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.

Testing and Treatment

Individual benefit as well as prevention benefits.

But do they really need to start that day, or does a few weeks matter?

Rapid intervention in the US combined the first few visits into one to initiate treatment earlier.

Of 227 patients in a clinic 39 underwent rapid initiation.

70% of participants had acute HIV.

All had no insurance.

90% opted to start ARVs on the first day.

1 in 4 required a change in their ARVs within the first 18 months compared to none who were not recruited on to rapid intervention.

The rapid intervention group still had to attend multiple times for a variety of reasons.

High dropout rates in the rapid intervention group.

Posted by on in Testing and Treatment

The Empowered patient by Lance Feeney,Positve Life NSW, Australia

Factors influencing patients decision making: One of the major factors that influenced patients decision on starting treatment was having a trusted, educated and engaged HIV doctor who explained treatment and care options and provided quality advice. In a survey conducted by positive life NSW 57% would go with above option as one of the most important factor influencing them starting on treatment. Other factors include articles from publications, via internet and community HIV agencies(33%) and advice from other PLHIV (10%)

What makes it difficult HIV? 20% say they have no factors making it difficult to reach an informed decision about HIV treatment and care, however 80% do. Majority worry about its potential side effects, drug interactions with non-HIV meds and their impact on long term use. Other factors include lack of information on new treatments, information being too technical and difficult to understand. there were a few who did agree that the Stigma and discrimination associated with HIV itself is an independent factor that will influence their treatment and care.

 It was interesting to know that patients rather preferred Drs with professionalism( open, motivated, engaged, non-judgemental and listens and discusses issues) and a relationship built on mutual respect, trust and confidentiality over Drs with competency (educated and up to date with HIV care and the management of otherb health conditions).

Notes from talk stream:

Men who have sex with men are at significant risk of HPV related anal cancers. HIV negative MSM are at an estimated 20-40x risk and HIV positive MSM are at 100x risk!

HPV Vaccination is going to be one of the keys to help reduce this risk.

Many gay men have not been vaccinated for HPV and this is a key move that can help reduce incidence.

Many doctors are not doing DRE to examine for any anal lumps.

It's a simple, cheap and easy exam and can detect early anal cancers from 0.5cm diameter.

Early detection <1cm results in simple surgical treatment that may not require chemo/radiation therapy.

HIV positive men should be offered annual DRE and HIV neg MSM every 1-3 years.

Anal Paps are difficult to fully roll out at the moment as many early anal changes will self regress. Sadly anal colposcopy services are very limited currently making this one area of bottle neck in evaluation of early anal lesions.

This session has absolutely changed the way I will be practicing and caring for my MSM patients from today!

Good resource for futher information for both doctors and clients is this site created by AFAO.

http://www.thebottomline.org.au

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. 

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.