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.

Kathryn Bell

Kathryn Bell

I have worked in the field of HIV for 16 years around Australia and overseas. Currently I am working in the community, conducting health assessment and promotion activities, which includes education and support of PLWHA, in predominately low socio-economic areas.

As a nurse who has repeatedly encounter negative attitudes to PLWHA, by nursing students, I was looking forward to this presentation.

David Pickles presented research on the socio-cultural influences on the perceptions of nursing students toward caring for the people living with HIV/AIDS: Implications for Nursing Education.

Negative attitudes of nurses impacts patients. With the increasing number of overseas student, studying nursing in Australia, they bring with them beliefs from their home countries.

The interviews with the undergraduate students showed fear of transmission, myths & misconception, homophobia, responsibility and disparity. The quotes from the participants made it clear, some couldn't overcome their prejudice even with sound knowledge of HIV and its transmission.

The discussion afterwards was even more interesting, as different people spoke about how they had managed prejudice. Suggestions given included- calling out the prejudice, having PLWHA speak to students and having strong role models.

I agree with all the suggestions in the study and by the audience, but having worked in HIV for 20 years, I find it disappointing that we are still encountering this prejudice. When will the tide turn?

 

 

Two presentations. The first looked at the impact Lay Health Workers can make on male and female HIV transmission, contraception and ART take up in South Africa. The second looked at the effected of decentralising testing in Myanmar.

Low HIV Incidence amongst Pregnant and Post partum Women Receiving a Lay Health Worker HIV Prevention Intervention in South Africa.

Background

 

Each year 1 million woman in South Africa become pregnant. Of those 30% is HIV positive.

 

Study

 

Health Workers provide information, education and counselling to male partners. They also education on multiple partners, mental health, alcohol use, provide condoms as well as linking care for those found to be HIV positive. They offered circumcision for men HIV negative and referred them accordingly, as well as symptom screening of STI’s.

 

Outcome

 

There was a huge decrease in people needing treatment within the group, verses the background South African population.  Maternal HIV incidences 73-86% lower than previous studies. Community based HIV prevention was effective, and Health Workers were found to be highly effective.

 

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High HIV Positivity amongst other Vulnerable Populations Reached Through Decentralized HIV Testing and Counselling in Myanmar.

 

I found this presentation interesting, as it demonstrated how taking the test to the people is more effective than having the people come to the test. This will change my practice, as instead of providing information on where people can have a HIV test, I will investigate the possibility of having the test ready to administer to my patients.

 

Introduction

 

224,794 PLWHA in Myanmar live with HIV, which equates to 0.6% of the population. The key populations are People Who Inject Drugs, female sex workers and men who have sex with men. However HIV appears in other population groups, which are not being well serviced by the centralised testing program.

 

In 2014 HIV testing was decentralised. Since then, there has been a steady increase in testing. The number of people diagnosed with HIV steady decreased.

 

Results

 

There are high rates of stigma and discrimination towards PLWHA. High rates of diagnosis have been detected in miners, boarder regions, migrant works and mobile populations i.e. truck drivers.

 

Tailored services need to be developed to cater for the mobile population and increase access to testing for gold/jade miners.

 

 

I chose to review these two posters, as they both concern women, the first is about empowering through employment, the second is identifying the barriers to accessing services.

 

SEW Tanzania: Showcasing the Resilience of HIV+ Women in Tanzania. Lead author: Lees, N.

 

S.E.W. stands for Supporting Empowering Women, which is a social enterprise in Tanzania, which provides employment to HIV positive women.

 

The participants make conference bags from recycled wheat sacks and are provided with fair prices for their products. This shows them to be resilient, industrious and capable. By providing this work, S.E.W. seeks to end the stigma associated with HIV.

 

Examining the benefits to women living with HIV of a community organisation led research project. Lead author: Boughey, A.

 

Positive Women Victoria’s membership is increasingly becoming women born in Africa and the Western Pacific. They tend to be diagnosed later and often during their reproductive years.

