HIV session

11.00am - 11.10am The Future of the Australian HIV Response – A Consensus Statement on the Progress Towards Virtual Elimination and Beyond

Tiffany Phillips (Monash University), Habib Taouk (Health Equity Matters), Phyllis Lau (Western Sydney University and the University of Melbourn), Reuben Kiggundu (Monash University), Andrew E Grulich (Kirby Institute), Scott Harlum (National Association of People with HIV Australia), Dash Heath-Paynter (Health Equity Matters), Jasn Ong (Monash Central Clinical School, Melbourne Sexual Health Centre, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine)

Background: Rates of new diagnoses of HIV have continued to decline in Australia, with the possibility to achieve virtual elimination within reach by 2030. This research aimed to support and lead the HIV response in identifying priority areas and activities to achieve and move beyond virtual elimination. Methods: A co-designed, cross-sectoral Delphi consensus was performed. Firstly, a steering committee of clinicians, researchers and community members was formed to draft statements for the Delphi process. A qualitative analysis was conducted to form 35 draft statements. Secondly, an expert panel was formed using a purposive and then a snowballing method.   One hundred and sixty-four cross-sectoral HIV experts across Australia were invited to score the draft statements’ importance to achieve and move beyond virtual elimination using a 4-point Likert scale. Experts were asked for suggestions and comments at the end of the Round-One survey. A statement required a score over 80% to achieve consensus. Statements that failed were re-scored in Round-Two, in addition to six newly formed statements from Round-One feedback. Results: In Round-One, 106 experts across the HIV response scored 30 statements above 80%. In Round-Two, 5 statements failed to reach consensus after re-scoring and 6 new statements achieved a consensus, scored by 89 experts. The following 6 themes categorised the final 36 statements  – Prevention, Testing, Treatment, Management & Care, Stigma & Discrimination, Community-led Response and Research. Future Actions: This research provided a roadmap to ensure Australia remains on its trajectory towards virtual elimination of HIV transmission and to move beyond this point. This research also identified areas of priority and activities required to build upon the response’s achievements and continue to reduce new HIV diagnoses. Conclusion: This research utilised a rigorous and collaborative approach, ensuring that the statements represented and supported the Australian HIV response to continue achieving world-class results.

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11.10am - 11.20am The path towards virtual elimination: An epidemiological review of HIV in WA from 2019-2023 and insights for future approaches 

Byron Minas (Surveillance and Disease Control Program, Communicable Disease Control Directorate, Department of Health WA), Sian Churcher (Sexual Health and Blood-borne Virus Program, Communicable Disease Control Directorate, Department of Health WA), Caitlin Wilshin (Surveillance and Disease Control Program, Communicable Disease Control Directorate, Department of Health WA)

Background/aim: An examination of the HIV epidemiology in Western Australia (WA) from 2019-2023, with an overview of key trends in notifications, WA’s linkage to care processes, and how the state’s epidemiology informs policy alongside highlighting issues for virtual elimination. Methods: HIV notifications data from 2019 to 2023 were sourced from the WA HIV Database and analysed by risk exposure, gender, place of birth and acquisition, stage of infection and viral load. Results: From 2019 to2023, the number of HIV notification in WA decreased by 37% to 66 cases. In this period, Australian-acquired HIV notifications decreased by 50% to 22 cases in 2023, a trend which was mainly seen among men who have sex with men (25 to 11 cases). In contrast, the number of overseas-born HIV cases who acquired HIV overseas remained stable over this period (34 to 31 cases), representing nearly half (47%) of all new notifications in 2023. In 2023, 44% (n=29) of new HIV cases were diagnosed with late-stage infection, an increase from 38% (n=39) in 2019. In 2022 an estimated 98% of people living with HIV (PLHIV) on treatment had achieved viral suppression, exceeding the 95% HIV elimination target.  Future actions: The changing epidemiology in WA highlights considerations for the prevention and testing of people in WA, particularly for HIV acquired overseas, and for people living with HIV that are diagnosed late. Conclusions:

Over the term of the 2019-2023 WA HIV Strategy, a considerable decrease in local HIV transmission was achieved, particularly among MSM. However, this decrease was not observed among people from overseas who acquired HIV overseas. Similarly, late diagnosed cases with high HIV viral loads represent a challenge in reducing WA’s overall community viral load. Early detection remains pivotal, with WA having rapid linkage to treatment and growing antiretroviral options to improve adherence.

