The Nursing Satellite Session

The nursing satellite session at AIDS2014 was themed “Nurses Stepping Up, Stepping Forward and Stepping Beyond!” to link to the conference theme of “Stepping up the Pace” and to provide an opportunity for celebration of the how the work of HIV nurses globally has a significant impact.

Kim Carbaugh, Executive Director of the US-based Association for Nurses in AIDS Care (ANAC) opened the session with a reflection on the UNAIDS 90:90:90 goal – 90% diagnosed, 90% on treatment and 90% on treatment with an undetectable viral load. However, there has been a lack of discussion in the main plenaries, or in any sessions, about the role of nurses in reaching these goals – and with 80% of the global health workforce being nurses, as Kim said, “We can’t get to 90:90:90, without the 80.”

Denise Cummins, a community HIV nurse from Sydney, then discussed her work over the past decade volunteering in Nepal, providing harm minimisation education, clean syringes, workshops and mentoring to people living with, or at risk of, HIV.

Her key message was that all nurses have skills that they can share with those in need and encouraged participants to contact local agencies when they travel and offer to help, even if just for a few hours. Why? to challenge yourself, for cultural exchange, to share your skills, to make a difference, to make friends and to have an adventure.

A/Prof Jason Farley, from Johns Hopkins University (JHU) School of Nursing, Adjunct Associate Professor at the University of KwaZulu Natal in South Africa and UTS in Sydney, and Adult Nurse Practitioner (NP) at JHU spoke about his work in upskilling nurses to manage multi-drug resistant TB (MDR-TB) in South Africa. As the majority of TB in South Africa is diagnosed by nurses, and nurses initiate treatment for non-MDR-TB, the next step in scaling up the response to the TB epidemic was to train and support nurses to initiate MDR-TB treatment.

Jason and colleagues explored whether primary health care nurses were able to safely and effectively initiate treatment for MDR-TB in South Africa, with the support of decision-making tools. Following appropriate training, mentoring and support, the study demonstrated that negative outcomes were not increased and final treatment outcomes were not worsened.

The successes demonstrated in Jason’s program, are so well recognised they have been incorporated into the National Strategic Plan of South Africa on HIV, STIs and TB 2012-2016, “…all primary care, antenatal, TB and mobile outreach health facilities must become fully functional nurse-initiated ART and MDR-TB initiation sites for adults, children and pregnant women.”

A/Prof Jane Tomnay from the Centre for Excellence in Rural Sexual Health (CERSH), University of Melbourne, outlined the model for a comprehensive and coordinated rural sexual health service, incorporating a nurse practitioner (NP), a workforce development network, expanding access to condoms and building GLBTI friendly rural services. Jane explored the benefits and challenges with working in a rural setting and discussed the path to establishing a self-sufficient sexual health NP model.

Sandra Gregson, from the Victorian Aboriginal Health Service, then talked about the model of HIV care and management available to Aboriginal people at the 2nd oldest Aboriginal Health Service in Australia. Conducting about 200 HIV tests/month, the recent new diagnoses have mainly been in Aboriginal people who are injecting drugs. The health service provides holistic care, with allied health and others services available or linked, to aim to engage clients in the improvement of their health and wellbeing in the long term.

Carole Treston, Chief Nursing Officer at ANAC, closed the session with a discussion about the role of nurses in advocacy and policy. Her message was a clear one: nurses, as one of the most respected voices in the community, can have an influential and powerful voice as public policy advocates and should step up and step forward to have their voices heard.

The session was very well attended and the participants were so grateful to have a session focused on the work of nurses.

Nurses need to use the strong evidence base, established globally and locally, to justify their advocacy (and that of their supporters) around expanding the role of nurses in caring for people with HIV.

The nursing satellite session held yesterday morning at the AIDS2014 conference demonstrated the fantastic work of nurses Stepping up, Stepping forward and Stepping beyond in Australia, Nepal, the US and South Africa.

As A/Prof Jason Farley (from Johns Hopkins Uni) explained, there is a significant amount of evidence available to demonstrate that nursing care, delivered by competent and endorsed nurse practitioners (NPs) can have no adverse outcomes, can be cost-effective, and is acceptable to physicians and patients. As Jason put it so elegantly... "If we were a statin, based on the evidence to support us, we would be used more widely. There is less evidence supporting some statin use than there is supporting the role of NPs in HIV."

