Successful expanded clinic network collaboration and patient tracing for retention in HIV care.

BACKGROUND: There are more than 7,800 people living with human immunodeficiency virus (HIV) in Victoria, Australia. Crucial in maximising the individual and population level benefits from antiretroviral therapy (ART) is understanding how to achieve patient retention in care and the factors that drive it. This study was an expansion of a 2015 assessment of HIV-care retention in Victoria, which sought out to determine whether the inclusion of a broader range of HIV-healthcare sites would yield more accurate estimates of retention in HIV-care. We aimed to improve our understanding of HIV-care retention in Victoria, Australia, identify people living with HIV (PLHIV) with unknown outcomes, and attempt to re-engage PLHIV in care. METHODS: A network of 15 HIV-care sites was established in Victoria, Australia across diverse care settings which ranged from low-caseload rural sites to high-caseload metropolitan GP clinics and hospitals. Individuals who had an HIV viral load (VL) performed in both calendar years of 2016 and 2017 were classified as retained in care. Individuals with a VL test in 2016 but not in 2017 were considered to potentially have unknown outcomes as they may have been receiving care elsewhere, have disengaged from care or died. For this group, an intervention of cross-referencing partially de-identified data between healthcare sites, and contact tracing individuals who still had unknown outcomes was performed. RESULTS: For 5223 individuals considered to be retained in care across 15 healthcare sites in the study period, 49 had unconfirmed transfers of care to an alternative provider and 79 had unknown outcomes. After the intervention, the number of unconfirmed care transfers was reduced to 17 and unknown outcomes reduced to 51. These changes were largely attributed to people being reclassified as confirmed transfers of care. Retention in care estimates that did not include the patient outcome of confirmed transfer of care ranged from 76.2 to 95.8% and did not alter with the intervention. However, retention in care estimates which considered confirmed transfers and those that re-entered care at a new site as retained in care significantly increased across five of the sites with estimates ranging from 80.9 to 98.3% pre-intervention to 83.3-100% post-intervention. Individuals whose outcomes remained unknown post-intervention were more often men who have sex with men (MSM) when compared to other categories (person who injects drugs (PWID), combined PWID/MSM, men who identify as heterosexual or unknown) (74.5% vs. 53.5%, [p = 0.06]) and receiving ART at their last HIV-care visit (84.3% vs. 67.8% [p = 0.09]). CONCLUSION: This study confirmed high retention in HIV-care and low numbers of people disengaged from HIV-care in Victoria. This was demonstrated across a larger number of sites with varying models of care than a prior assessment in 2015. These data align with national and state targets aiming for 95% of PLHIV retained in HIV-care.

Evaluation of the Implementation of a New Nurse-Led Express "Test-And-Go" Human Immunodeficiency Virus/Sexually Transmitted Infection Testing Service for Men Who Have Sex With Men at a Sexual Health Center in Melbourne, Australia.

BACKGROUND: In August 2015, a nurse-led express human immunodeficiency virus (HIV)/sexually transmitted infection (STI) testing service "Test-And-Go" (TAG) for asymptomatic men who have sex with men (MSM) was implemented in a large public sexual health center in Melbourne, Australia. We aimed to compare the clients' characteristics between the TAG and routine walk-in service among asymptomatic MSM. METHODS: This study was conducted at the Melbourne Sexual Health Centre, Australia, between August 5, 2015, and June 1, 2016. General estimating equation logistic regression models were constructed to examine the association between the use of TAG service and clients' demographic characteristics, sexual behaviors, and HIV/STI positivity. Clients' consultation and waiting times for both services were calculated. RESULTS: Of the 3520 consultations, 784 (22.3%) were TAG services and 2736 (77.7%) were routine walk-in services for asymptomatic MSM. Asymptomatic MSM were more likely to use the TAG service if they were born in Australia (adjusted odds ratio, 1.29; 95% confidence interval, 1.07-1.56), and had more than 6 male partners in the last 12 months (adjusted odds ratio, 1.13; 95% confidence interval, 1.08-1.58). Age, HIV status, condomless anal sex and HIV/STI positivity did not differ between the two services. The TAG service had a shorter median waiting time (8.4 minutes vs 52.9 minutes; p < 0.001) and consultation time (8.9 minutes vs 17.6 minutes; p < 0.001) than the routine walk-in service. CONCLUSIONS: Although country of birth and sexual behaviors differed between clients attending the 2 services, there were no differences in HIV and STI positivity. Importantly, the TAG service required less waiting and consultation time and hence created additional clinic capacity at the general clinic to see clients who are at higher risk.

An evaluation of an express testing service for sexually transmissible infections in low-risk clients without complications.

UNLABELLED: Background One effective way of reducing the prevalence of sexually transmissible infections (STIs) in a population is ensuring easy access to clinical services and screening of populations at high risk of STIs, including HIV. We aimed to describe the features of clients using the express testing service (ETS) and the overall impact on the service. METHODS: This retrospective cross-sectional study involved all clients attending the walk-in triage service at Melbourne Sexual Health Centre before the introduction of ETS in 2009 and after ETS (2011 and 2012). RESULTS: There were 32?720 and 82?265 consultations before and after ETS respectively. The ETS saw 4387 (9%) of 55?648 consultations (excluding appointments and results), giving rise to a fall in the proportion of lower-risk clients having full consultations (from 53% to 50% of consultations; P<0.001). The consultations testing for HIV and chlamydia (Chlamydia trachomatis) were marginally higher (HIV: 48% v. 47%, P=0.017; chlamydia: 70% v. 68%, P=0.015) with ETS. Young (26 v. 27 years) females (38% v. 34%) utilised the ETS more (P<0.001). The time taken for consultation and the total time spent in the clinic was significantly decreased during the ETS period (from 25min to 6min for consultation time and from 59min to 29min for total clinic time; P<0.001). CONCLUSIONS: The data suggest that fast-track services such as ETS are effective in increasing access for higher-risk individuals while streamlining screening of asymptomatic low-risk clients.