ASHM Report Back

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.

Harris Cabatingan

Harris Cabatingan

I am currently employed with QLD health as a Clinical Nurse in a rural and remote setting at the Lotus Glen Correctional Centre (LGCC) for 3 years. I manage the Hepatitis C and B portfolio and in coordination with the sexual health team in Cairns, I also attend to the HIV positive clients, monitoring results of those in treatment.
With the current directive of making available the Hep C drugs in the PBS, the combined efforts of the sexual health team, and the coordinated work of the nurses with myself leading the portfolio, LGCC is now the first in Australia to achieve a Hep C free prison status.

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Are we there yet? Reaching global goals for HIV in Asia and Pacific Regions

Treatment approaches should also be within context of a country’s culture. Any approaches for it to work must be culturally appropriate. HIV and drug use are indeed global issues but unfortunately, successful approaches in first world countries does not automatically translate to the same level of success in third world countries. Take the Philippines as an example. MSM is an issue that is still taboo in many places, particularly in very remote places; therefore, collecting accurate data will remain questionable. Studies will always be one sided for not all views will be collected. Drug program and HIV intervention as mentioned, are treated separately for the reason stated above. Are we there yet? Certainly not. But until culturally appropriate treatment strategies could be devised, HIV will always remain a stigma and the 90-90-90 target will remain a long way from achievement.

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PrEP Implementation

Brent Clifton is the Manager of Gay Men’s Sexual Health Programs. He has taken us to the journey of PrEP implementation. They developed 2 models: Nurse led, and Peer led.

He described how on the early days, PrEP medications can be accessed through import from doctors and from reputable medical sites

That all changed on December 2015, when then Health Minister Jillian Skinner announced a landmark clinical trial on PrEP in NSW named Epic NSW ("Expanded PrEP Implementation in Communities"). A proposal was then sent from ACON to: support the implementation and rollout of the Epic-NSW Study; lead the education and increase community awareness of PrEP. These proposals included a PrEP mailing list, a full-time staff position to lead the community education of PrEP, holding community forums (9 in total were held), community awareness during Mardi Gras Festival and the development of the campaign “Is PrEP right for You?”

They have 2 clinical partners RPA Sexual Health and SSHC. Both centres deliver Nurse and Peer led programs. One of the key services offered was dispensing of PrEP medications on site. This program saw a substantial increase in enrolment within a month.

Some of the peer experiences  they had were feeling less anxious about sex, what will be the possible side effects? they had more conversation about STI, undetectable viral load and some comments like “I’m not high risk enough but still want PrEP.

Some of the take home notes are If we have enough support and education on marginalized population we will be able to eliminate HIV. The availability of PrEP is very crucial in HIV elimination.

Presented by Darren Russell: Associate Professor, Cairns Sexual Health Service

 

Darren mentioned in his report that of the 450 PLHIV attending Cairns Sexual Health service, 13% were Aboriginal and/or TSI. This number though not out of control, presented an issue for concern. In 2014, there was an outbreak in FNQ aka “the Cairns Cluster”. This outbreak was more predominant in the younger male population (18-30) and because these individuals are young and highly mobile, the threat of infection spreading was notable.  Other reasons elevating the risks are social disadvantage propagating poorer health outcomes, increased drug and alcohol use and low health literacy.

The HIV care continuum was used to guide treatment from detection to viral suppression. This care model enabled the team to observe how their Indigenous clients moved in and out of the treatment cascade influenced by personal life circumstances at a given time. This constant shift though multi-factorial, revolves around the social determinants of health such as income, housing, education and family situation. 

With gaps identified, the team came up with means on how to keep clients engaged in their treatment. An invidualised response is essential; support the client with their needs; have the consultation where the clients want it done (even under the tree!); utilise Aboriginal health workers to build trust and provide culturally appropriate care. The team also identified areas for improvement like expanding the multidisciplinary team to involve more members; Increasing contact tracing and linkage and finding novel approaches to make the service more available and appealing to the Indigenous members of the community.

