PFSHSs have procedures in place to maximise the number of patients who remain engaged in care and remain on ART.
Giving a diagnosis
Prepare for the consultation before seeing the client but do not delay the consultation, especially if the client has been contacted and asked to attend. Clinicians delivering positive HIV results should be experienced and familiar with best practice provision of information. Ensure privacy and that you will not be interrupted. Avoid information overload—information and support may be provided over a number of consultations.Refer to Giving an HIV diagnosis: a resource for diagnosing doctors.
Before seeing the client:
- check the test result and that all identifying details match
- assess the information provided when the test was done, especially if the test was ordered by a different clinician
- consider what is needed to provide effective communication, including adequate time for explanation and questions, written information, and immediate emotional support if required.
The text below outlines the five key support services that every newly diagnosed patient is entitled to and key points that should be addressed in each.
Highlight that treatment is safe and effective and that starting treatment as soon as possible after diagnosis has many individual health benefits.
Undertake medical assessment if this is probably a late diagnosis or the patient is unwell.
For serology at baseline and medical assessment refer to HIV monitoring.
Offer this document to your patient: Benefits of HIV treatment: information for people with HIV.
Actively offer counselling appointments where available within the PFSHS or community health service.If urgent psychosocial issues are identified, referral to local counselling or mental health services is required.
The HIV support program and five key services can assist in identifying appropriate services.
There is a medico-legal responsibility to inform patients about the HIV disclosure laws and prevention of HIV transmission to others. Discuss prevention of transmission, including condom use, benefits of treatment and risk reduction strategies. Outline the role of pre-exposure prophylaxis (PrEP) for current and future partners.
Provide resources including Just diagnosed with HIV?
Identify all partners at immediate risk, i.e. anyone with whom the patient had unprotected sex or injected drugs within the last 72 hours. Explain the availability of nonoccupational postexposure prophylaxis (nPEP) for these partners. Partners identified as having been exposed in the past 72 hours need to be contacted as a priority.Provider referral is the preferred method of contact tracing when notifying partners of a possible exposure to HIV.
For contacts that are difficult to reach, the NSW Sexual Health Infolink Partner Notification Service will undertake partner notification using social media, sex networking websites or apps.
If you have concerns that a person with HIV may be infecting others, discuss the case with a senior clinician. The NSW Health Policy Directive provides a framework for the management of people with HIV infection who risk infecting others. It included interventions at the local level and how to seek further support.
Arrange a follow-up appointment to discuss how the patient is managing their HIV diagnosis, whether they are linked in with support services and whether any additional partners need to be contacted. Consider recommending or arranging a counselling appointment where available.
If the patient fails to attend the appointment, the minimum follow-up is at least four attempts over two weeks, using two different notification methods (if available) and including attempts outside normal business hours. If you receive no response and there is a postal address on file, consider sending a registered letter. Document all attempts at contact.
Additional measures may be possible through the NSW Sexual Health Infolink Partner Notification Service.
Documentation should include:
- information about the content of the discussion, including prevention of HIV transmission and discussion of reasonable precautions
- contact tracing discussion, including who will notify these partners and any identified partners who are at immediate risk and the plan for notifying these partners
- clear documentation in the medical record of discussions with the patient and with contacts where provider contact tracing was provided.
References and further reading
- NSW Health. Ending HIV. Sydney: NSW Health; 2017. Available at: http://www.health.nsw.gov.au/endinghiv/pages/support-program.aspx
- Decision Making in HIV 2017, Sydney: Australasian Society for HIV Medicine (ASHM); 2017. Available at: Decision-making in HIV 2017
- Hoy J, Lewin S, Post JJ, Street A, editors. HIV management in Australasia: a guide for clinical care. Sydney: Australasian Society for HIV Medicine (ASHM); 2009. http://hivmanagement.ashm.org.au/
- Bradford D, Hoy J, Matthews G, editors. HIV, viral hepatitis and STIs: a guide for primary care. Sydney: Australasian Society for HIV Medicine (ASHM); 2008. https://www.ashm.org.au/products/product/1976963411
- Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) Sub-Committee for Guidance on HIV Management in Australia. Antiretroviral guidelines. Australian commentary on the US Department of Health and Human Services (DHHS) guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Sydney: ASHM; 2014. Available at: http://arv.ashm.org.au/
- Australasian Society for HIV Medicine (ASHM). General practitioners and HIV. Sydney: ASHM, 2015. Available from: https://www.ashm.org.au/products/product/978-1-920773-37-3
- Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine. National HIV testing policy 2017. Sydney: ASHM; 2017. Available at: http://testingportal.ashm.org.au/images/HIV_Testing_Policy_Feb_2017.pdf
- NSW Health. Infection prevention and control policy. Sydney: NSW Health; 2017. Available at: http://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2017_013.pdf
- Foster R, Morris S, Ryder N, Wray L, McNulty A. Screening of HIV-infected patients for non-AIDS-related morbidity: an evidence-based model of practice. Sexual Health. 2011;8(1):30–42. Abstract available at: http://www.publish.csiro.au/nid/164/paper/SH10021.htm