Summary

Immunizations are a crucial component of comprehensive primary care for persons living with HIV infection or AIDS. Recommendations for immunization are provided in the DHHS Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents, the IDSA clinical practice guideline for Vaccination of the Immunocompromised Host, the IDSA clinical practice guideline on Primary Care Management of HIV-Infected Patients, and adult immunization guidelines from ACIP and from the CDC. The DHHS guidelines are updated regularly and provide a key resource to identify the specific immunization recommendations for persons living with HIV infection or AIDS. Although the responsiveness to vaccines may be reduced in persons with immune deficiency, their risk of disease is higher and the population of persons living with HIV infection or AIDS is more likely to benefit from immunization than the general population.

Prior experience has shown that passive approaches to immunization that rely on the initiative of the practitioner alone lead to inadequate rates of immunization in the population. The CDC has outlined a 4-part strategy, called AFIX (Assessment, Feedback, Incentives, eXchange), to improve immunization rates.[72] The AFIX strategy is described in Table 2.

The proliferation of electronic medical records (EMRs) has made it feasible to give health care practitioners systematic assessment and feedback regarding immunization status. Care transitions and the lack of standard systems for communicating immunization histories remain barriers, however. Efforts to facilitate this information transfer and commitment on the part of health care practitioners and ancillary staff to record information in a manner compatible with the EMR assessment and alert features are needed. To improve performance through incentives and systematic exchange of information regarding best practices, it is first necessary to make immunization a priority for improvement in a practice. Educating practitioners regarding the benefits of immunization and the gaps that persist is a key first step.