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.

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This presentation was given by Associate Professor Suzanne Belton from the Menzies School of Health Research.

A/Prof Belton presented data from the study using quantitative and qualitative data to capture clinical process and outcome data from a telehealth abortion provider, Tabbot telehealth service.

She explained that access to abortion in Australia is limited by several factors, especially in regional, rural and remote areas.

Since the TGA approval of medical abortion in Australia, only 1.5% of registered medical practitioners have obtained certification to prescribe.

Telehealth models of care have been found to work well internationally. The study looked at whether telehealth abortion was a safe, effective and acceptable option in Australia.

The study aimed to provide information to health managers and policy makers which can be used to inform a responsive reproductive health care system.

The clinical outcomes included efficacy and safety , and process outcomes included acceptability by women using the service.

The data showed that one quarter of women chose not to proceed with a telehealth abortion, but for whose who did, clinical outcomes were very good. No adverse events were reported.

Interestingly, of the 717 women in the study, only 8 (1%) and 2 (<1%) of women registering with the Tabbot telehealth service were from remote or very remote areas respectively. 296 (41%) of women were from major cities and 318 (44%) from inner regional areas.

The women interviewed reported high levels of satisfaction, privacy, quality of care and levels of support.

In conclusion, telehealth abortion is safe, effective and acceptable to Australian women who experience limited reproductive health service options.

A/Prof Belton also presented a comparison of three telehealth abortion services available in Australia. These included the Tabbot Foundation, Cairns Doctors and Marie Stopes. The Tabbot Foundations provided the cheapest option for patients at $250 (no medicare rebate). Aside from cost, the three services were found to be similar in the way they are set up and run and in terms of patient requirements.

The presentation provided some valuable insights into access issues for medical abortion in Australia, and innovative ways to help provide women with choices and improved access.

 

Closing Plenary - Is there a role for STI prophylaxis in Australia? Panel Presentations and Discussion

 

 

 


As part of the closing plenary, there was a panel on the role for STI prophylaxis and it's potential use in Australia. The concept of bacterial STI prophylaxis is similar to that of PrEP in preventing HIV infection, however the use of antibiotics instead of anti-virals (of course).

 

 

 

The consideration of this raises several differing points of view among panel members from a number of backgrounds. I myself initially considered the use of antibiotics in an age of increasing resistance to our current frontline antibiotics to be a potential issue. This was an eye opener into what could be a potentially very effective tool for prevention of bacterial STI's.

 

 

 




 

 

 

Facilitated by

 

 

 

Associate Prof. David Templeton, Senior Staff Specialist, RPA Sexual Health Clinic, HARP Unit, Kirby Institute.

 

 

 

Panel Members

 

 

 

Craig Cooper, CEO Positive Life NSW.

 

 

 

Dr Bridget Haire, Research Fellow, Kirby Institute, UNSW.

 

 

 

Dr Jeffrey Klausner, Prof of Medicine, Division of Infectious Diseases University of California.

 

 

 

Prof David Lewis, Director of Western Sydney Sexual Health Centre, NSW.

 

 

 

Chris Williams, Co-founder of PrEP'd for Change, Victoria.

 

 

 

Dr Kathryn Daveson, Staff Specialist, Canberra Hospital, ACT.

 

 

 

 

 

 

 

As with my previous reporting to panels, I will not attempt to assign particular quotes to people, lest I lose their ability to articulate their point, being from their particular backgrounds and expertise. Rather I will paraphrase the panel and draw attention to particular themes raised.

 

 

 

Pro

 

 

 

That there is great potential for a range of populations ie. MSM, but should be used in combination with other treatments.

 

 

 

Con

 

 

 

There may be issues with accessibility for clients to medications (rural/remote, clinics, ? GP's) and feasibility of executing programs effectively (time sensitive large scale dosing, organisation and adherence).

 

 

 

Pro

 

 

 

Targeted groups with Doxycycline could be effective. It has been proven to be safe for use (ie. treating acne in teenagers). There has been no documented resistance to Chlamydia or Syphilis (to doxycycline). The potential for doses post high risk episode has potential (ie. single dose 200mg doxycycline).

 

 

 

Con

 

 

 

From an antibiotic stewardship point of view, this can have issues. Already significant change in bacterial resistance to antibiotics, noted in some strains of STI's. Largely, Australia is yet to see this but it is becoming more of an issue.

 

 

 

Pro

 

 

 

There is a lot of interest from people in the PrEP community to opt into this type of treatment. Treatments such as this would help to diminish the stigma associated with STI infections.

 

 

 

Con

 

 

 

Outside of Sexual Health, antimicrobial resistance has already become a significant issue. Skin and soft tissue infections are becoming more significant and risks of sepsis from resistant bacteria causing significant issues in other areas of health.

 

 

 

Okay, I'll change my rule on quotes because there were two that were great.

 

 

 

"We think we're smarter than the bugs but we're not!" and (if you're concerned about microbial resistance "STOP EATING FACTORY FARMED MEAT AND FISH".

 

 

 

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This brings me to the end of my reporting from the ASHM HIV & AIDS Conference in Canberra, 2017.

 

 

 

I would like to thank ASHM for the opportunity to have attended this conference and recognise the efforts of all the organisers and presenters this conference. It was a fantastic conference with much learnt and I look forward to the conference next year in 2018 to be held in Sydney.

