1. Aging gracefully with HIV
Maximising care of the ageing HIV population in a rural Sexual Health Clinic
Grant Sweeney 1, Elizabeth Leprince 1, Nathan Ryder 1, 2, 3
1- Hunter New England Sexual Health Services, NSW Australia
2- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW
3-The Kirby Institute, UNSW, Sydney, NSW
Background
With improvements in HIV diagnosis and management, people living with HIV (PLWH) are now aging similarly to those without HIV. UNAIDs reports that in high income countries 30% of PLWH are aged >50yrs. 1 It is thought that HIV speeds up the aging process, increasing the risk of co-morbidities and resulting in poorer health outcomes, particularly cardiovascular, neurocognitive and bone health.
Successful aging has been described as 2:
Low risk of disease and disease related disability
Maintenance of high mental and physical function
Continued enjoyment of life
This project was a file audit of our PLWH aged > 50yrs. We were interested in how well we are caring for our patients and in what areas we could improve.
Multidisciplinary team
The National Association of People with HIV Australia (NAPWHA) suggests a multidisciplinary team provides best patient care 3. We feel our team provides a holistic approach to patient care, improving wellbeing and quality of life, as evidenced by our findings. Our team aims to:
Keep patients connected to the service and ensure continuity of care and regular follow-up
Encourage patient involvement in their care
Promote an environment for open HIV related healthcare discussions
Our Clinic
Clinic 468 is a Sexual Health Clinic based in Tamworth a regional town in north west NSW, 1 of 3 clinics in Hunter New England Health.
Our HIV Team consists of ;
HIV CNC
GP VMO
Sexual Health Physician
Aboriginal Health Worker
Social Worker
HNE Health covers a total area of Sq. Kms. We service roughly half of that area. Some patients have a 600km round trip to be reviewed.
Our Patients
32 of 56 patients were >50yrs (57.1%)
Characteristics of PLWH > 50yrs
n (%)
Gender
Male
Female
Other
29 (91)
3 ( 9)
ART adherence > 95%
31 (97)
HIV monitoring last 12 months
31 (91)
Reviewed by both CNC and Doctor in last 12 months
32 (100)
Consent to communication with GP
23 (72)
Receives a Government Pension
15 (47)
What can we improve on
Data Entry
Ensuring all important information has been transferred from the paper records to the electronic files
Updating details each visit
Encourage 2 way communication with GPs especially around medical histories and medications
Focus on vaccinations and ensure each patient is up to date
Ensure the clinic stocks the relevant range of government funded vaccines
Screening for osteoporosis
Screening for frailty
Increase access to HIV advocacy groups, social events
Referral to ADAHPS when relevant
Potential Future audits;
Breakdown of sexual preferences including sexual risk factors
Age of diagnosis including nadir
References
1-UNAIDS: HIV and Aging:
2- Rowe JW, Kahn RL. Human Aging: Usual and successful. Science 1987;237:143-9
3-NAPWA: HIV and Aging in Australia: