Background: HIV prevention and health promotion interventions operate at a number of levels ranging from individual through to broad community and structural levels. With the mobilisation of combination prevention, it is critical that we understand how the different levels work, and work in synergy. Methods: The ESAPP (Evidence Synthesis and Application for Policy and Practice) Project aimed to • Identify the areas of community HIV prevention where the published evidence of effectiveness and quality practice is most, modestly, and least developed; • Identify where the monitoring and evaluation methods used in day to day practice in community organisations to contribute to that evidence are most, modestly, and least developed; The project focused on concentrated epidemics similar to Australia. A systematic literature search was undertaken of recent published and unpublished articles and reports, and this was supplemented through liaison with key community organisations in Australia as well as Europe and North America. Over 600 documents were utilised in the review. Results: The investment in developing effective approaches to building evidence has not been consistent across health promotion approaches. While individual focused behavioural strategies have had the most attention, evaluation of key aspects of combination prevention at the community and structural level have had little investment. The evaluation of the synergies between strategies – central to combination prevention – has had even less attention. Conclusion: There is inconsistent evidence across HIV prevention and synergies of combination prevention are not well understood. Practitioners and policy makers need evaluation to be driven by an understanding of the program within a broader system and positioned as a quality improvement and strengthening processes. Without the strengthening and sharing the evaluation of interventions conducted outside of research trial contexts then most real time/real world evidence will be lost and result in policy and strategy based on incomplete evidence. Disclosure of Interest Statement: The ESAPP Project was funded by the Commonwealth Department of Health and Aging. The Australian Research Centre in Sex, Health and Society (ARCSHS) receives funding from the State, Territory and Commonwealth Government Departments. No pharmaceutical grants were received in the development of this study. ARCSHS is affiliated with La Trobe University.
The case is of a 30 year-old HIV positive Zimbabwean woman (UK resident) who arrived in Australia in January 2011 on a one-year working visa. She was diagnosed with HIV in 2003 in the UK and commenced on Atripla® in 2005. She was first seen in Adelaide in May 2011, requesting a script for Atripla.®.
Background: Liquid based anal Papanicolaou smears, followed by High Resolution Anoscopy (HRA) guided biopsies are increasingly being advocated to identify areas of High Grade Anal Intraepithelial Neoplasia (HGAIN). We hypothesized that the ability to identify HGAIN would increase with experience of the anoscopist, and that comparison with contemporary Papanicolaou smears might yield insights into technical abilities.
Indigenous Australians experience a greater burden of sexually transmitted infections, however are less likely than the general population to access sexual health services. We examined the effectiveness of an Indigenous cultural appropriateness audit in assessing a sexual health clinic with low rates of Indigenous clients.
Despite the high proportion of young people annually accessing general practices, including Aboriginal Medical Services (AMS), testing for Chlamydia trachomatis remains relatively low in urban areas. A project officer was employed within the Institute of Urban Indigenous Health (IUIH) to serve a mentoring and facilitation role for the SE Queensland network of AMS and their sexual health workers, with a view to improving testing, management and follow-up of chlamydia and other STIs by community controlled medical services.
Monocytes are a heterogeneous cell population having specialised functions and differing phenotype. They are a link between innate immune system and adaptive immune system therefore, to identify if immune activation exists in HIV-1 individuals with controlled virema and recovered CD4 T cell counts, we assessed cell surface monocyte activation markers (MAM) within the monocyte subsets.
Involving consumers in healthcare decisions is important for high quality care. We previously tested a brief, consumer-led intervention consisting of three questions in a trial employing trained, standardized patients. The intervention enhanced discussion of evidence and increased patient involvement. We now report a research translation study which tested implementation with real patients at a reproductive and sexual health clinic.
Case presentation: A 27 year-old Vietnamese man was diagnosed with HIV in April 2012 when he presented with cerebrospinal fluid (CSF)-culture positive Cryptococcus neoformans meningitis. CD4 count was 4 cells/µL and HIV viral load 228827 copies/mL. He was treated with two weeks of amphotericin B (0.7mg/kg/day) and 5-fluorocytosine (25mg/kg/QID), followed by consolidation and secondary prophylaxis with fluconazole. CSF cultures were negative at two weeks. A ventriculo-peritoneal shunt was inserted to manage persistently raised intracranial pressure and had to be replaced two weeks later due to bacterial shunt infection. Antiretroviral therapy (ART) was commenced after four weeks of treatment, and by September 2012, CD4 count was 107 cells/L and viral load 150 copies/mL.