Fresh Conference News

posted: 25/02/2011

HIV Conferences come in different sizes and the biggest this year is CROI, in Boston, USA, which begins this Sunday. This conference is about understanding, preventing and treating HIV.
 

Among this year’s main attractions will be the latest about using antiretroviral drugs to prevent HIV infection, new drugs, and treatment when people also have hepatitis C.
 

Keeping Informed

NAM has writers who will report the news on their website. The CROI conference website has its own webcasts and summaries.

You can read NAM’s conference bulletins on their own web site.

You can also sign up for NAM’s email conference news bulletins here – at the bottom right of the page: a daily email news bulletin over the four days.

HIV Teenagers to Adults

posted: 21/02/2011

Older teenagers with HIV are our HIV pioneers because they are the first generation of young people growing up with HIV. Being the first at anything is often exciting, but with HIV it can be much less fun and more of a struggle.
 

Making the change better

The Children and Young People HIV Network are working to make it easier to move from being a teenager with HIV to being an adult with HIV.

Young people with HIV have two main challenges 

• growing up from a child to adult with HIV (e.g. beginnning sex and relationships with HIV)
• moving from children's HIV clinic and education, into adult HIV services and employment or claiming benefits with HIV.

The Children and Young People’s HIV Network have now finished checking all the expert articles and books about changing from child to adult with HIV in a ‘literature review’.

They looked to learn lessons about improving the change from child to adult, including learning from experience with other conditions like diabetes and epilespy.

The HIV child to adult change literature review is here 

The review 

• has statistics about young people with HIV in the UK
• finds existing policies and guidelines for the child to adult change
• looks for useful lessons from other longterm conditions, like diabetes
• considers the needs of carers and family
• considers rural areas with very low numbers of young people with HIV.

Professionals tell us

Last week we pointed out the useful article where HIV health workers describe helping teenagers to make the change from child to adult with HIV, which is in the 200th issue of HIVTreatment Update.

Teens talking life with HIV
Two young people making these changes talk about their own lives. JD Bailey (20, female) talks about growing up with HIV, and Max, (19, male) talks about telling others about HIV
 

‘Transition of care from a paediatric to adult setting is not specific to HIV … However there are important differences … with HIV which may make this process more difficult’  Lyall, 2007.

Better Primary Care for HIV

posted: 11/02/2011

How should HIV clinics and GPs work together caring for people living with HIV, when HIV clinics look after the HIV, and the GP is responsible for general healthcare? Lots of people with HIV, GPs and HIV doctors find this split rather clumsy. Two central London NHS Trusts asked Positively UK to investigate what people want and how we can make things work better.

Their report gives Manchester as one example of how to offer better primary care for people with HIV.
 

Manchester Primary Care Trust did this by introducing compulsory HIV awareness training for GPs and offering guidelines about disclosure and confidentiality. It made this a compulsory part of every GPs contract.

Another way of improving GP care for people with HIV is being used in Brighton. There they didn’t try compulsion, but invited GPs there to sign up to offer a Local Enhanced Service (the doctors are paid extra for this) where there is HIV training, see a minimum number of HIV+ patients, and carry out some extra health tests and checks.

This Positively UK study surveyed people with HIV, primary care staff and HIV clinics about what would help patients make the change from using the HIV clinic for everything, to using a GP for day to day, non-HIV healthcare. The report includes these 15 recommendations.

15 suggestions for action and improvement

• Increase people with HIV’s use of primary care by providing services in new ways 
• Provide short training sessions for all general practices to raise awareness of HIV, patients’ concerns and to boost practice confidence
• Introduce enhanced GP services for HIV using a 2-day training course and annual update training
• All staff (including receptionists) of practices that offer an enhanced service for HIV must attend HIV awareness training
• Develop quality standards on the basic information GPs should gather on patients’ HIV health and medications; increase standard length of appointments for patients living with HIV; agree protocols for protecting patient confidentiality
• Incorporate these quality standards into the existing GP Quality Outcomes Framework, to help implementation and monitoring of progress
• Provide enhanced HIV services to patients outside the practice catchment area where people with HIV have no local practice offering an enhanced HIV service
• Encourage practices already offering an enhanced local STI service or HIV testing to extend this by offering an enhanced HIV service
• PCTs consider providing primary healthcare for people with HIV in any ‘one-stop shops’ that are developed
• Base a GP at HIV clinics to offer short-term primary care as a step to using a local GP for primary care
• Consider how to manage the transfer to primary care of people using clinics in another PCT district
• Provide a ‘hotline’ at HIV clinics for GPs with concerns about HIV patient care
• Use the CQUN standards as a basis for routine sharing of information between HIV clinics and General Practice
• Following past recommendations appoint a nurse specialist and community lead as ‘champions’ to promote good practice and care shared between General Practice and HIV Clinics
• Provide information for people with HIV about finding a GP, patient rights and telling the doctor.

