Program Description:

The AIDS Institute’s Office of the Medical Director directly oversees the development, publication, dissemination and implementation of clinical practice guidelines, in collaboration with The Johns Hopkins University, Division of Infectious Diseases. These guidelines address the medical management of adults, adolescents, and children with HIV infection; primary and secondary prevention in medical settings; and include informational brochures for care providers and the public.

Guidelines Development:

AIDS Institute clinical guidelines are developed by distinguished committees of clinicians and others with extensive experience providing care to people with HIV infection. Committees meet regularly to assess current recommendations and to write and update guidelines in accordance with newly emerging clinical and research developments. When formulating guidelines for a disease as complex and fluid as HIV/AIDS, it is impossible to anticipate every scenario. It is expected that in specific situations, there will be valid exceptions to the approaches offered in these guidelines and sound reason to deviate from the recommendations provided within.

The Committees rely on evidence to the extent possible when formulating recommendations. When data from randomized clinical trials are not available, Committees rely on developing guidelines based on consensus, balancing the use of new information with sound clinical judgment that results in recommendations that are in the best interest of patients. All guidelines are externally peer reviewed by at least two experts in that particular area of patient care, which ensures depth and quality of the guidelines. The HIV Consumer Advisory Committee (CAC) reviews all chapters. The Young Adults Consumer Advisory Committee (YACAC) reviews all adolescent chapters.

Current committees include:

• Medical Care Criteria Committee
• Committee for the Care of Children and Adolescents with HIV Infection
• Dental Standards of Care Committee
• Mental Health Guidelines Committee
• Committee for the Care of Women with HIV Infection
• Committee for the Care of Substance Users with HIV Infection
• Physicians’ Prevention Advisory Committee
• Pharmacy Advisory Committee

Evidence-Based Ratings for the Recommendations:

Recommendations in the guidelines are based upon scientific evidence and expert opinion. Each recommended statement is rated with a letter of A, B, or C that represents the strength of the recommendation and with a numeral I, II, III, according to the quality of the evidence. Because of ethical considerations of conducting randomized clinical trials in the field of HIV care, most recommendations will carry a rating of II or III with respect to quality of evidence.

The following rating scheme, developed by the Department of Health and Human Services, is used.

Guidelines Dissemination:

Guidelines are disseminated to clinicians, support service providers, and consumers through mass mailings and numerous AIDS Institute-sponsored educational programs. Distribution methods include the HIV Clinical Resource website, the Clinical Education Initiative, the AIDS Educational Training Centers (AETC), and the HIV/AIDS Materials Initiative. Printed copies of clinical guidelines are available for order from the NYSDOH Distribution Center.

Guidelines Implementation:

The HIV Clinical Guidelines Program works with other programs in the AIDS Institute to promote adoption of guidelines. Clinicians, for example, are targeted through the Clinical Education Initiative (CEI) and the AIDS Education and Training Centers (AETC). The CEI provides tailored educational programming onsite for healthcare providers on important topics in HIV care, including those addressed by the HIV Clinical Guidelines Program. The AETC provides conferences, grand rounds and other programs that cover topics contained in AIDS Institute guidelines.

Support service providers are targeted through the HIV Education and Training initiative which provides training on important HIV topics to non-physician health and human services providers. Education is carried out across the State as well as through video conferencing and audio conferencing.

The HIV Clinical Guidelines Program also works in a coordinated manner with the HIV Quality of Care Program to promote implementation of HIV guidelines in New York State. By developing quality indicators based on the guidelines, the AIDS Institute has created a mechanism for measurement of performance that allows providers and consumers to know to what extent specific guidelines have been implemented.

Finally, best practices booklets are developed through the HIV Clinical Guidelines Program. These contain practical solutions to common problems related to access, delivery or coordination of care, in an effort to ensure that HIV guidelines are implemented and that patients receive the highest level of HIV care possible.

Contact:

Tracy E. Hatton
HIV Clinical Guidelines Program
Office of the Medical Director
1-212-417-4617
teh04@health.state.ny.us

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