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Category Archives: Blog
The ADOPT project will look at the feasibility of PDPT for chlamydia as standard clinical practice. In the evaluation, ADOPT will also identify a potential PDPT model. At present the selected services in the study are Illawarra Sexual Health Centre, Liverpool Sexual Health Centre, Sydney Sexual Health and Western Sydney Sexual Health Centre.
Patients eligible for PDPT are:
Only patients with a laboratory diagnosis of oral-pharyngeal or ano-genital chlamydia.
Heterosexual patients with partners who are unable or unlikely to seek clinical services in a timely manner.
Further info can be found here: http://stipu.nsw.gov.au/public-sector-resources/patient-delivered-partner-therapy-adopt/
Today’s plenary session included a talk provided by Dr Patrick Mallon titled ‘ Why should we switch for Toxicity?’. While this talk very much spoke to those who prescribe antiretroviral therapy it did highlight some key points that nurses seeing HIV patients should be aware of. Dr Mallon also did a great job in presenting the information in a way that all clinicians involved in HIV care not just the prescriber should have an awareness of the role of toxicity and tolerability when talking with our clients about their satisfaction with their regime and adherence. Key points that Dr Mallon discussed that apply to nurses providing HIV care included:
– The key differences between tolerability and toxicity: Tolerability is subjective as this is what our clients report. In contrast, toxicity is somewhat more difficult to assess as it is only detected though monitoring hence prescribing clinicians need to determine what toxicities they should be monitoring for.
He gave a great example here from a study that examined patients on a regime that included a placebo. Patients were on regimes, which either included Efavirenz, or a regime including a placebo. As patients didn’t know whether they were being given Efavirenz or not they were warned about the potential for nightmares. Interestingly 10% of the patients on the placebo reported nightmares, which highlighted the role of subjective toxicity.
– Treatment for life and what patients want: Research has shown patients want single tablet regimes and that their satisfaction plays an important role in their ability to tolerate adverse events (which would otherwise be considered toxicity). However, some patients may tolerate such events better due to their satisfaction with the regime.
– The drop versus switch debate: Prescribers need to ensure they take a holistic approach when considering what approach to take with those patients experiencing toxicities. Does the drop or switch outweigh the proposed benefits? The example given was in regards to a study where patients were switched regimes due to concerns about decreasing bone mineral density. This switch resulted in saving 3 years of bone mineral loss but in an era where patients are moving towards being on treatment for life is this actually a significant change? In addition does if such a change is to result in significant increases in costs or decreased patient satisfaction – does it outweigh the benefits?
As nurses we play a key role in assessing our clients adherence and satisfaction with their regimes. This talk highlighted some key points we need to consider when talking with our clients about their regime. At times we are an additional link between our clients and their prescribers hence having an awareness of such issues will assist us further in advocating for our clients.
Gilead generously provided sponsorship & funding for the breakfast & education session, an amazing & inspiring presentation by Belinda Henget (PhD!) on the challenges & barriers to HIV & STI testing in remote communities, accommodated us in the rooftop function room of the Rydges hotel (adjacent to the Brisbane convention centre); providing us with a superb continental + hot breakfast (5 star I might add). We had a a very gratifying 37 attendees, the chatter during & following the breakfast & presentation was testament to the valuable networking & connection opportunity the breakfast meeting provided.
For me personally (Garry Kuchel, M Clinic Perth), Belinda’s presentation demonstrated, yet again, the importance & power of the ‘do and get done, + be accepted’-ability of nurses & other non-medicos(NOT taking away from our medical colleagues) in the ‘hard to reach’ populations. Note to self: do not underestimate the value & power of your nursing skill
ASHHNA awarded a Research and Innovation Poster Prize at the Congress yesterday. This award recognised the outstanding contribution to sexual and reproductive health and HIV nursing that a nurse made and also aims at encouraging nurses to develop research and present that research to a wide audience.
It was fantastic to see an overwhelming number of entries from nurses receiving a total of 14 entries. Voting was conducted by 6 ASHHNA members from across Australia and 2 ASHHNA executive members.
The 2015 winner was DONNA TILLEY for her poster titled:
OUTREACH CHLAMYDIA TESTING UPSKILLING A MULTIDISCIPLINARY WORKFORCE
The aim of this project was to increase the opportunities for chlamydia testing in Aboriginal and Torres Strait Islander people and young people by addressing structural barriers to service access. This was achieved by building the capacity of non-clinical sexual health and youth health service staff to offer information about urine testing for CT and GC at targeted community events. A total of 9 staff completed training between August 2014 and January 2015 and the staff were from varying disciplines.
Participating in the training demonstrated an increase acknowledge, confidence and skills of non-clinical health workers to undertake urine CT and GC testing in an outreach setting. The training and ongoing support has further enhanced a strong collaboration between the sexual health service and clinical and non-clinical teams.
Launch of the 2015 Kirby surveillance report. Reporting on HIV Testing and treatment cascade and a new chlamydia cascade.
It was great to see all the nurses networking this morning at the nurses breakfast. Thanks to Belinda Hengel who presented findings from the STRIVE trial and her PhD. She encouraged all nurses to use thier unique perspectives and insights into clinic processes and patient care to inform and frame questions for research.
An engaging forum on the rapidly changing area of PrEP in Australia. Bob Grant from San Fancisco SIDS Foundation provided an over view of evidence for use and the PrEP market for use could be the same as the treatment market. He also talked about the tipping point for use and how information disseminated in and by the community drives up use. This was followed by Chris Williams who is taking PrEP and started the conversation with peers through the development of a Facebook community. PrEP is prescribed in Aust from GPs, sexual health or demonstration trials but funding and access are ongoing issues. Darren Russell announced roll out of affordable access in QLD for low income people from the HIV Foundation QLD.
Convincing arguments provided by the panelists in favour of the use of PrEP; these arguments were in some part counterbalanced by concerns regarding potential in increase in rectal STIs which may increase risk of HIV transmission plus other potential side effects such a renal dysfunction and bone density loss. Comments were provided by the panel about evidence and options for monitoring and breaks from PrEP.
A concern was also raised about potential for increase in HIV resistance; Bob Grant argued there was good evidence there would be much more resistance with treatment only vs proactive use of PrEP. Chris Williams the community PrEP advocate reminded us that PrEP is not just a pill but a program for looking after health.
World STI HIV Congress
Interesting Q and A in the ACCEPt session. Increases in screening rates in the intervention GP services compared with the control GP services over 3 years. The sustainability of screening will be examined in the ACCEPt-able study looking at the outcomes following systematic removal of service visits and incentives, including incentive payments for practice nurses, from GP services in the study. Discussion on the importance of primary prevention, partner treatment and vaccination in chlamydia control. Future chlamydia control also needs to look at the impact of not only testing but the impact of using testing as an educational opportunity. Potential opportunities to evaluate the role of nurses in chlamydia control.
World STI HIV Congress
Powerful talk in the plenary session by Kerry Arabena- Issues for Aboriginal and Torres Strait Islander Women who want to be sexually healthy. As clinicians we need to be engaged with innovative clinical practice and also be involved in advocacy. Share any ideas about how ASHHNA can engage in advocacy at [email protected]