 

The needs and preferences of this growing, culturally diverse population have not been effectively identified. With further research needed to identify the barriers to accessing services for the group.

 

 

Nurses on Placement: Primary Health Care Nurses undertaking Clinical Placements at Publicly Funded Sexual Health Services: Can it be done? Is it worthwhile? Lead author: Desreaux, C.

 

I found this poster very interesting, as STI testing seems to be limited to sexual health services and GP’s. If Primary Health Care Nurses were encouraged and educated to provide testing, would that increase testing rates? Also, how do I get a placement??

 

Introduction

 

The role of Primary Health Care Nurses (PHCN) is underutilised in sexual health care in GP settings. To expand their role, a pilot program was developed in which clinical placements at a publically funded sexual health service were offered. They were supported by mentors/supervisors, during the five half or full day observation placement. A series of questionnaires were completed by the participants and mentors before and afterwards

 

Conclusion

 

The program was well received by the participating nurses and mentors/supervisors. It is hoped that more support can be provided to the PHCN to undertake the placements and implement changes in the GP practice.

 

Several sessions of ASHM have compared Viral Load (VL) when patients are retained in care, vs those who don't. This session examines the results of the IEDEA Collaboration on VL in adults and children.

The IEDEA is an International Epidemiological Data Base, which gathers data around the world, grouped into 7 regions.

35,561 adults and 2,601 children (81% perinatal infected) from four regions were examined. They found 90% of adults had VL suppression at 3 years. Unfortunately the children didn't fare so well, with only 70-80% having VL suppression at the same time. Both of these data sets, were people who were retained in care. When people who were lost to care were added to the figures, the rates of VL suppression was much lower.

Conclusion: Adult patients retained in care have good VL suppression. Each region has different rates of VL suppression. The W.H.O. aim for 90/90/90 in children will be difficult as adherence is more challenging in this group.

Has Australia met the W.H.O. guidelines on preventing HIV Mother to Child Transmission (MTCT)? This session looked at the current guidelines for antenatal care, management and rates of transmission.

As I work with antenatal and postnatal mums, I was interested in seeing if the current practices have had a positive effect on transmission rates. The answer...yes we have met the guidelines and reduced the rate of transmission.

Australian guidelines

1) HIV testing is conducted at the first antenatal appointment.

2) Clinical care of the mother include; CD4, VL, STI screening, starting ART and resistance testing

3) Strategies at birth; ART for the baby immediately, mode of birth decided by maternal VL, formula feeding exclusively. Baby to have HIV testing at 6 weeks and 3 months.

Surveillance of perinatal exposure

Data reviewed for the 30 years 1986-2016. 714 babies born to mothers who were HIV positive.

The rates of perinatal exposures are increasing, however the rates of babies with HIV have dropped significantly.

Rates of HIV testing has increased dramatically, and the exclusive use of formula feeding has also increased.

Conclusion

There has been an increase in the number of HIV positive mothers, but a reduction in the MTCT. Australia meets the W.H.O. targets. Which is fantastic news!

Posted by on in Testing and Treatment

Encouraging people to test for STI, is an ongoing issue for all health services. These three posters trialled different ways to increase testing, with varying results. SMS, parlor and ads via websites proved the least effective, while pop-up at community events was effective and highly acceptable.

 

Evaluating the impact of Grindr advertising on website traffic and HIV testing at a regional sexual health clinic Lead author: O'Reilly,M. et. al.

This poster looked at the effectiveness of advertising on Grindr. It was found that a large number of people viewing the website clicked on the ad, however it didn't translate to visitors to the clinic.

The conclusion was that they redesigned their website to make online bookings easier and are exploring other ways to increase visitors to the clinic.

Pop-up Rapid HIV Testing at Community Events: expanding the PRONTO! Testing Model! Lead author: Ryan, K.E. et. al.

They explored the uptake, acceptability & development of pop-up HIV testing via field notes and client surveys. 

After 78 tests, 98% of respondents reported being likely to test again at community pop-up events. 22% had no previous HIV test. 

Pop-up testing at community events was successful and highly acceptable amongst those surveyed and will be used at future events.

