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An extension of the UNAIDS 90-90-90 target proposes >90% of people living with HIV (PLHIV) should have good health-related quality of life (HrQoL); however, limited guidance exists. The "Health Goals for Me" framework, an individualized approach to HIV care, provides a framework to assess HrQoL. We analyzed several patient-reported outcome measures (PROMs) to develop a practical toolkit to facilitate shared physician-patient decision-making. HrQoL subdomains, actionable in the clinical setting and measurable as PROMs, were selected. PROMs were collated through systematic literature searches, scored by the authors on usability, validation, and availability, after which practical recommendations were made. Nine subdomains were selected across physical, psychological, social, and environmental domains; 46 validated PROMs were identified. After pre-screening, from 39 evaluated PROMs, we recommended PROMs in the following subdomains: fatigue/energy loss, frailty/resilience, sleep disturbance, substance use, anxiety/depression, cognition, sexual function and desire, and stigma. Using this toolkit, healthcare professionals and PLHIV can collaborate and mutually agree on individual care objectives. Following the "Health Goals for Me" framework, appropriate care interventions can be implemented and reviewed in a continuous cycle. We discussed how eHealth interventions, which will have increasing importance in the post-COVID era, can facilitate improved HrQoL for PLHIV by utilizing toolkits such as the one described here. Implementation of this practical framework and the PROMs toolkit could provide a useful approach to assessing HrQoL in PLHIV and could enhance the physician's ability to gain valuable insights into the patient's daily life across a broad range of HrQoL issues.

BackgroundMarginalised communities such as homeless people, people who use drugs (PWUD), lesbian, gay, bisexual, transgender and intersex people (LGBTI), prisoners, sex workers and undocumented migrants are at high risk of poor health and yet face substantial barriers in accessing health and support services. The Nobody Left Outside (NLO) Service Design Checklist aims to promote a collaborative, evidence-based approach to service design and monitoring based on equity, non-discrimination and community engagement.MethodsThe Checklist was a collaborative project involving nine community advocacy organisations, with a focus on homeless people, PWUD, LGBTI people, prisoners, sex workers, and undocumented migrants. The Checklist was devised via a literature review; two NLO platform meetings; a multistakeholder policy workshop and an associated published concept paper; two conference presentations; and stakeholder consultation via a European Commission-led Thematic Network (including webinar).ResultsThe NLO Checklist has six sections in line with the WHO Health Systems Framework. These are: (1) service delivery, comprising design stage (6 items), services provided (2 items), accessibility and adaptation (16 items), peer support (2 items); (2) health workforce (12 items); (3) health information systems (7 items); (4) medical products and technologies (1 item); (5) financing (3 items); and (6) leadership and governance (7 items). It promotes the implementation of integrated (colocated or linked) healthcare services that are community based and people centred. These should provide a continuum of needs-based health promotion, disease prevention, diagnosis, treatment and management, together with housing, legal and social support services, in alignment with the goals of universal health coverage and the WHO frameworks on integrated, people-centred healthcare.ConclusionsThe Checklist is offered as a practical tool to help overcome inequalities in access to health and support services. Policymakers, public health bodies, healthcare authorities, practitioner bodies, peer support workers and non-governmental organisations can use it when developing, updating or monitoring services for target groups. It may also assist civil society in wider advocacy efforts to improve access for underserved communities.

Since HIV has evolved from being a fatal illness to a chronic condition, this brings new challenges relating to long-term health, as increasing numbers of people living with HIV (PLHIV) navigate their lives beyond viral suppression. This review presents the challenges facing patients and health-care providers managing HIV in Europe today. We highlight the challenges that the evolving landscape in HIV brings, including managing an aging and more diverse population of PLHIV; this requires a shift from managing disease to managing health and may best be achieved by multidisciplinary teams in the long term. We introduce the concept of "health goals for me:" an individualized approach to the management of HIV, and use this as the basis for a proposed framework for assessing health-related quality of life for PLHIV. Our framework comprises a continuous cycle of "ask and measure," "feedback and discussion," and "intervention," based on collaboration between the health-care professional and patient. For improved long-term management of PLHIV, we consider that this framework should become an intrinsic part of HIV care in the future and that the "health goals for me" concept be used as a tool to facilitate healthy living for PLHIV beyond viral suppression.

Introduction: Many marginalised, vulnerable people in Europe who are most in need of healthcare, such as migrants, sex workers, the homeless, people who inject drugs (PWID), prisoners, or LGTBI people, are amongst the least likely to receive it. This is owing to a complex mix of administrative and structural barriers, and often a lack of understanding or unintentional discriminatory practices by service providers. Innovative policy responses and a rethink of health service design, informed by the groups affected, are needed to address these inherent inequities. Policy context and objective: Sustainable Development Goal target 3.8 emphasises universal access to quality health services. Despite being at elevated risk of poor health, marginalised groups are underserved by health systems. Their exclusion from health service planning results in a misalignment between the service design and the users’ fundamental needs, which limits their uptake and effectiveness. The Nobody Left Behind (NLO) Platform provides a forum for community organisations to collaborate at European level to identify common challenges and solutions to improve access to integrated health and social services. The NLO Platform has developed a Service re-Design Checklist intended for use by health service providers and policymakers to design and deliver targeted services that are accessible to all, particularly underserved, vulnerable people, and for advocacy use by community representatives. Targeted groups: Migrant, homeless, PWID, sex worker, prisoner and LGTBI communities Highlights: The NLO Checklist resulted from project meetings, research and a policy incubation workshop at the European Health Forum, Gastein (2017). It provides a structured series of questions which service providers and policymakers should consider to ensure that health services are accessibie to target groups and to foster engagement with community representatives. Following the World Health Organization Health Systems Framework, the NLO Checklist comprises six sections. A). Service delivery (aiming to design and deliver an easily accessible service that meets the needs of target communities, considering design-stage issues, the range of integrated or linked services provided, accessibility and adaptation measures, and peer support. B) Health workforce (to prevent and address discrimination and ensure the workforce is enabled to deliver the service through education and training). C. Health information systems (to ensure the service is used and meets users’ needs). D. Medical products and technologies (to ensure that all service users have equitable access to care. E). Financing (to ensure the service is adequately sustainably resourced) and F). Leadership and governance (to ensure that community representatives are involved in the governance of a well-organised service). The Checklist is supplmented by an Implementation Guide. NLO Platform members are using the Checklist in ongoing projects. Conclusion: Marginalised groups are often described as ‘hard to reach’ whereas, from the perspective of users, it is frequently the services that are hard to reach. The NLO Platform is a unique collaboration between underserved communities facing common and inter-related healthcare access challenges. The NLO Checklist is a practical tool useful at the policy and local implementation levels to improve access to integrated services, in alignment with the SDGs and universal health equity principles.