This second edition provides recommendations for clinical practice adaptations to provide quality health care for persons with HIV/AIDS experiencing homelessness. The report discusses diagnosis, evaluation, health care plans, and management, including issues such as self-management and medications. It utilizes case study examples from different populations experiencing homelessness, including women, adolescents, and transgender individuals.
Clinicians with extensive experience caring for individuals who are homeless routinely adapt their medical practice to foster better outcomes for these patients. Standard clinical practice guidelines often fail to take into consideration the unique challenges faced by homeless patients that may limit their ability to adhere to a plan of care. Recognizing the gap between standard clinical guidelines and clinical practices used by health care providers experienced in the care of individuals who are homeless, the Health Care for the Homeless (HCH) Clinicians’ Network has made the adaptation of clinical practice guidelines for homeless patients one of its top priorities.
In 2002–2003, 11 health and social service providers experienced in the care of homeless individuals with HIV/AIDS developed the original edition of these adapted clinical guidelines, drawing from their own experience and from that of 28 other practitioners working with HIV-infected homeless persons across the United States.1 In 2008, an advisory committee, including some of the original authors, reviewed and revised these recommended clinical practice adaptations to assure their consistency with updated U.S. Public Health Service guidelines for the diagnosis and management of HIV/AIDS and with best practices in homeless health care.
The primary source documents for these adaptations are: the U.S. Department of Health and Human Service (DHHS) Guidelines for the Use of Antiretroviral Agents in HIV-1- Infected Adults and Adolescents, January 29, 2008, and the DHHS Public Health Service Task Force Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-infected Women for Maternal Health and Interventions to Reduce Perinatal HIV-1 Transmission in the United States, July 8, 2008. Recommendations found in these guidelines are not restated in this document except to clarify a particular adaptation.
We offer this second edition of Adapting Your Practice: Treatment and Recommendations for Homeless Patients with HIV/AIDS to promote continuing improvement in the quality of HIV care provided to individuals whose lack of financial and social resources complicate the treatment and self-management of their chronic disease. (Authors)