tions in the rates of infection of HIV/AIDS. These services include, but are not limited to, primary medical care services (Ashman et al., 2002), substance abuse treatment (Turner et al., 2001), mental health services (Ashman et al., 2002; Davis, 2002), prevention counseling for the infected population (IOM, 2001a), and medical and social case management services (Laine et al., 1999; Ashman et al., 2002; Lo et al., 2002; Levi, 2002).

To fully support the management of chronic illnesses, a “chronic care model” has been developed and described more fully by Wagner (2001), Wagner et al. (1996, 2001), and Bodenheimer et al. (2002). In this model, chronic care takes place within three spheres: the community, the health care system, and the provider organization. The workings of each sphere can help or hinder optimal care. In the community sphere, community-based resources such as community support, social service resources, and policies provide critical linkages to provider organizations. In the health care system and provider spheres, the structure, goals, and values of the provider organization and its relationship with purchasers, insurers, and other providers are established. These spheres support critical dimensions of chronic care, including recognition of the patient and family as the source of control with the practice team collaborating and providing expertise and tools, the creation of a care delivery structure that is appropriate to the planned management of patients with chronic illness with clear roles for all staff, the integration of evidence-based guidelines into daily practice, and the development of clinical information systems that allow clinicians to plan care for both individuals and whole populations of patients and to monitor and receive appropriate feedback (Bodenheimer et al., 2002; IOM, 2002).

The management of HIV/AIDS is very similar to that of other chronic diseases. It requires coordination of care, clinical integration of services, and development of delivery system and community relationships. The management of HIV/AIDS also differs in important ways from the management of other chronic diseases. In this section, the Committee illuminates some of the similarities and differences in the managing adherence to diabetes and HIV/AIDS treatment.

In 2003, the American Public Health Association developed a comparison of the management of diabetes and HIV/AIDS as part of a Web-based document on Treatment Adherence to Antiretroviral Therapies: Recommendations for Best Practices (APHA, 2003). The comparison highlighted shared features and influences that influence adherence or utilization of treatment and features that distinguish between the two diseases that may complicate adherence. Table 5-2 provides an overview of these similarities and differences.

Experiences in promoting adherence in diabetes provide some lessons for promoting treatment adherence in HIV. The report identifies several



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