening and management of comorbidities according to evidencebased guidelines.