Presentation by Ruth Hennessy showed a study in a Sydney based HIV clinic.  This demonstrated a higher level of mental health issues, depression, anxiety, suicide, alcohol and IV drug use, social isolation in people who are HIV positive.

It was also found that these client has issues compliance to treatment in general thereby mitigated against optimal care

 Considering this complex association between HIV and mental health illnesses it is suggested that;

-          A multidisciplinary intensive specialist care should be adopted in caring for people with HIV

-          Establishing guidelines for identifying patients who will require extra supports and appropriate referrals will ensure adequate care for people living with HIV

Wonderful talk by Prof. Gracelyn Smallwood who brought in her wealth of experience and activism to elucidate the sexual health burdens faced by the indigineous populations resulting from inequities in health care due to unfavorable governmental policies that has long disadvantaged the ATSI

Everyone will agree that for equity in health care to be achieved in the country as a whole, governmental policies has to be aligned to carter for the disproportionate distribution of social determinant of health which includes; social/physical environments, education, access to health services, health literacy, housing and employment amongst the ATSI

Mark Bloch elucidated several advantages of rapid self-testing which includes

1.      Privacy

2.      Convenience

3.      Short time interval to obtain result

4.      Less anxiety period prior to knowing test result

5.      Easy to use in remote communities with little or no access to health care

Results of the NSW study demonstrated a high uptake and usability of people performing a  rapid self-testing and also correctly following all the steps.

 Clinicians are still concerned about commencing treatment based on results of this self-tests which is also self-reported by patient.

 Example, after a patient self-tests, how will a clinician have documented evidence of test result in patients chart prior to commencement of therapy or even referrals to a specialist

In addition, after a positive self-testing and a patient fails to present for treatment, how can one ensure follow ups.

The Atomo device would undoubtedly improve access to HIV testing but much work has to be done regarding guidelines to clarify concerns as above to make it universally acceptable

I enjoyed the talk given by Natalia Edmiston on predictors of unplanned admissions.

It was surprising to note that studies have shown that most unplanned admissions amongst HIV infected people were due to multi-morbidity rather than HIV specific factors.

Natalie, also demonstrated that recommendations from the NSW studies is in keeping with other international studies such as National Institutes for Health and Care (NICE) guidelines.

Recommendations:

-          Clinicians should consider a mult-morbidity approach to care in treating people with HIV

-          Obtain a CIRS score at entry to care and update this annually

-          CIRS score is a very strong predictor of hospital admissions in HIV positive individuals

Prof Georg Behrens discussed the impact of co-morbidities in HIV patients.

This is relevant in every area of care in people with HIV but I was particularly interested in the pathophysiology of HIV and co-morbid conditions.

The speaker stated that HIV infections is associated with varieties of co-morbid conditions including; Hepatitis B virus, Diabetes, Cardiovascular diseases, Myocardial infarctions, Osteoporosis and Cancers.

These co-morbidities are as a result of chronic inflammation which stems from the virus infection

Keeping these in mind, a whole patient approach is important in the care of people with HIV.

In addition to treating the virus, attending to the co-morbid conditions is necessary for optimal management of HIV patients.

Commencing antiretroviral drugs early (“Starting early”) will lead to immune re-construction and a fall in CD4 counts and further improve life expectancy in HIV patients