Sexual Health morning Plenary and the REACH Programme: Engaging the vulnerable and hard to reach.

Day 2 Morning Session.

Good morning folks, welcome back. The sun is shining, its still a bit cold in Canberra but you wouldn't recognise the place. I started the morning with the Opening plenary for the Sexual Health Conference, some fantastic speakers with valuable insights. Prof. Kit Fairley from Melbourne Sexual Health Centre was a highlight (fantastic speaker) as was Prof. Gracelyn Smallwood speaking on Indigenous HIV and sexual health with her career highlights numerous. Not just an informative session but also very entertaining. Wonderful speakers.

Our last speaker for the morning was Dr Ayden Scheim from the University of California speaking on Trans Rights, sexual health and HIV, referring to the studies, or lack thereof, in regards to Trans people in HIV and Sexual Health research. This as another area where work needs to be done and the way in which we as clinicians or researchers attend this will greatly impact on our ability to be proactive and effective. If I say something from personal and professional experience, work with us, not on us.

I will get off my high horse now and am currently sitting in the next session with Leah Williams, a Nurse Practioner from Perth Hospital speaking on the REACH Programme where maintaining clinical contact with at risk patients more likely to not be presenting.

Normally where referred patients would be discharged from care after two missed appointments, the Immunology clinic sought a change in the structure of clinic visits which is REACH. Candidates were identified as living in metropolitan area, with a detectable viral load and who would avoid or miss clinical appointments.

A cohort of 108 patients was found for the programme, consisting of 65% men, 32% women and 3% people identifying as trans. The research found that the most hard to reach people were Australian and not  born overseas. Interestingly a number of these people were identified as attending the clinic weekly despite no appointments, an indicator that people felt safe to be within this clinical area and with staff. Collaborating with other services, such as Emergency Department presentations by REACH clients being notified to the clinic and staff being able to take the opportunity to engage with the client.

Once i the programme, REACH patients could turn up whenever they like, which was no different to many of their previous attendance. No appointments were made on the books and so no data on "Did Not Attend" was recorded, a huge plus to the clinics KPI's. Focus was on the presenting issues of the patient rather than making visits specifically HIV focused. Another important change was having clinic Administration staff aware of the clients being part of the REACH programme and no reason for a visit was necessary, another way of making clients feel welcome and the clinic appear more accessible.

The "Virtual Clinic" was one innovation of REACH where patient case files were reviewed weekly by a multidisciplinary team and any changes in care or needs were identified in order to facilitate the above changes and give appropriate patient care.Ensuring more support was avaialble to patients commencing new treatments early on and after diagnosis was identified as an effective strategy and client medications were also made available to be picked up from the clinic daily or weekly and use of webster packs to keep things simple and accessible again were effective changes.

In total, DNA rates were halved, patients were happy and were no longer discharged by the service and quality care was given to the patients. The take home message was that we make small tweaks ourselves to make things work becuase patients less likely to do so. Hahaha, so true.

Thanks for following me and looking forward to the second part of the day.