Review of services for people living with HIV in New Zealand

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InquiryResponseChallenges to service deliveryMost significant is the challenge in securing a coherent consensus on needs andservice changes differing views of PLWHA organisations from each other as well askey PLWHA stakeholders who have disassociated from the PLWHA organisations.Purchasing a formal externally purchased research project such as HIV Futures2 isessential. Majority views do not ensure agreement for example Wellness Fund.Strong feedback to not devolve to a PLWHA organisation.HIV is now a chronic condition with almost full life expectancy on treatments. Asignificant challenge exists in assessing what is reasonable for tax payer supportwhen compared with other chronic conditions that have higher fatalities amongstspecific populations groups yet may be less resourced.Lack of MoH leadership in respect to chronic conditions and national public healthdirection.7. What obstacles – if any –exist for potential serviceusers?Times, geography,culture, information,language, ideology8. How is the service workingon an administrative level?Administrative capacity(staff numbers)Administrative needsAdministrativestrengths andweaknesses – howburdens affect outputsWhat obstacles – if any – exist for potential service users?Minority cultures and internalised HIV and homophobia/stigma in their communitiesfor: African heterosexuals – particularly men; Asian homosexuals and heterosexuals.The challenges of being a minority within a minority: sense of isolation through beingsmall marginalised within HIV. Heterosexuals, children and families.Young people who have grown up with HIV.High need complex diagnosis gay and bisexual men – often high need existing beforediagnosis. HIV complicating who is best placed to provide support and meet varietyof needs.Confusion on who is best placed as a service provider to meet the variety of needs.Uncertainty and competition.Personal views of ID clinicians as who is best placed to serve and support PLWHApatients.Administrative capacity (staff numbers) 39 staff, not FTEs, excluding admin staff (10 regular volunteers – include studentplacements) 7 administration, IT and finance staff 1 Trust Board secretary (part‐time).Administrative needs Supporting three centres that have regular client visits (i.e., 2876 HIV and syphilis testclients in 2009). Supporting six community‐based workers across the country. Supporting six national roles in communications, campaigns and technology. Supporting one international development project. Supporting finances processes for over $300,000 accounts payable/receivable permonth. Supporting 300 membership and 400+ volunteers.Administrative strengths and weaknesses – how burdens affect outputs Aim to keep administration costs to 18% or under. Vulnerable at times of sickness or high demand. IT and network time increased to full time.60 REVIEW OF SERVICES FOR PLHA
Inquiry9. How is impact,effectiveness and valueassessed, and what havethose assessmentsindicated to date?Criteria employedFrequency and modesof assessmentsEvidence of data forpolicyResponseHow is impact, effectiveness and value assessed, and what have those assessmentsindicated to date?Assessing the impact, evaluating our effectiveness and valuing our services are asignificant, complex and multi layered range of activities. It is an area of constantfocus and improvement.A major impediment to effective evaluation is the cost of external, expert,independent contractors not being budgeted/funded specifically by the MoH.Another major impediment is the being very little benchmark data (i.e., no sexualbehaviour survey of all New Zealanders since early 1990s, no funding for next HIVprevalence study, only pilot funding for a small sexual behaviour survey of Africanpopulations).Criteria employedGAPSS and GOSS behavioural surveillance on sexual behaviour of MSM and attitudesto HIV with components surveying attitudes towards and recognition of NZAFinterventions, e.g., maintenance of numbers reporting constant condom usebetween 2002–2008.Early stages of cost/benefit analysis as data on tests and treatment costs becomeavailable.Independent external research when able to purchase – i.e., Shore centre ‘Men Talk’on non condom users. Included survey on attitudes towards NZAF’s effectiveness.Client surveys, non‐client surveys.Close analysis of the New Zealand epidemiology where feasible and funded.Dr Saxton’s PhD thesis including GAPSS and GOSS data.External financial audit annually.Charitable registration.Ministry response to NZAF reporting against our Ministry of Health contract. External MoH audits 2006 and 2010.Whilst indicative only:– increase in client use of services especially HIV testing– increase in clinician referrals– increase in volunteers, members and supporter database– increase in visitors of new website– increase in ‘members’ for social networking sites – GiO, Bro on Line, facebookand beebo– increase in fundraising– increase in qualifications and appropriate skills sets of candidates for vacancies– increase in suitable candidates for election to Trust Board.Frequency and modes of assessments GAPSS and GOSS data 2002, 2004, 2006 and 2008.Ongoing analysis of research and published literature.HIV Futures 2000 and HIV Futures2 in 2005/06 – no funding for future surveys.HIV Prevalence study of sexual clinic attendees 2006 – no funding for future surveys.External behaviour surveillance.Evidence of data for policyGAPSS & GOSS Data 2002, 2004, 2006 and 2008 – informing and directing HIVprevention campaigns (Bullfighter 2007, Fuck buddies 2003, HIV prevention Plan2009–2014). Briefing papers provided by Research and Analysis Unit direct NZAF policy position –e.g., blood donor deferral policy.Use of New Zealand and international literature and research studies accessedthrough NZAF library to inform policy – i.e., Public Health Bill submission.REVIEW OF SERVICES FOR PLHA 61
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REVIEW OF SERVICES FORPEOPLE LIVING
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ACRONYMSAEGAMTACANCAPPARVBPCBOCSWDH
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CONTENTSACRONYMSACKNOWLEDGEMENTSEXE
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EXECUTIVE SUMMARYThis review has id
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INTRODUCTIONThe national clinical a
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The available data show that in the
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Family Planning is a not‐for‐pr
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METHODOLOGYThis review effectively
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Page 23 and 24: perceived as formally (if implicitl
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Page 43 and 44: Despite INA’s development constra
Page 45 and 46: Difficulties in maintaining quality
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Page 51 and 52: CONCLUSIONSFrom the foregoing, some
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Review of services for people living with HIV in New Zealand

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