Loretta Healey

HIV result giving. Is it time to change our thinking

BACKGROUND Ensuring patients receive post-test discussion when collecting HIV test results is an integral component of the HIV testing process. New South Wales Health Department (NSW Health) policy recommends that all patients be given their HIV results in person. We assessed the number of patients who returned for HIV test results to Royal Prince Alfred Sexual Health Clinic in Sydney, Australia, and predictors of return. METHODS The files of 218 patients having consecutive HIV tests from the beginning of January to the end of April 2007 were manually reviewed. Non-consenting patients and those returning to the clinic for another reason were excluded. Multivariate logistic regression was used to determine factors associated with return for HIV results in person within 4 weeks of having the test. RESULTS Seventy-two of 159 patients (45%) returned for their HIV result within 4 weeks of testing. Independent predictors of return were male gender (P = 0.041), attending the outreach men-only (v. base) clinic (P = 0.017), first HIV test at the clinic (P = 0.002) and sex overseas in the past year (P = 0.048). CONCLUSION Over one-half of patients did not collect their HIV results in person and thus did not receive any post-test discussion. The strongest predictor of return for HIV test results was having a first HIV test at the clinic. Current NSW Health policy is failing to achieve high levels of HIV post-test discussion. For many patients, giving results by telephone may be a more appropriate strategy to ensure HIV post-test discussion.

Does the informal caregiver notice HIV associated mild cognitive impairment in people living with HIV

ABSTRACT HIV associated minor neurocognitive disorder (MND) may be difficult to identify as key signs and symptoms (S & S) may be due to other clinical conditions. Using a self-assessment booklet “HIV and associated MND” we recruited 123 people living with HIV (PLHIV) from three sites: two hospital HIV clinics and a sexual health clinic in Sydney, Australia. Patients may down play S & S. Caregivers may notice subtle changes. By including caregivers, we aimed to find whether the caregivers noticed S & S undetected by the PLHIV. This is a sub-study of a prospective observational multi-site study aimed to validate the usefulness of a patient self-assessment tool (HIV-associated MND booklet). Using the booklet, participants and their caregivers subsequently identified S & S of MND. Sixty-four per cent (79) did not nominate a caregiver to be contacted. Participants from 2 sites 44 (36%) nominated caregivers to be contacted. Twenty-five caregivers identified more than four S & S of MND. S & S reported most by caregivers related to participants being more tired at the end of the day (76%). Participants agreed (77%). Participants also reported that they found it more difficult to remember things such as taking medications or attending medical appointments (67%). The most agreed on symptom was the requirement for increased concentration to get the same things done (Kappa P 0.599 <0.001 and McNemar 0.289). For each question at least one caregiver identified a symptom when the PLHIV did not. Caregivers were more likely than participants to report irritability and communication difficulties. It is important to include caregivers when investigating PLHIV for MND, as caregivers may validate the experience of the patient, and may also be uniquely placed to identify S & S not otherwise identified.

Efficacy and acceptability of an intervention for tobacco smoking cessation in HIV-positive individuals at a public sexual health clinic

The negative health impacts of cigarette smoking have particular relevance for HIV-positive individuals who have high rates of smoking1 and elevated risks of cardiovascular disease and some malignancies.2 Counselling and nicotine replacement therapy have been shown to be effective in smoking cessation.3 These interventions were offered free to HIV-positive individuals at a publically funded sexual health clinic in Sydney in an effort to curb the comorbidities associated with smoking. Between January 2010 and November 2011, 41 HIV-positive male smokers were enrolled in a smoking cessation programme at RPA Sexual Health. Participants were asked to return at 6 and 12 months post-treatment for …

Short message service broadcasting to improve the uptake of influenza vaccination in HIV-positive patients at a metropolitan sexual health clinic

A trial of using Short Message Service (SMS) broadcasting at a metropolitan sexual health clinic in 2013 to promote the awareness and uptake of influenza vaccinations in HIV-positive patients resulted in a significant increase in the number of patients contacted (35% vs 81% P<0.0001) and vaccinated by the clinic (26% vs 47% P<0.001) compared with 2012, when individual telephone calls were made to patients. Additional benefits were less staff time used promoting influenza vaccination and the resultant lower staff cost. SMS broadcasting is an efficient and inexpensive method of communicating health messages to large numbers of patients.

HIV Results: Practice at Public Sexual Health Clinics in New South Wales

New South Wales (NSW) Health guidelines recommend all HIV results be given in person, however this practice fails to achieve high levels of result collection. Fourteen of all 38 NSW public sexual health clinics (37%) surveyed offer HIV results by telephone to low-risk patients, although all positive results are given in person. Efficiency of result-giving, accessibility to results, patient acceptability and awareness of more flexible national guidelines were cited as reasons for varying practice from state guidelines. NSW guidelines require revision to allow clinicians to determine the most effective and efficient mode of HIV result delivery to their patients.

Retaining HIV-positive patients in HIV care: a personalised approach for those at risk of loss to follow-up at an inner city sexual health service

In 2013 a personalised approach to follow-up of HIV patients who had withdrawn from HIV care was taken at RPA Sexual Health, a Sydney metropolitan sexual health service. HIV patients were telephoned, sent text messages, emailed and sent letters multiple times where applicable. With this intervention 20 of 23 people who had withdrawn from HIV care re-engaged. Since that time, active follow-up of all people diagnosed with HIV has resulted in only 2% of HIV patients at RPA Sexual Health being lost to follow-up.