Early initiation of antiretroviral therapy for people newly diagnosed with
            <scp>HIV</scp>
            infection in Australia: trends and predictors, 2004–2015

McManus, Hamish; Callander, Denton; Donovan, Basil; Russell, Darren; O’Connor, Catherine; Davies, Stephen; Lewis, David A.; Hellard, Margaret; Chen, Marcus Y; Petoumenos, Kathy; Varma, Rick; Cogle, Aaron; Boyd, Mark; Grulich, Andrew E.; Pollard, James; Medland, Nicholas; Fairley, Christopher K; Guy, Rebecca

doi:10.5694/mja2.50006

Cited by 8 publications

(6 citation statements)

References 16 publications

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“…ACCESS data have been used previously to report on HIV treatment outcomes mostly in NSW and VIC [14,19]. The ACCESS database has a high coverage of treatment and viral load data for PLHIV in NSW and VIC.…”

Section: Study Population and Data Sourcesmentioning

confidence: 99%

Gaps in the HIV diagnosis and care cascade for migrants in Australia, 2013–2017: A cross-sectional study

et al. 2020

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Background Globally, few studies compare progress toward the Joint United Nations Program on HIV/ AIDS (UNAIDS) Fast-Track targets among migrant populations. Fast-Track targets are aligned to the HIV diagnosis and care cascade and entail achieving 90-90-90 (90% of people living with HIV [PLHIV] diagnosed, 90% of those diagnosed on treatment, and 90% of those on treatment with viral suppression [VS]) by 2020 and 95-95-95 by 2030. We compared cascades between migrant and nonmigrant populations in Australia. Methods and findings We conducted a serial cross-sectional survey for HIV diagnosis and care cascades using modelling estimates for proportions diagnosed combined with a clinical database for proportions on treatment and VS between 2013-2017. We estimated the number of PLHIV and number diagnosed using New South Wales (NSW) and Victorian (VIC) data from the Australian National HIV Registry. Cascades were stratified by migration status, sex, HIV exposure, and eligibility for subsidised healthcare in Australia (reciprocal healthcare agreement [RHCA]). We found that in 2017, 17,760 PLHIV were estimated in NSW and VIC, and 90% of them were males. In total, 90% of estimated PLHIV were diagnosed. Of the 9,391 who were diagnosed and retained in care, most (85%; n = 8,015) were males. We excluded 38% of PLHIV with missing data for country of birth, and 41% (n = 2,408) of eligible retained PLHIV were migrants. Most migrants were from Southeast Asia (SEA; 28%), northern Europe (12%), and eastern Asia (11%). Most of the migrants and nonmigrants were males (72% and 83%, respectively). We found that among those retained in care, 90% were on antiretroviral therapy (ART), and 95% of those on ART had VS (i.e., 90-90-95). Migrants had larger gaps in their HIV diagnosis and care cascade (85-85-93) compared with

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Section: Study Population and Data Sourcesmentioning

confidence: 99%

Gaps in the HIV diagnosis and care cascade for migrants in Australia, 2013–2017: A cross-sectional study

et al. 2020

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“…This finding may also reflect a shift in mindset among patients, with more patients newly diagnosed with HIV infection requesting immediate treatment. The movement towards earlier initiation of treatment is supported by Australian HIV‐management guidelines 23 and is reflected in other data reported elsewhere 24,25 …”

Section: Treatment Of Hiv Infectionmentioning

confidence: 73%

“…The movement towards earlier initiation of treatment is supported by Australian HIV-management guidelines 23 and is reflected in other data reported elsewhere. 24,25 Reported comfort levels to begin treatment on the day of diagnosis further support this apparent trend towards early therapy initiation. Across all specialties, 46% stated they were comfortable to start treatment on the day of diagnosis, which was higher than the result observed in the baseline survey (30%; Fig.…”

Section: Treatment Of Hiv Infectionmentioning

confidence: 97%

Trends in practice: attitudes and challenges in the diagnosis, treatment and management of HIV infection in Australia

Smith

Woolley

Russell

et al. 2020

Internal Medicine Journal

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As life expectancy for people living with human immunodeficiency virus (HIV) (PLWHIV) increases, management models for HIV infection are changing. To understand approaches to practice within this shifting climate and across different medical settings, in 2017 we conducted a baseline survey among the main medical practitioner groups responsible for HIV‐infection care in Australia: hospital‐based physicians (HBP), sexual health physicians (SHP) and ‘accredited general practitioners’ (referred to in 2017 study as ‘s100 GPs’), who are GPs authorised to prescribe HIV therapies after completing accredited national training. The follow‐up survey presented here explores any changes in approaches, attitudes and challenges associated with HIV‐infection management among the same practitioner groups: 17 HBP, 15 SHP and 69 accredited GP (referred to throughout as GP; includes those with sexual health diploma). Analysis of survey results showed practices remained largely similar between surveys, with a few notable exceptions. Greater consistency in attitudes, knowledge and approaches was observed between the practitioner specialty groups, with only small differences between modes of practice. A trend towards earlier initiation of HIV treatment was also identified, with a higher proportion of practitioners than baseline reporting they were comfortable beginning therapy on the day of HIV diagnosis. The impact of the introduction of two‐drug therapy in Australia was also explored. Although the majority of survey respondents (and SHP in particular) expressed greater preference for three‐drug compared with two‐drug regimens, interest in two‐drug regimens appears to be growing and may influence future prescribing practices. Addressing mental health issues for PLWHIV was again highlighted as a major priority, with practitioners overwhelmingly reporting mental health management as among their most difficult clinical challenges. Reduction in stigma/discrimination and better access to substance dependency programmes were also identified as unmet needs for this patient cohort. Consistent with our baseline survey, it appears targeted interventions and supports appropriate to this population are still required to improve overall wellbeing for PLWHIV.

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“…This reduction is greatest in men who have sex with men (MSM), a broad term which includes gay‐identified men, heterosexually identified MSM and bisexual men . Significant improvements in early initiation of antiretroviral treatment provide individual as well as public health benefits . However, new diagnoses in the Aboriginal and Torres Strait Islander population increased by 41% compared with a decline of 12% in the non‐Indigenous population between 2013 and 2016 .…”

Section: Hiv and Sexually Transmitted Infectionsmentioning

confidence: 99%

The Guttmacher– Lancet Commission on sexual and reproductive health and rights: how does Australia measure up?

Bateson

Black

Sawleshwarkar

2019

Medical Journal of Australia

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Early initiation of antiretroviral therapy for people newly diagnosed with HIV infection in Australia: trends and predictors, 2004–2015

Abstract: Objectives:To determine trends in and predictors of early treatment for people newly diagnosed with human immunodeficiency virus (HIV) infection in Australia.

Cited by 8 publications

References 16 publications

Gaps in the HIV diagnosis and care cascade for migrants in Australia, 2013–2017: A cross-sectional study

Gaps in the HIV diagnosis and care cascade for migrants in Australia, 2013–2017: A cross-sectional study

Trends in practice: attitudes and challenges in the diagnosis, treatment and management of HIV infection in Australia

The Guttmacher– Lancet Commission on sexual and reproductive health and rights: how does Australia measure up?

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