Review of services for people living with HIV in New Zealand

CONCLUSIONSFrom the foregoing, some conclusions recommend themselves as a natural outcome of this briefreview.First, the Ministry of Health HIV/AIDS Action Plan (2003) is out of date and needs revision. Theoperational content of the plan needs to be strengthened and the activities it covers need greaterdefinition, to enable greater specificity in benchmarking of performance against objectives.In addition to this is the need for an action plan linked to the Sexual and Reproductive HealthStrategy. Given the obvious and often‐remarked link between STIs and HIV transmission, and theconcerning increases in STI rates around the country, development of such a plan is a necessarycomponent in terms of future HIV prevention and management. It would also provide an excellentopportunity for a coordinated process of reflection on prevention approaches and how they can besupported in this new decade, as a counter to the apparent behavioural complacency linked tocommunity perception of HIV treatment successes.Second, there is currently no coordinated strategy in place for research for policy and programmerefinement in HIV/AIDS in New Zealand – this means that any research undertaken is opportunisticand incidental. The development of a national agenda for operational research for policy andprogrammatic strengthening should be a priority. Furthermore, evaluation of service delivery qualityis absent across sectors. A framework for external audits is needed as a complement to existingfinancial and governance auditing mechanisms and self‐report measures, and should be developed aspart of a broader research agenda for HIV in New Zealand.Third, repeatedly expressed concerns over levels of mental health coverage for outpatient PLHAhighlight the need to establish benchmarks in this area linked to ID and SH services in particular, andto explore and identify options for increasing access to quality MH services and personnel amongPLHA.PLHA (particularly those with young families) often cited cost as an obstacle to accessing primary careservices for many PLHA. In this regard, a review of primary care fee costs for PLHA is advisable. Areview could have a significant effect on resources within outpatient ID and SH services for PLHA,since many PLHA currently use such services as a proxy for expensive primary care services. PLHAalso made adverse comments about the quality of some primary care services: it is timely to reviewthe reach and depth of core primary care staff training in HIV.There are significant variations in HIV testing processes within and across sectors in New Zealand.Although New Zealand has its own national protocols for HIV T&C, these are not well known (at leastto the majority of participants in this review). New Zealand is also a national participant indevelopment and ratification of the standards and rights‐based guidance published by WHO andUNAIDS. WHO and the Regional Office for the Western Pacific published updated guidance on HIVT&C last year, but the existence and content of this guidance was unknown to the majority of thoseinterviewed for this review. A national discussion on standards in HIV T&C appears necessary. Such adiscussion could also cover necessary training in administration of tests, protocols for pre‐ and posttestcounselling and service backup, and compatibility with established national and internationalbenchmarks for HIV T&C.REVIEW OF SERVICES FOR PLHA 43