Structure of a primary care support system to coordinate comprehensive care for children and families infected/affected by human immunodeficiency virus in a managed care environment

Background. Children with HIV infection require coordinated primary and tertiary care. Objectives. To describe the structure of the Wisconsin HIV Primary Care Support Network, a decentralized program for care of children and families infected or affected by HIV infection. Methods. Review of data concerning all children with HIV infection included in the Network's database. Results. In this Network centralized HIV specialists work with primary care practitioners throughout Wisconsin to assure that children with HIV infection have access to care of uniform quality no matter where they live. Network staff care for children with HIV infection both directly and through the education and support of primary care providers. Care requirements are outlined in a state-published protocol supplied to practitioners. Audit of care is possible because of a centralized data collection system, and ongoing feedback and education occur via the activities of nursing care coordinators and both hospital- and community-based social workers. Conclusions. This system of care may serve as a model for care delivery to children with HIV infection in low prevalence areas and may be applicable to the care of children with other chronic diseases being cared for in a managed care environment.