Review of services for people living with HIV in New Zealand

informally arranged with SH colleagues in other DHBs. There is no formal remuneration arrangementbetween DHBs for this practice. The ability to provide inter‐DHB support more ably to smallercentres would be a significant improvement. Staff reported often fielding clinical phone calls fromareas outside the CCDHB region: for example from Nelson and other smaller centres. On a per headof population approach, CCDHB SH are under‐resourced in terms of specialist SHPs, and report thatthis is reflected in their clinic waiting list times .Peer support for SH management is achieved through a national online SH peer group, which wasdescribed as very helpful. However, it is still the case that the most recommended thrust in terms offuture investment would be in the area of training – perhaps through strengthened workforcedevelopment for SH, and the institution of a full‐time training registrar.D. CANTERBURY DISTRICT HEALTH BOARD (www.cdhb.govt.nz)For this review, interviews were undertaken with the CDHB Infectious Diseases and Sexual Healthservices in Christchurch, staff of the Christchurch office of the NZAF, a self‐selecting group of PLHAbased in Christchurch and a number of individuals providing HIV support services in the community inChristchurch and Dunedin.The Department of Infectious DiseasesThe Department of Infectious Diseases has, at time of writing, 230 patients under its care. Patientsare monitored regularly – from three‐monthly to yearly, depending on their health status. TheDepartment employs three consultants and one registrar working with PLHA.Like many DHB ID and SH facilities, the Department finds itself acting as a primary care service byproxy for many PLHA. The reasons for this include the following.1. It helps patients avoid the consultation fee that primary care services charge.2. Patients perceive that the relative anonymity of a hospital environment may dissuade theassumption – in the eyes of their community – that their visit is specifically HIV‐related.Hospital visits are seen as enabling greater privacy and confidentiality than NGO HIV servicevisits.3. The ID department acts as a nexus for facilitated referral to appropriate specialist and otherservices – additional and related health issues can be coordinated and addressed efficiently,saving money and time for patients and staff.4. Among Christchurch PLHA interviewed, primary care staff have a mixed reputation for qualityof HIV management (validation of this widely held perception was beyond the scope of thisreview).As is the case around the country, efficient inter‐departmental and cross‐sector collaboration inpatient care in Christchurch is, to a substantial degree, dependent upon interpersonal relationshipsbetween key DHB and NGO partners. In the case of ID and SH services, there appears to be closecollaboration and mutual patient‐centred support. There is also reportedly close collaborationbetween these services and NZAF counselling services.It will be interesting to see how collaboration with the NZAF develops following the soon‐to‐befinalised appointment of an NZAF‐funded clinical nurse specialist to be based in ID, working in ID andSH and with community support services. The parameters of management responsibility andaccountability appeared to be still subject to some negotiation during the period of this review,though what is certain is the clear need for such an arrangement, given the lack of funding availablewithin CDHB.REVIEW OF SERVICES FOR PLHA 19