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11.20am - 11.30am Perth Gay Community Periodic Survey: HIV-related trends among gay and bisexual men and priorities for health promotion

Curtis Chan (Kirby Institute), Anthony KJ Smith (Centre for Social Research in Health [CSRH]), Timothy Broady (CSRH), James MacGibbon (CSRH), Benjamin Bavinton (Kirby Institute), Limin Mao (CSRH), Martin Holt (CSRH)  

Background/aim: The Perth Gay Community Periodic Survey monitors HIV-related behaviour among gay, bisexual, and other men who have sex with men (GBMSM). This analysis reviews trends in HIV testing, HIV treatment, condom use, pre-exposure prophylaxis (PrEP) use, and sexual behaviour. Methods: Cross-sectional surveys of GBMSM were conducted during PrideFEST with peer recruitment conducted by WAAC in November-December 2023, supplemented by online advertising. Analyses included 5 survey rounds (2016-2023). Trends and the profile of participants at risk of HIV were assessed with logistic regression. Results: 4,189 GBMSM participated between 2016-2023. The proportion identifying as gay decreased from 86.8% to 68.9% (p<0.001), and those identifying as bisexual increased from 8.9% to 19.0% (p<0.001). After a decline during 2021 (coincident with COVID-19), annual HIV testing returned to pre-COVID levels of 71.8% in 2023 (non-significant trend). HIV treatment and viral suppression remained at over 95% in 2023. PrEP awareness increased from 40.1% to 93.5% (p<0.001), and recent PrEP use increased from 1.4% to 33.9% (p<0.001). In 2023, 33.2% of PrEP users were taking it ‘on demand' (2-1-1- dosing). Among participants reporting casual sex, the use of any safe sex strategy (‘net prevention coverage’: condoms, PrEP, or undetectable viral load) increased from 62.5% to 72.2% (p<0.001). In 2023, participants who reported casual sex with a risk of HIV transmission were more likely to identify as bi+ than gay (p<0.001), less likely to have a university degree (p=0.028), and were less socially engaged with gay men (p=0.005). Future actions:

To improve HIV prevention coverage, health promotion should focus on bi+ men, those who have not attended university, and those less connected to gay networks. Conclusions: HIV testing and PrEP use have recovered after COVID-19, but a quarter of GBMSM having casual sex continue to report sex with a risk of HIV transmission.

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11.30am - 11.40am Experience of using long-acting injectable antiretroviral therapy in hard-to-reach and vulnerable people living with HIV

Leah Williams (Royal Perth Hospital), Genevieve Nolan (Royal Perth Hospital), Mina John (Royal Perth Hospital), David Nolan (Royal Perth Hospital) 

Background/aim: Long-acting injectable antiretroviral medication (LA ART) represents a new era of treatment for people living with HIV. Two monthly injections provide a welcome alternative to traditional daily medication. However, with a need for more frequent clinic visits there is some nervousness amongst clinicians in offering injectable treatment to clients with complex needs. Royal Perth Hospital is the largest single-site prescriber of injectable treatment in Australia with 177 clients on LA ART. Within this cohort, 20% are considered hard to reach or vulnerable, and are under the care of the REACH programme, offering enhanced surveillance and support. This project aims to explore the nature of complexity of this sub-cohort and engagement with this treatment modality for hard to reach and vulnerable PWHIV. Methods: Individuals from the REACH cohort receiving LA ART were identified and a notes-based audit was conducted. Demographic information, injection clinic attendance and viral load results were collected. The level of client complexity was estimated using a validated tool (CCRS-HIV) to provide a score. Results: 34 REACH clients are currently using injectable therapy. 15% identified as Aboriginal or Torres Strait Islander, 24% were experiencing homelessness or unstable housing. 82% of individuals had complexity scores of over 40 (classified as a complex presentation in accordance with the CCRS-HIV). 24% required support from public health case management and 26% were engaged with community support services. All 34 individuals have remained virally suppressed. Future actions: Further exploration of barriers and supports in order to successfully offer LA ART to all with development of criteria in establishing suitability for LA ART to promote greatest success. Conclusions: This audit confirmed that LA ART has been a successful treatment option for individuals with high levels of complexity and/or a history of poor adherence and engagement.

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11.40am - 11.50am Nurse Practitioner led PrEP and STI testing at a MSM sex on premises venue

Garry Kuchel (WAAC)

