Optimisation of Care in Vulnerable HIV Infected Individuals

"Each patient will be evaluated by~* An HIV physician~* A nurse~* A social worker~* A psychological therapist~* A cultural mediator/member of patients community if needed for migrants~Following these interviews and visits, a multisciplinary team will define for each patient an individualized OPTICARE program based on the following items: clinical, psychological/psychiatric, social status and follow up visits will be planned with the patient.~Regular (Day 15 and monthly) phone calls will be set up during the first six months of the OPTICARE program, to assess the clinical status and ART adherence.~Patients will have their medical, biological and social status assessed through visits at W4, W12, W24, W36 (medical and social status only) and W 48 with all members of the OPTICARE team."