Chlamydia infection is an important public health issue for young people, yet testing rates in Australian general practice are low. ACCEPt, a large cluster randomised control trial of annual testing for 16 to 29 year olds in general practice, is the first to investigate the role of practice nurses (PN) in maximising testing rates. We aimed to determine the current role of PNs, their opinions in relation to taking a role in chlamydia testing and the perceived facilitators and barriers to testing.
Structured in-depth telephone interviews were conducted with a purposive sample of 25 PNs participating in ACCEPt. PNs described a wide and varied role, with other clinic staff viewing them positively as a “link” between the doctors and other clinic staff. PNs identified a number of patient benefits to them becoming involved in chlamydia testing, such as an improved service with greater access to testing and feeling more comfortable engaging with a PN rather than a doctor. An alleviation of doctors’ workloads and expansion of the PN role were also identified as benefits at a clinic level. Time and workload constraints were commonly considered as barriers to chlamydia testing, both generally and for PNs, along with concerns around privacy in the “small town” rural settings of many of the clinics. Some PNs felt a lack of support from doctors as well as issues with funding for PN work could also be barriers. The provision of training and education and changes to pathology ordering processes would facilitate PN involvement in chlamydia testing, whilst some identified the development of a “formal” system of chlamydia testing, both on a clinic and national level, as facilitators.
PNs want to be involved in chlamydia testing and identify benefits in doing so. Strategies to facilitate their involvement and overcome identified barriers must be explored.
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.
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.
Gay men remain the primary population affected by HIV in Australia. While recent attention has been focused on increasing HIV testing and the use of antiretroviral-based prevention to reduce infections, it is equally important to sustain safe sex and other risk reduction practices. Increases in unprotected anal intercourse (UAI), for example, may counteract any beneficial changes in testing and treatment.