Newly diagnosed HIV patients could be under-referred to support

New findings from interviews with sexual health doctors and HIV support workers to gauge their patient-centred approaches to delivering HIV diagnoses have been published in the Sexual Health journal.
 
Led by Dr Nathanael Wells of the Kirby Institute, the research found that, while referrals to peer-support services are important due to the changing demographics of HIV diagnoses in Australia, they are being under-utilised.
 
There were 10 sexual health clinicians and four support workers interviewed between June 2019 and February 2020 for the study.
 
The authors note that while new HIV diagnoses in Australia have traditionally been concentrated in dedicated sexual health and high HIV caseload clinics, new diagnoses are increasingly occurring in general practice and primary care settings.
 
‘The demographic of new HIV diagnoses in Australia has changed in recent years, particularly with the uptake of pre-exposure prophylaxis [PrEP] and more people living with HIV having undetectable viral loads,’ Dr Wells told newsGP.
 
According to a 2021 Kirby Institute report, new diagnoses among Australian-born men-who-have-sex-with-men (MSM) are decreasing compared to other demographics.
 
‘While rates of new diagnoses among Australian-born [MSM] are decreasing, that same rate of decrease has not been observed among heterosexuals, and there has been an increase among overseas-born MSM,’ Dr Wells said.
 
‘As well as the changing demographic, we’re seeing more diagnoses being made in much more generalist practices and by clinicians who may have less familiarity with HIV, including support services.’
 
This means better awareness of supports for patients newly diagnosed with HIV, such as counselling, psychology and peer-support.
 
Previous studies suggest that peer-support can play an integral role in treatment adherence and retention in care among people living with HIV.
 
Those who have been recently diagnosed and access peer-support are also less likely to engage in practices that risk onward transmission of HIV, as well as being more active in clinical decision making and having an improved quality of life.
 
Peer-support services such as ACON, Queensland Positive People and Living Positive Victoria offer a lived-experience approach and play an integral role in treatment adherence and retention in care, according to Dr Wells.
 
‘As the demographic make-up of new diagnoses changes, patient needs at diagnosis will similarly diversify,’ he said.
 
Given that in Australia HIV has disproportionately affected gay, bisexual, and other men who have sex with men (GBMSM), study participants commonly characterised Australian-born GBMSM, who were also involved in gay communities, as having greater awareness of HIV and as being more likely to have HIV-positive men in their social networks.
 
‘Some people process the diagnosis extremely well and in a short timeframe. You generally find those people [are] gay, white men … so they have good knowledge and awareness about HIV,’ one peer-support worker said.
 
However, overseas-born MSM with HIV may face increased difficulties applying for permanent residency, getting a Medicare card, knowing where to locate appropriate services or have cultural barriers.
 
Other patients may be navigating homelessness, food insecurity, mental health issues or intellectual disability. That is where primary care comes in.
 
‘Centring patients at diagnosis may better enable clinicians to understand the patient’s needs to ensure best possible care,’ Dr Wells said.
 
‘It can also allow clinicians to determine patients’ HIV awareness and from that to consider the appropriateness of taking a more clinician-led approach.’
 
Although Australian guidelines for HIV treatment recommend initiating immediately (or as soon as possible), with a patient-centred approach, best-practice care may involve delaying HIV treatment while services are implemented.
 
‘Number one is social support. I think the most essential thing … is to ensure that the patient returns because if they don’t return, there’s nothing else that you can do with them,’ one doctor interviewed for the study said.
 
Dr Wells pointed to another recent study published in the Health & Social Care in the Community journal which explored experiences of peer support from the perspective of people recently diagnosed with HIV.
 
‘Given their role from pretty much the beginning of the HIV/AIDS epidemic in Australia, these have become well respected and firmly entrenched health organisations in the LGBTIQ+ communities,’ he said.
 
‘Peer navigation, whereby peers help [the] newly diagnosed navigate health systems – including sometimes accompanying people to appointments – can also embed peer support in clinical practice and create more formal connections with HIV organisations and clinical practices.
 
‘As we highlight in this paper, peer support can provide a sense of belonging and shared lived experience, while also providing non-clinical perspectives on the day-to-day aspects of living with HIV.’
 
Most GPs utilise a patient-centred approach to deliver healthcare, weighing up factors such as age, disability, costs and comorbidities. As they deliver more HIV diagnoses, the study findings provide a reminder of services they can offer to their HIV patients.
 
‘Despite advances in HIV treatment, prognosis and prevention, receiving a positive diagnosis remains a challenge for many,’ Dr Wells said.
 
‘We’re hoping this paper is an opportunity to learn from the approaches of specialist HIV care providers.’
 
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