 

A point that struck me as important and should be given great consideration when managing patient’s HIV treatment is that they be given all available treatment options and that their choice should come first before a practitioner’s favourable choice of treatment. This given enhances treatment compliance which could spell success or failure of therapy. The patients are the masters of their bodies and therefore the best source of information as to effectivity of treatment for medications affect everyone differently. Medication’s efficacy is not measured by the number of pills taken.

 

When a patient contemplates and opens about wanting to change their medication, these should be given appropriate consideration; alternative medications be discussed freely and effects both positive and negative be laid out. Viral load testing is not necessary in all cases unless the medication change is due to drug resistance.

 

Patient-centred care should be the gold standard for practice.

 

Jennifer Hoy: Director HIV Medicine, Alfred Hospital and Monash University

 

Most cities and countries have now achieved the 90-90-90 HIV target: 90% of people living with HIV (PLHIV) are diagnosed, 90% of HIV-positive people receiving antiretroviral (ARV) treatment and 90% of PLHIV have viral load suppression. Now a push for a 4th 90 is on the table – 90% receiving Quality HIV care.  

 

Jennifer discussed two perspectives on this approach to quality care: the patient’s and the healthcare provider’s perspective.

 

From a patient’s perspective, approaches to quality care can be measured through patient satisfaction surveys and reported patient outcome measures. Such reportable measures includes individualised patient-centred care encounters, experiences of HIV related discrimination and stigma and ease of access to care.

 

From the healthcare providers perspective, quality care means establishing appropriate management, monitoring and screening of HIV related co-morbidities, ensuring efficient care in a patient-centred manner delivery.

 

Adapting a new culture of quality of care improvement in HIV treatment would be crucial. This new culture is the key to future sustainability of this 4th 90% target, with clinical audit being its main driver. Clinical audit scrutinises care delivery at different care provision levels. Starting at individual healthcare level providers, to health care settings, the state level and to the highest national level. Vital shortfalls in care delivery could then be identified, feedback these outcomes, for crucial brainstorming of targeted intervention strategies. 

Therefore, to achieve this 4th 90% of HIV care which is ‘Quality of Care’, audits are important! The “measurement-intervention-measurement-intervention” approach to care, because viral suppression is not the end goal of HIV treatment. It is health-related ‘quality of life’.

 

 

 

Day 1: SARAH Bell - Research Officer, University of Queensland

 It is interesting to know of such a project in Queensland:  HIV Self Testing (HIVST) service.

 The aim of the service is to pilot and evaluate the efficacy of the program, determining if it increases access to HIVST particularly for gay and other men who have sex with men (MSM), infrequent and new testers and those in regional and remote areas. A model was formulated which includes recruitment pathways through dating apps, word of mouth, gay apps and social media sites; all designed to engage those mentioned population. Ordering of the HIVST kit along with a completed survey were all done on-line. They receive and return the kit. Once test was done, they receive a follow-up phone call giving contacts to organizational support if test was reactive and an option for test reminders if non-reactive.

 As of 30 September 2017, 630 kits were ordered of which 516 are from Queensland and the rest are from different states. Main reason stated for availing of the service was unprotected sex and test access convenience.

These are the preliminary results from the targeted population:

  • 71.9% reside in Major QLD city compared to only 1.4% from remote or very remote QLD.
  • 65% of gay and other MSM used the service.
  • 38.3% are those that have never had any form of HIV testing
  • 23.9% those who have had HIV tests done >12 months

In the light of these findings, it can be said that the service will be a success if rolled out state-wide or nationally mainly because of its dicreteness and test accessibility. However more should be done to somehow tap those in remote places and to also target Aboriginal and TSI populaion. These findings will inform further improvements to better the service and provide more access to marginalized population.  

 

 

RT @hepqld: Curing #hepatitis C is easy, and no longer needs a specialist to prescribe treatment. Community doctors play a pivotal role in…

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