But nurses need to learn how to use and understand the evidence, and advocate as a united voice.

Tracey Cabrie, hep B CNC, presented this morning on the Integrated Hepatitis B Service, a pilot program based at the Royal Melbourne Hospital.

The program was set up with funding from the Department of Health Victoria, received following significant advocacy work from General Practice Victoria (GPV) and others in the sector.

There are 2 hepatitis B CNCs working part time in the role (0.6 FTE in total) to build capacity and support GPs in high prevalence areas of
Melbourne, to care for patients with chronic hepatitis B. The GPs/clinics collaborating in the pilot have high caseloads and are keen to be involved. A parallel ground swell of hepatitis B education is also providing primary care, more broadly, with the skills to upscale management and care.

For more information, contact This email address is being protected from spambots. You need JavaScript enabled to view it. .

Jac Clegg from Justice Health NSW presented today on the nurse-led model of care for hepatitis C – a safe and effective model for hep C assessment, management and treatment. The nurse-led model of care is led by clinical nurse consultants who use protocols to assess and triage patients.

The role of these CNCs also includes treatment education, initiation, monitoring of adverse effects and follow-up post treatment. Evaluation of the pilot has shown that there is a strong correlation between the triage category determined by CNCs and specialists, indicating nurses are appropriately triaging patients.

What would be the barriers to implementing a similar model in other settings, for example rural/remote environments?

Would other States/Territories establish a similar model in their prison systems?

I hope this successful pilot in NSW fuels the discussion of rolling out nurse-led models of care.

Ben Cowie, ID physician at the Royal Melbourne Hospital and Epidemiologist at the WHO Regional Reference Laboratory for Hepatitis B, Victorian
Infectious Diseases Reference Laboratory, presented a thought provoking session yesterday on actively linking epidemiology with public health policy and resourcing.

Ben explained that we have a responsibility to make the surveillance systems work for the individuals the surveillance system is capturing data on. He
advocated for using surveillance systems to deliver health outcomes, not just measure them.

Seems like a very logical message – so why don’t we do this automatically?

Despite a delayed flight, a bumpy trip across the Tasman and arriving in Auckland at 3:30am this morning, today’s Hepatitis Nursing Workshop (bolstered by several coffees) was a great start to the 8th Australasian Viral Hepatitis Conference. Initially, I was wondering how the Workshop would address the learning needs of both New Zealand and Australian nurses, however I felt that the speakers were very inclusive and considerate of different clinical contexts, and the concepts discussed were relevant to both sides of the Tasman.

Underpinning many presentations was an exploration of the viral hepatitis nursing role and how it is constantly being redefined. Val Honeyman, from the Hepatoma Service at Auckland City Hospital, presented on the recent and rapid change in her role, moving from absorbing HCC into her existing liver transplant coordinator role, to a dedicated HCC coordinator nursing role, to manage the increase in referral rates from 3-5/month in 2005 to 13/month currently.

Professor Ed Gane suggested that it won’t be long until nurse-led clinics will be managing cirrhosis and associated complications, not focusing on treatment as the role demands now. Janet Catt, Clinical Nurse Specialist from London, discussed the different prescribing models for viral hepatitis in the UK, including nurse and pharmacist prescribers and their role in prescribing triple therapy and managing the associated side effects. Janet also explained that all Fibroscan readings are conducted by nurses in her service. In the afternoon, Kelly Barclay from Hepatitis Foundation of NZ described the role of the new community based hepatitis nursing roles (and secondary care nurses), integral components of the new hepatitis C model of care pilot, coordinated by the Hepatitis Foundation of NZ. There was also frequent mention throughout the day of multidisciplinary teams and the benefits of working collaboratively.

The nursing role in viral hepatitis and associated complications is undeniably in a state of flux and it is exciting to see this discussed in an Australasian forum.

Thankfully, Val Honeyman also included in her session the point that research shows that caffeine intake reduces HCC risk, so in the interest of my liver health, I am off to find another coffee to see me through the evening.