 

Thank you.

 

 

 

Lynda Carlye is a sex and relationship therapist and director of the Society of Australian Sexologists, Australia. Lynda has over 10 years experience in the field and presented a very engaging talk which looked at why 27.3% of women do not enjoy sex (Australian study of Health and Relationships)

Lynda kicked off her talk by going through the pathological and non-pathological reasons of vulvodynia which is a pain in one area of the vulva. Lynda established the importance of understanding the 237 reasons people have sex from the YSEX survey under the following four subcategories; physical, emotional, goal attainment and insecurity.

At a clinical service level, it is important that once organic causes have been ruled out, appropriate referrals are made within the multidisciplinary team which should include a solution focused psychosexual management/ treatment within a counselling framework for the individual and/or couple.  

Amongst many, Lynda recommended Dr. Anita Elias’s practical assessment and management tool that helps patients understand the connection between their thoughts emotions and physical sexual response.

Certainly psychosexual therapy is invaluable although public funding for this is limited and therefore a barrier for many. 

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The first ASHM conference symposium on HTLV-1 proved extremely insightful, as to date I had very limited exposure and education related to it. 

Numerous speakers provided comprehensive talks on this largely neglected topic. Two back to back session from Graham Taylor (imperial college London( and Fabiola Martin (University of Queensland) provided a great overview of the topic.

Like HIV, HTLV-1 is a retrovirus, however rather than triggering cell death, HTLV-1 triggers Tcells to proliferate. Where there is cell proliferation there is risk of mutations and malignancy. The virus is transmitted sexually, vertically and through blood exposure. 95% of those exposed are asymptomatic, however the virus may cause a HTLV-1 inflammatory syndrome characterized primarily by myelopathy. It also can eventually cause T cell leukemias/ lymphomas (emphasizing the importance of monitoring LDH and lymphocytes). Median age of onset of symptoms is 48, though its usually 7 years before patient present.

In terms of treatment steroids have shown improvement in the short term (though usually benefit does not persist beyond 4 wks. More recent studies suggest a role for steroid sparing agents with one showing at 48wks slight improvement in spasticity, walk tests, CSF VL and no increase in VL in the blood. Other more promising agents include AZT (for unclear reasons) in combination with interferon, and in Japan monoclonal antibodies to ccr4.

My take home message from this is in patients from endemic areas who present with a myelopathy, a HTLV-1 should be part of my routine work up.

Follow the Conference on Twitter with @ASHMMEDIA and with #ASHM17.

 

 

 

Day 1 ASHM HIV & AIDS Conference 2017 - Canberra

 

 

Day one, it's wet. Bring an umbrella. It is worthwhile to mention to the conference bag from SEW Conference bags, made by women in Tanzania living with HIV, they are made from recycled wheat flour sacks. It's a fair trade set up where employees are paid a fair wage, which is fantastic as well. They're pretty funky, I tried looking up their website but the domain expired a couple of weeks ago, so hoping it's only temporary. 

 

 

First up is the Opening plenary with Martin Holt and Denise Kraus chairing.

 

 

Acknowledgement of the Ngunnawal people on whose lands we meet with a welcome to country by Wally Bell, a Ngunnuwal man. Wally reminds us that if you take care of the land, the land takes care of you. I can't agree more with that sentiment.

 

 

 

A welcome from the government from Senator Richard Di Natale was next with a reflective Senator considering his own previous work in public health and HIV prevention in India prior to his career in politics. Senator Di Natale then spoke to how Australia was once leading in many ways for it's response to the emergence of HIV, the care and dedication of healthcare workers and how early implementation of Needle Syringe Programs helped stem infection rates. However we have more work to do as a nation, with examples given specifically as the still anticipated approval by the PBAC for PrEP on the PBS and that of our collective position as a leader in our region from a funding and policy standpoint with ending HIV. A final sobering example was given; the disparity between the Indigenous population and non-Indigenous persons. Among other indicators, preventable disease being five times greater in the ATSI population compared to the people not of indigenous background remains a stark reminder that we have far to go.

 

 

 

The Acting CEO of ASHM Scott McGill followed with his opening remarks and paying respects to Levinia Crooks who recently passed, who will be sorely missed. Later, In memoriam of Levinia Crooks will be conducted by Edwina Wright at the end of this session.

 

 

 

Dr Bridget Haire, President of Australian Federation of AIDS Organisations AFAO also welcomed us with again further reminders that work is yet to be done across the nation, highlighting that "Best practice depends on where you live". City to country, we have large gaps within our reach as clinicians despite the hard work we all do. A few take home messages for me, that advances in the field of HIV treatment, prevention and screening are not always technology based (such as the advent of home testing), but community based programs can be of even greater significance. Also, that we need to ensure equitable action to ensure proper prevention, screening and treatment.

 

 

The last welcome of the morning was from Cipri Martinez, President of the National Association of People with HIV Australia (NAPWHA). The important news that undetectable viral loads in people living with HIV means it is sexually untransmissible. This still has not resonated across society and the stigma associated with HIV still remains, to quote "letting go of our fears and the modern reality of U equals U".

 


I will end this post with Cipri's last quote, "People deserve our care, and our best. Thank you for continuing to care and welcome to ASHM 2017".

 

 

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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