Primary Care Access: GPs responding better to the needs of people living with HIV – executive summary and recommendations
 

Primary Care Access full report and recommendations 
 

free to download HIV in Primary Care book from MedFash

End to HIV Health Staff Ban?

posted: 10/02/2011

The much criticised ban on surgeons and dentists with HIV from working could be lifted this year. At long last, the government is acting on HIV campaigners’ calls to end the employment ban.

Department of Health rules stop HIV-positive health workers from carrying out what are called ‘exposure prone procedures’ which are thought to risk HIV and hepatitis transmission. Basically 'exposure-prone procedures' are treatments where the healthcare hand goes inside the patient body, especially when there are sharp things like bones and surgical tools around - like when a dentist is extracting teeth.

But the rules are old and there is very little solid evidence of actual HIV transmissions from health care workers to patients. Despite this, the UK rules mean no dentist with HIV can carry on working as a dentist, and many midwives, surgeons, some nurses and ambulance workers have also had to end or change their careers.

Rules review

The Department of Health has now said there will be a review of the rules. HIV charities have been invited to join the working group that will draw up new guidelines.
 

The British bans on healthcare workers with HIV and hepatitis are stricter than in many European countries and the USA and Australia, where dentists with HIV can work, so there are alternative rules ready to be adapted for Britain.

Evidence gap

With effective HIV treatments there is usually almost no virus in healthcare workers’ blood, so whatever risk there was, is even smaller now, say campaigners. It is extremely unusual for blood-borne viruses to be passed between doctors and patients. Only four patients worldwide are thought to have contracted HIV from health workers. There have been no transmissions from healthcare workers in the UK. And there are significant doubts about the evidence even for these few transmissions. 

Deborah Jack, chief executive of the National Aids Trust, said ‘advances in testing technologies and treatment’ and ‘high levels of infection control’ supported calls for change.

Catherine Murphy, of the Terrence Higgins Trust, added: ‘We’re not saying entirely lift restrictions but it is time for another look – especially for dentists.’ The British Dental Association has backed calls for change.

UK healthcare workers and exposure prone procedures policy

Source

HIV Message to Social Services - Protect Funding

posted: 09/02/2011

Deborah Jack, the chief executive of National AIDS Trust, has now written to every director of adult social services, calling on them to protect spending for people with HIV.

We very recently reported (Disadvantage Affects HIV Futures) how much of a difference support to end people's social disadvantage makes to whether people live well with HIV, or fall ill and die early.

This multinational study showed that social disadvantage - poverty, class, gender, ethnicity - make a critical difference to how long and healthily people live with HIV. People nearer the bottom of the heap – because of low income, poverty and social disadvantages - get ill much sooner, and die much younger.

That’s why spending on HIV social care matters. It makes a clear difference in life and death.

Here’s what Deborah Jack wrote and told all the Social Services directors :

Dear Director

The importance of social care for people with HIV

Our chair, Dame Denise Platt, has asked me to write to you, in your capacity as director of adult social services, to highlight the vital importance of continuing to fund social care services for people living with HIV over the next year.

As you will know, the Aids Support Grant, which funded social care for people with HIV, is now part of councils' overall formula grant. However, AIDS support remains an identifiable allocation specifically calculated to enable you to meet the needs of people with HIV in your area. I am sure you will be aware how much your council has been allocated for 2011-12, We firmly believe that spending this allocation on services that meet the specific needs of people living with HIV will deliver value for money and be a cost-effective investment in the long term.

Social care for people with HIV provides a lifeline for many vulnerable people, enabling them to retain their independence and have as normal as possible life. The government has clearly identified this as a primary aim and has acknowledged the continuing need for HIV social care and the necessity to protect these services through the continued existence of a specific and distinct amount of money with its own allocation formula.

Investing in HIV social care services has long-term benefits both in terms of the council's finances, but also for the health of your local population. Good-quality social care is an essential part of keeping people well and avoiding expensive hospital in-patient care and more complex and costly community support. The closer liaison between yourselves and the local NHS as we go forwards only goes to further increase the benefits of the continued funding of HIV social care.

A reduction in HIV social care services will also have public health implications which, with the council's forthcoming public health role, should be taken into consideration when determining funding now. Research shows that when people with HIV are suffering from depression and other forms of psychological distress they are less likely to adhere to their HIV treatment. Non-adherence not only impacts on the individual's own health but also on the health of others, as they become more infectious and therefore there is a greater risk they will pass the virus on, creating further demands for local health and social care services.

HIV social care provides a wide range of services including counselling, peer support, support for carers, respite care and support for children and young people affected by HIV. Many of these services are provided by small community-based voluntary organisations who deliver value above and beyond the direct cost of the services. As well as delivering support these organisations often provide a voice for people living with HIV at a local level, but a reduction in short-term funding for HIV social care services by the council may well threaten their future viability.

I hope that the issues I have highlighted above will serve to convince you of the importance of using the money allocated to 'HIV/AIDS support' within the formula grant to continue to fund essential social care support for people living with HIV. If you would like to discuss any of these matters further please do not hesitate to get in touch.

Yours sincerely,

Deborah Jack