Intiatives to Improve Sex Worker access to STI screening in Sydney Local Health District: Lead author: Hatten, B. et. al.

Two methods were used. The first was SMS messaging to send reminders to sex workers to encourage them to have their scheduled 6 monthly testing. The second was offering testing in a parlour setting.

Both methods were found to not significant impact the rates of testing. 

Posted by on in HIV Cure, eradication of HIV

Brent Allan spoke on the jading effect he feels, with the constant media reports of HIV "cures". He started by asking for a show on hands, to indicated how long it would be, before a cure would be available. The majority of the audience voted for 10-15 years.

He read several headlines from news report, published in the last week. These included "Cairns to trial HIV drug cure" which turned out to the trialling of PrEP. Unfortunately most of these headlines were from respected news agencies, which generates online discussion and the resulting analysis has a demoralising effect.

Brent also identified the need to provide hope for newly diagnosed HIV, even with these headline grabbing misinformation.

The session ended with an interesting question to the audience. If we expect a cure in 10-15 years, then what are we doing to help people living with HIV to transition to life without HIV? As positive as living without HIV sounds to me, for some who have lived with the virus for 20+years, they may lose their identify. 

This session of the Sexual Health Conference was musical and entertaining, starting with the music video of "Lady Sings it Better". It was played, to introduce the audience to the website:

www.iloveclaude.com  (this website is 18+, so check your kids are out of the room)

The target audience are Kink, BDSM, LBQ and sexually adventurous women, who have a high incidence of STI's and often feel culturally excluded from safe sex and health information/services. 

The website uses art projects (some sexually explicit) to entice woman to the website, then they can navigate to identify resources, events, testing, Q&A, health services and party packs (the last is posted to the persons house).

In the last 8 months, they have had an increase of 300% in traffic to the site.

The take home message

Woman who identify as not heterosexual have a higher incidence of STI's and risk behaviour, due a lack of targeted services, information and testing. As this demographic don't identify with the images and language currently used in woman's health services.

I see a need for an urgent rethink on how to engage this communitys needs for services/education/testing.

Posted by on in Testing and Treatment

This was a sponsored satellite symposium, held at the ASHM/Sexual Health conference. It consisted of a panel discussion which was chaired by Dr Norman Swan.

The question posted was- Can Australia be Hep C free by 2026? The short answer is....possibly.

Back ground

Hep C eradication treatment started this year. 20,000 people have been treated and by the end of this year 45,000. The bulk are patients were keen for treatment. Currently 82% of people with Chronic Hep C in Australia, have been diagnosed. This leaves 22% diagnosed. There is a dis-proportionally higher prevalence in the indigenous and incarcerated populations.

Resistance to treatment

Concerns remain in co-infected patients, that eradication treatment is difficult or may impact their HIV.These concerns linger from previous Hep C eradication treatments. They don't translate to the new treatment.

There are some drug interactions between ART and Hep C eradication treatment, however these can be managed.

Attitude change

An attitude change in government, patients and health care providers is required, to identify the remaining 22% of undiagnosed patients. This is needed, as without a significant reduction in Hep C in the general population, reinfection may occur. Re-treatment will then be required, and should be offered.

Hep C resistance

This has already occurred and needs to be avoided. Ways to prevent resistance is discussing with the patient to determine if they can access and afford the medication, for the entire treatment course. A wavering of the cost of opioid replacement therapy, needle exchange in prisons, nurse practitioner to subscribe treatment and patient education on preventing reinfection, will also contribute to preventing resistance.

Take home message

The uptake of Hep C treatment has been fantastic. Limit the opportunity for resistance by reducing the opportunity for partial treatment. Educating patients on preventing re-infection. Identifying patients who may have Hep C but never tested.

If this treatment to work, then we (and the government) needs to approach this treatment, like the Small Pox Eradication Program.

 

 

Please join us for a memorial event celebrating the life of one of Australia’s leading HIV advocates, Levinia Crook… https://t.co/N7dof5xaGa

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