Victoria Hounsfield

Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.

HIV and Migration: All is NOT fair in Love and War

Posted by on in Global issues, HIV in developing setting
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Slightly belated report back from Friday morning's session.

President of AFAO, Dr Bridget Haire opened this session - in the absence of Dr John-Paul Sanggaran, the former Medical Officer, Christmas Island, Queensland. Bridget read extracts from a moving letter Dr John penned to highlight to governing bodies the multiple inadequacies in health management of HIV testing and treatment on Christmas island.

In it he pointed out that often an HIV test result takes at least 1-2 weeks due to logistical factors, by which time the patient has usually been "processed" and moved on to another island and so they will not receive their result in time.  If the HIV result is positive then there are further problems once the patient has been tracked down, as they have been transferred to places such as Nauru where treatment access and roll-out is sub-optimal.  He then described how HIV positive refugees on the island had often been placed in the "White Building" - usually reserved for people with behavioural difficulties.  His experiences really highlighted the challenges faced by clinicians and patients alike, in difficult health care settings, in stark contrast to my own, well resourced Sexual Health Clinic in Sydney.

Then in the second session Dr Kathy Petoumenos presented findings from the ATRAS Study Group: The Australian HIV Observational Database Temporary Residence Access Study, of which several patients from my clinic have been gladly enrolled.

The NAPWHA group engaged various pharma companies to provide free ART to 180 medicare-ineligible patients for up to 4 years.

This study aimed to determine reasons for Medicare ineligibility, time to become eligible for HIV treatment on Medicare, and assess their long-term clinical outcomes once on ARTs. Enrolment was from 2011 - 2012. Results from the 24 month findings were presented.

Interesting results from baseline showed that 73% were male, most common visa status was Student Visa (34%) and 63% of the cohort had experienced prior ARTs (either as self-funded, trial participant, origin country or compassionate access).

Encouragingly over the period of the study, the mean CD4 count increased from a baseline of 376 to 534 at 24 months. Even more pleasing was that the percentage of patients with an undetectable viral load increased from 47% at the start of the study to a fantastic 94% at 24 months, with 100% of females achieving undetectable viral load.

So far 74% of participants have dropped out as they became Medicare Eligible, 17% have gone overseas and 9% were lost to follow up. Students were least likely to have stopped requiring ATRAS medications.

In the 2nd part of the presentation the group attempted to estimate cost benefit of expanding ARTS to all medicare-ineligible patients. The survey findings estimates there are approximately 450 medicare-ineligble HIV clients in Australia.  After 2 years patients with a detectable viral load reduced from 53% to 6%.  i.e. a 93% risk reduction in onward transmission of the infection.  Thus 81 new infections would be averted/ 5 years. 

Mathematical modelling using these figures shows that expanding ARTS access and treating all the temporary resident HIV+ population was determined to be at least cost-neutral - i.e. it saves as much as it costs.   Of course, the public health benefit and the benefits to the HIV-supressed individuals alike is so much more than that.

Aaron Cogle (Exective Director for NAPWHA) pointed out that medicare-ineligible people are not recognised as a priority population nationally, this and other federal and state barriers to ART access need to be tackled imminently.   If universal test-and-treat policy is to be realised then this population needs to be included.

Atras Ceases Nov 2015.

Sadly I was unable to attend the last presentations in this session as I had to catch my flight.

What a great conference, see you all in Adelaide (and Rio) and thanks to all or any who managed to read this far into my blog!!

 

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Guest Monday, 21 May 2018