Review of services for people living with HIV in New Zealand

RESULTS1. DISTRICT HEALTH BOARD SERVICES FOR PLHAA. AUCKLAND DISTRICT HEALTH BOARD (www.adhb.govt.nz)Infectious diseasesADHB’s Adult ID service has the largest HIV cohort in New Zealand, currently providing care forapproximately 750 PLHA. Referrals to ID come from primary care staff, other ADHB services, NZAF’sBurnett Centre, Body Positive (BP) rapid testing, antenatal care (ANC) and the refugee centre. TheAdult ID service covers Northland to Bombay (including Waitemata and Counties, who pay forservices on a pro rata scale). The service makes a conscious effort to link with SH services in thesame region.Adult ID runs five HIV clinics on Wednesday mornings and Thursday afternoons. For outpatientclinics there are six ID physicians, three clinical nurse specialists and one registrar. They aresupported by the Community HIV team, and liaise with primary care staff, although, as appearscommonplace in DHB services for PLHA, ID can almost become a default primary care service –especially for immigrant populations. This issue is raised frequently in this report.Adult ID, together with two paediatric ID physicians and a paediatric clinical nurse specialist, run afamily clinic for children and parents affected by HIV. At the time of the review, the establishment ofa paediatric/young person clinic was under discussion. Adult ID liaises closely with the Maternal‐Foetal Medicine service, which provides for the care of women with HIV infection who are pregnant.Usually up to four patients receive inpatient ward care at any one time, although more inpatients canbe accommodated as required. Follow‐up care for outpatients is provided according to their clinicalstatus – appointments can vary in frequency from monthly to yearly.Adult ID staffs the Community HIV team, comprising four part‐time nurse specialists and one full‐timesocial worker, housed in the Adult ID department. As well as its work with inpatients and theoutpatient clinic, the team has a significant role in the community, addressing issues such asmedication, treatment monitoring, treatment adherence and primary care liaison. The majority ofpatients that the Community HIV team deals with are cared for by the Adult ID service. However,small numbers of patients are cared for by the Paediatric ID service and by SH.Sexual healthSH services currently have 70 PLHA under their care, some of whom are seen in conjunction with ID.Patients are generated internally: some are referrals from Body Positive (who have their own rapidtesting programme), and a few come following rapid testing at the NZAF Burnett Clinic. SH doesn’thave dedicated HIV clinics. They see PLHA on average every three to six months, and the majority ofpatients are gay men (they currently see fewer than 10 women with HIV, and very few heterosexualmen). SH services provide outpatient care only: any hospital admissions are made through ID.There is no direct nursing input in SH – staff noted the general lack of nurse education on HIV in SH.SH provides the following services and clinical interventions: STI screening, diagnosis and management an outreach programme to the New Zealand Prostitutes Collective10 REVIEW OF SERVICES FOR PLHA