Aboriginal and Torres Strait Islander people are a priority population for hepatitis B (HBV) prevention, testing and treatment with current estimates of the prevalence of active infection between 2-4% in urban settings. The Victorian Aboriginal Health Service (VAHS) has provided universal childhood vaccination from the early 1990s. The aim of this project was to evaluate HBV-related clinical practice within VAHS through examination of clinical data including testing, immune status and follow up of chronic infection, and to implement evidence-based practice as per current guidelines.
This project was part of the REACCH collaboration. HBV testing data of all patients attending VAHS from 2009-2012 aged 15-54 were extracted from the clinical database (Communicare) using GRHANITE® software. All serological markers relating to HBV immunity and infection were examined. A chart audit was undertaken to further examine immune and infection status, and management of chronic HBV infection. Changes were implemented to improve testing protocols, target immunisation of those at high risk of HBV infection, and better manage those with chronic HBV infection.
Of the total 5427 individuals who attended the medical service within VAHS in this period, 815 (15%) were tested for HBV. Of those tested, testing in accordance with current guidelines, increased from 6.4% to 71.8% in the study period. The findings of the chart audit (n=279) were; 53% Immune Vaccinated, 22% Resolved infection, 20% Non-immune, 3% Chronic infection. The changes implemented were (i) a routine testing protocol (HBVsAb and HBVcAb +/- HBVsAg), (ii) addition of HBV immune/infection status as a Clinical Item in Communicare and (iii) development of a Communicare template and recall system to support management of chronic HBV infection.
Clinical audit and implementation of protocols consistent with current guidelines has improved HBV-related practice at VAHS.
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.