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It has been a wonderful yet wearing conference attended by over 23,000 people. We now look forward to the AIDS 2014 conference in our own Melbourne, Australia.
A key cross-cutting theme for me, wearing my hat as a general practitioner, has been the challenges current and in the future in managing the intersection caused by aging, HIV and non-communicable diseases (NCDs).
Australia continues to struggle with its approach to chronic and complex disease care. Does it increase verticalisation and place extra burdens on hospital based services? Many patients find the work of multiple presentations to specialists to be overwhelming and unachievable. Or can we continue to build comprehensive primary care level teams comprising general practitioners, practice nurses and community nurses along with various allied health professionals?
Will Australia be able to embrace the opportunities and challenges of task shifting? Can different tasks be reallocated? The appropriate balance between self management, primary, secondary and tertiary services is a question of great importance. This is both a challenge in Australia and even more so in low and middle income countries where the only part of their system oriented to chronic care is that modeled by HIV services. There are many opportunities in operational level research ahead.