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.

Katherine Garnham

Katherine Garnham

Katherine is a Sexual Health and Infectious Diseases dual trainee, currently working in Brisbane. She has a strong interest in HIV medicine and health equity, and hopes to continue working in less resourced healthcare settings at a national and international level.

Presenter:  Professor Donna Mak

Given my own interest in gonorrhoea, it has been fascinating hearing what is happening in other parts of the country.

Here, Professor Mak presented the WA epidemiological data.

She noted that whilst rates remained highest in the historically high incidence ATSI group; these rates were relatively static.  The highest rate of rise of incidence was observed in heterosexual urban females.  The age group of highest incidence has shifted from the younger 15-24 age group to the 25-34yo age group.

They have an enviable program which allows them to assess the proportion of positive tests with the denominator of all requested pathology (apart from a single laboratory) and noted that the percent of positive tests are rising. 

From 1st July 2017, enhanced surveillance for gonorrhoea has been implemented in WA; which involves a fax to the test provider with treatment recommendations and contact tracing recommendations plus some data collection.  If there’s no response, in certain groups follow up will be implemented: that is if the patient is under 16, tested by corrective services, ATSI, pregnant, a sex worker or client, outside Metro Perth, homeless or tested in hospital or by an after hours GP. 

Strains circulating in ATSI populations seem to remain sensitive to triple ‘zap packs’ of amoxicillin, azithromycin and probenecid; whilst urban populations are being treated in line with dual therapy recommendations.

 

 

Presenters:  Rekha Pai Mangalore; Shu Jin Tan; Prianka Puri; David Griffin.

The early bird not only got the worm, it got fungi, bacteria, a host of psychosocial and engagement challenges and Haemophagocytic lymphangiohistiocytosis.

The case presentation was a wealth of diagnostic and treatment dilemmas in late presenting, immunosuppressed patients.  All were from different parts of the world, and all proved Higgins Dictum will always hold true in immune suppression: Patients can have as many diagnoses as they damn well please.

Cases included disseminated histoplasmosis; HLH driven by HIV with concomitant nasal NK/T-cell lymphoma; a cryptococcal IRIS unmasked by ART initiation in an unscreened Australian gentleman; and a challenging tertiary syphilis involving gummatous and neurological disease. 

  

 

Posted by on in Public Health and Prevention

Presenters:  Dr Llloyd Einsiedel, Shane Schinke, Professor Damian Purcell, Dr Genoveffa Franchini, Professor Graham Taylor, Dr Fabiola Martin

 

A truly amazing and well rounded session on a disease which has been around since the 1980’s.  Although it’s endemic to many parts of the world, including a high prevalence area in Central Australia, causing high burdens of morbidity with progressive and irreversible neurologic, pulmonary, inflammatory and immune diseases, there are no targeted therapies and it is not widely known in Australian health sectors.

 

All the speakers had considerable knowledge in identification, treatment and research of HTLV-1.  We were truly fortunate to hear from Shane Schinke, a long serving remote area nurse, who shared his own story of HTLV-1 associated HAMS/TSP which currently has him wheelchair bound. 

 

Key Points:

·      Endemic in central Australia (HTLV-1c subtype), and many tropical regions of the world

·      Causes adult T-cell lymphoma, pulmonary, neurological changes

·      If suspecting: Diagnose with a Western blot and request HTLV-1 pro viral load

 

·      More awareness and research is vital

Continuing the theme of acknowledging our own societal disadvantages and the urgent need for equity, the Sexual Health Opening Plenary featured Professor Christopher Fairley discussing his own encouraging and inclusive professional ethos. 

Key Point:  ‘Be nice, but not soft’

 

 

Next, Professor Gracelyn Smallwood from Central Queensland University, an Indigenous clinical nurse, midwife, activist, world traveller and ceaseless advocate shared her story.  I can’t be the only one there who wished she was my ‘Auntie Grace’, as she unravelled the burden of history currently contributing to growing inequity in our Indigenous, regional and remote communities. 

Key Points:

·      The disproportionate health burdens existing in ATSI communities are a result of societal breakdown

·      Equity will not be achieved until social determinants of health – employment, education, housing – are addressed collaboratively at a policy level, informed by grass roots knowledge

 

·      We must reconcile with historical truth

A/Prof Darren Russell: Complexities of providing prevention tools to a vulnerable population; Lessons from an outbreak in young Indigenous people in FNQ

 

A look at the rise in HIV cases in Indigenous Australians in Far North QLD with more than 30 cases since 2014.  This has come hot on the heels of the local syphilis outbreak in 2011, where over 1000 cases and 5 congenital syphilis cases were reported.

 

Darren talked about the public health and clinical response, which had to overcome barriers to treatment and engagement.  The community and individual cultural and social responsibilities can mean avoidance of care that might cause shame.  This is compounded by remoteness, low levels of health literacy, employment, housing, financial and substance issues.  Despite being a significant at-risk group, PrEP knowledge and use is scarce.

 

 

What stood out is the importance, and the difficulty given history, of building healthy, trusting community relationships.  The gap is not yet closed, but in some areas widening.

This whirlwind run with two enthusiastic and knowledgeable presenters reinforced that implementation of Evidence Based Medicine means clinicians need a basic understanding of how the data is being collected, sifted and analysed to provide treatment recommendations.  I’ve just completed (with some difficulty!) an introductory biostatistics university course and was looking forward to consolidating the knowledge.

First, Professor Matthew Law gave a rundown of the basics of statistical inference.  His Key Points:

      5% of all studies with a significant finding have occurred by chance – thinking of all the studies in all the journals in all the world, this is a sobering perspective!

      Look at confidence intervals to get an idea of how precise this estimate is – narrower is better, but crossing the ‘no difference’ value negates significant p-values.

      Failure to reject a null hypothesis doesn’t mean the null hypothesis is true.

      One tailed tests suggest mathematical jiggery-pokery and should be approached with caution!

Next, an explanation of what the different types of models and tests all mean, by A/Prof Kathy Petoumenos.   She ran through the differences in variable types, model types, and how to interpret reported calculations such as relative risk, odds ratios and hazard ratios.

Her (very reassuring) Key Point: Ask a friendly statistician!

 

 

In this era of information galore, KPIs and rapidly evolving evidence base, we as clinicians should consider basic statistics knowledge for ourselves mandatory, and biostatisticians part of our multidisciplinary team.

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

ASHM ASHM