Background: People Living with HIV (PLHIV) who are transitioning from custodial settings are at risk of experiencing treatment interruptions and loss to follow up for vital HIV care. The NSW Persons In Custody HIV Community Referral Project (PICHCRP) aims to ensure PLHIV who are transitioning from custodial settings back into the community receive seamless HIV service, care and support.
Methods: PICHCRP working group members collated demographic and clinical data on PLHIV who were referred to the project using information from referral forms, feedback from clinicians and information from JH & FMHN & LHD (Justice Health & Forensic Mental Health Network & Local Health Districts) medical records. Data were then collated to examine common characteristics and themes associated with the population group.
Results: These data identifies demographic details of the 51 PLHIV who were referred to the project over a 23 month period. 16% (N=7) clients had multiple referrals. 25% (n=11) of clients referred identified as Aboriginal. 84% (21 of the eligible 25) clients were still linked in with HIV health supports six months after release from custody. 18% (n=9) refused access to PICHCRP services or were lost to follow up after release. 18% (8 of 44) of clients referred were re-incarcerated. Housing remains an important issue for PLHIV with only 39% (14 of 36) having secure housing on release. Further evaluation of the project by staff and clients identified a number of areas to develop engagement, care and support.
Conclusion: The PICHCRP systematises referral pathways for PLHIV transitioning back into the community from NSW custodial settings. The project also evaluates levels of engagement and contact with medical and psychosocial supports for this marginalised client group. Data illustrates the successful partnership between NSW Health LHD and JH & FMHN staff enabling streamlined service provision and improved client health and psychosocial outcomes. Finally, this presentation identifies practice methods which assist to challenge institutional barriers for this client group.
Adherence to combination antiretroviral therapy (cART ) plays an important role on treatment outcomes. The TREAT Asia Studies to Evaluate Resistance – Monitoring Cohort Study (TASER-M) collects patients’ adherence based on a Visual Analogue Scale. The aim of this analysis was to assess the rates of, and factors associated with, suboptimal adherence in the first 24 months of initial cART in Asian patients.
REACH was a collaborative research and practice initiative to develop evidence building frameworks, capacity, tools and resources with the Victorian HIV community partnership.
HIV disease is associated with chronic inflammation and activation of the innate immune system. This state, as measured using plasma markers of inflammation, persists following suppression of HIV viremia using antiretroviral therapy, and may increase risk of non-AIDS co-morbidities. The causes of innate immune activation in the setting of virological suppression are unclear. Natural killer (NK) cells are innate immune cells that kill virus-infected and transformed cells without prior sensitization. We have shown that NK cells are activated both phenotypically (elevated expression of HLA-DR) and functionally (increased spontaneous degranulation measured by CD107a surface expression) in virologically suppressed (VS) HIV+ individuals. NK cells also lose expression of CD16, the receptor which mediates antibody-dependent cellular cytotoxicity.
Regular HIV testing is recommended in men who take sexual risks. We assessed the relationship between perceived barriers to HIV testing, and frequency of testing among men who engaged in unprotected anal intercourse with casual partners (UAIC), to inform HIV testing strategies.
The majority of HIV diagnoses including delayed diagnoses in Australia occur among men who report homosexual contact – hereafter called gay and bisexual men (GBM). Delayed diagnosis is strongly associated with increased HIV-related mortality and morbidity. People who are unaware of their HIV-positive status may also be unwittingly transmitting HIV. We assessed trends in delayed HIV diagnoses among GBM in Australia.
HIV-associated leishmaniasis, endemic in the Mediterranean basin is a growing problem in India, Brazil and East Africa. Despite surviving for than 20 years, the clinical course of our visceral-leishmania (VL)-HIV co-infected patient illustrates several management challenges including diagnosis, speciation and drug resistance; monitoring burden of disease; access to and use of VL-treatments; end-organ toxicity and the combined immunosuppressive effects of HIV-VL.
Most Australian guidelines for clinical screening of chlamydia infection advise testing sexually active individuals aged 16-24 years. Recent research shows that age at first sex in Australia is decreasing; a recent Victorian survey showed 29% of respondents reported being sexually active before age 16 years. There is also evidence that younger age at first sex is associated with risk behavior such as unprotected sex and having multiple sex partners.