Background/aim: WAAC, in partnership with the WA Department of Health and Perth Steamworks (PSW), increased the number of clinics over a one month period from 13/03/2023 to 06/04/2023. This was to increase the number of clients tested for sexually transmitted infections (STI) and blood borne viruses (BBV) but also in a first for the service, to provide a Nurse Practitioner (NP) at some clinics to prescribe Pre-exposure prophylaxis (PrEP) scripts to eligible clients. Methods: WAAC was already testing at PSW on Thursday nights. Medicare is not required for testing, however for PrEP, Medicare was required for the renal function tests and eScripts. The NP staffed six clinics and PrEP consultations were offered to clients on-site. The Clinical Nurse Consultant (CNC) staffed another five clinics for STI/BBV testing and could add renal function testing if the client was interested in PrEP and be rebooked for follow up. Results: A total of 51 clients presented during this period. The median age was 40 years and a third of the clients were new to the service. Just under half of the clients had tested within the last six months and seven clients had never tested before. One quarter of those clients who tested had an abnormal STI/BBV result and over half of these clients had a rectal bacterial infection. Of the 35 clients who saw the NP, a third were issued with a PrEP prescription. Future actions: The success of this program suggest an NP-led outreach at SOPVs model should be utilised in future to link MSM communities with HIV prevention mechanisms such as PrEP. Conclusions: This is an innovative project that was responsive to the needs of the men who have sex with men community to trial a NP-led PrEP clinic. Infrequent testing, high rates of STIs and not being on PrEP are all linked to increased HIV acquisition. This project shows that a NP-led outreach clinic reduces barriers to accessing PrEP in a high risk population group.

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11.50am - 12.00pm Maximising Impact: Pioneering Holistic Case Management for People Living with HIV

Lenny Brown (WAAC)

Background: A holistic case management model recognises the multidimensional needs of individuals, facilitating support and service access whilst addressing the underlying social determinants that fostered these needs. The holistic approach in healthcare is well documented under the scope of nursing, however a holistic case management model is not. For PLHIV, Viiv Healthcare strongly advocates for holistic care, and recent research suggests that holistic approaches have a strong potential to improve retention in care and adherence to medications. Our model is grounded in collaboration and tailored support, creating pathways to sustainable access to comprehensive care. The evidence supporting this model is scarce; however, the potential to revolutionize care and collect this data is available through WAAC’s innovative supports. Methods: At WAAC, we are not just reimagining case management; we are redefining it. Through seamless integration of diverse methodologies. Our holistic approach empowers clients to overcome barriers to help them achieve sustained wellbeing. Central to our success is our commitment to foster trusting relationships, this leads to the creation of individualised support structures that promote autonomy and sustainability. Results: In the past year alone, over 60 individuals have utilised the service and have been supported to maintain treatment and improve their quality of life. Each client’s story underscores the undeniable impact of personalised, comprehensive care in reshaping the HIV care landscape. Future Actions: Continued implementation of this approach is crucial; it is integral to understand that the goal for supporting PLHIV is not just medication adherence, it is improving quality of life. WHO defines health as a state of complete physical, mental, and social wellbeing and not merely the absence of disease of infirmity. Not all health is physical and not all treatment is medicine; case management, peer education and counselling are various treatment methods that assists with improving health and wellbeing.

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12.00pm - 12.10pm HIV and The Therapy Room: A Chance to Transition from Surviving to Thriving

Saba Danawala (WAAC)

Background: The HIV Counselling Service at WAAC provides comprehensive crisis and therapeutic counselling processes to people living with HIV (PLHIV) through a holistic model that acknowledges the medical aspects of living with HIV and recognises the importance of supporting emotional, social, cultural, and psychological well-being. While case formulations, treatment goals and implementation of evidence-based modalities remain a crucial part of the counselling process, the therapeutic relationship and maintenance of a compassionate space are vital to client engagement and facilitate behaviour change. Purpose: To track the impact of these client-centred processes, the counselling service has developed a mixed-methods evaluation process consisting of 3 tools: (1) Initial case assessments and PoZQoL, (2) mid-evaluation survey to assess progress and benefits from therapy, and (3) most significant change qualitative survey and PoZQoL at the end of the counselling process. As a result of counselling, some clients report improved relational patterns, working through cycles of addiction, better management of trauma triggers and symptoms, assertive communication, and finding purpose, among many others. Other important outcomes include client retention and likelihood of engagement with external services.

Target Audience: Medical practitioners, external service providers working with PLHIV (i.e. individuals managing medication adherence, multicultural organisations, refugee services, etc.) Key Learnings: Our findings suggest some implications for future programming and research. Medical practitioners and others working with PLHIV may see benefit in patient/client outcomes and engagement from referral to counselling services. Where appropriate, they also benefit from maintaining a collaborative working relationship and feedback loop with counsellors to better perceive the effects of therapy in and out of the therapy room. Individually, counselling can be crucial to helping people accept their diagnosis and shift internalised stigma. This may mean improving physical treatment adherence outcomes or preventing transmission. Indirectly, this may mean building self-efficacy and help-seeking behaviours among patients navigating an often complex and overburdened healthcare system, which is important considering the data around HIV and other chronic comorbidities. Relevance to Symposium Theme: Counselling is integral to the multidisciplinary approach of WAAC’s Allied Health Services Team and to overall adherence to and management of the challenges that come with HIV.

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12.10pm - 12.30pm Q&A session