Addressing the long term psychosocial and medico-legal needs of HIV positive patients: The West Sussex structured interview (WeSSI) Richard Williams Dr Andrew Nayagam Maureen Wotherspoon

Background Emotional support and induction Time constraints Patients’ recall Changing needs Chronic disease - changing advice

Background Up-to-date information Accountability for patient knowledge Responsibility to review and address patient need Long term HIV positive patients as well as those more recently diagnosed

Rationale A framework is required to set standards in the management of HIV positive patients by addressing relevant medical, legal and psycho- social issues

The West Sussex Structured Interview (WeSSI) Produced by multi-disciplinary team Addressed a range of psychosocial and medico-legal issues Focussed on patients diagnosed for more than 3 years Patient satisfaction questionnaire

Audit results: Demographics (N=20) 10 male, 10 female 11 White European, 9 Black African 13 heterosexual, 7 homosexual 2 age 16-24, 8 age 25-39, 10 age diagnosed < 6/12, 1 diagnosed 6-12/12, 15 diagnosed > 3 years

Results (N=20) 19/20 required either an intervention or received new information 14/15 patients diagnosed >3 years received either an intervention or new information

Results: Interventions (N=14) Referral to Clinical Nurse Specialist (N=7) Referral to Doctor (N=3) Referral to Nurse Psychotherapist (N=3) Referral to Women’s Group (N=5) Provider Notification (N=2) Rearrangement of appointments due to concerns about confidentiality (N=1)

Results: New information received Post exposure prophylaxis for a sexual exposure (N=14) Prevention of mother to child transmission (N=11) Safe sex (N=4) Criminalisation of transmission (N=3)

Results: Interventions for patients diagnosed >3 years (N=15) Referral to CNS (N=4) Referral to Doctor (N=3) Referral to Nurse Psychotherapist (N=1) Referral to Women’s Group (N=4) Rearrangement of appointments due to concerns about confidentiality (N=1)

Results: New information received for patients diagnosed >3 years (N=15) Post exposure prophylaxis (N=12) Prevention of mother to child transmission (N=7) Safe Sex (N=3) Criminalisation (N=2)

Results: An insight into our patients 8/9 Black African patients had not disclosed their result to friends 3/9 Black African patients had not disclosed their results to friends, family or partners; 2 were referred to a women’s group 7/20 patients indicated they did not receive social support; 5 received an intervention

Results: Patient satisfaction questionnaire (N=16) 15/16 patients found the WeSSI ‘completely’ or ‘mostly’ acceptable All 16 patients who responded found the WeSSI comprehensive and relevant

Conclusion The WeSSI addressed unmet knowledge gaps by providing new information for 18/20 patients As a result of the WeSSI, 14/20 patients received an intervention 14/15 patients who had received their diagnosis >3 years prior to the WeSSI received either an intervention or new information Patients found the WeSSI relevant, comprehensive and acceptable

Recommendations Health advising services should consider adopting the WeSSI A modified WeSSI should be considered for follow up on an annual basis

Richard Williams Lead Health Adviser Warren Browne Unit Southlands Hospital Shoreham-by-Sea West Sussex BN43 6TQ