REACH was a collaborative research and practice initiative to develop evidence building frameworks, capacity, tools and resources with the Victorian HIV community partnership.
REACH consisted of three areas:
• The development of a broad policy logic framework – which aims to simultaneously look at the project, program and prevention system to understand the role of and relationship between the various programs and projects in HIV prevention.
• Participatory action research to develop and trial program logic models and evidence building approaches with staff from five projects across three community organisations
• Capacity building of sector staff through a series of capacity building workshops and mentoring activities. To monitor the impact of these initiatives, the REACH project conducted, among other strategies, a sector survey of in November 2011 and November 2012.
results: The sector survey indicated some small shifts in organisational culture towards supporting and conducting evaluation. Evaluation was valued more as was staff involvement in evaluation activities, incorporating evaluation into project planning and support for staff to develop evaluation skills. There was increased desire to share skills and learn from other staff across the sector. Although the project achieved some of its aims, there were aspects that were less successful in achieving sustained organisational change and much has been learned from these challenges.
Conclusion: Once the momentum for monitoring, evaluation and learning (MEL) and quality Improvement (QI) has been created at a project level, it needs to be followed by strategies that will embed the organisational practice changes. There should be a shift towards working at a program, agency and sector level. This includes establishing networks of practice to develop, implement and support MEL and QI guidelines for priority areas such as organisational evaluation leadership, sustainable evaluation approaches, and inter-agency evidence sharing to maximise the role of combined HIV prevention strategies.
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.
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.
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.
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.
Early first sexual intercourse has been proposed as an important marker of later sexual and reproductive health. Discussions of what constitutes early sexual debut in this context, however, have been limited.