As antiretroviral therapy (ART) has become simpler and more effective, many persons living with HIV (PLWH) can be successfully managed by primary care practitioners. However, surveys show that residents and residency program directors do not feel conventional training adequately prepares graduates to independently care for PLWH. The Institute of Medicine has recently expressed concern over the future number of HIV practitioners.
We developed an innovative HIV Primary Care Track for internal medicine residents who are interested in providing care for HIV-infected and lesbian/gay/bisexual/transgender (LGBT) patients. The 3-year curriculum includes several unique elements. Residents in the track are assigned continuity clinics at an urban community health center that serves large numbers of LGBT individuals and PLWH. A weekly conference presents key topics including ART, STD diagnosis and treatment, LGBT health, substance abuse, contraception/family planning and chronic disease management. Participants have opportunities to participate in infectious disease and public health electives and a global health rotation in an HIV-endemic area. They also complete a scholarly project in HIV or LGBT care. At the end of each training year, we use OSCEs to measure knowledge attainment, skills acquisition and professionalism.
The track was established in July 2011, enrolling 4 new trainees per year, and graduated its initial class in June 2014. Residents have demonstrated competence in HIV and LGBT care on the OSCEs, and patient satisfaction reports show excellent communication and professionalism skills. All graduates have passed the AAHIVM certification exam, and 75% (6/8) of them plan to work in primary care and manage PLWH. Elements of our curriculum have been published in peer-reviewed venues. We are currently collecting clinical data to assess resident compliance with accepted quality metrics in HIV care.
We successfully developed and implemented a novel residency track focused on primary care for LGBT individuals and PLWH. This primary care training approach provides a valuable pathway to prepare adequate numbers of future clinicians to serve these patient populations, particularly as HIV care continues to evolve into a chronic disease model.
J. Potter, None
J. Baker Jr., None
H. Libman, None