Shared care: enabling access to hospital treatment for PLWHA with complex lifestyles
Cain, A., Coombs, A., Turner, K., Hyland, N., Manolikos, C., Herrmann, S.E., McKinnon, E., Williams, L., Skett, J., Forsdyke, C., Martinez, P. and French, M. (2007) Shared care: enabling access to hospital treatment for PLWHA with complex lifestyles. In: 4th International AIDS Conference on HIV Pathogenesis, Treatment and Prevention, 22 - 25 July, Sydney, Australia.
Objectives: To describe a ‘shared care’ model of HIV ambulatory care between the Royal Perth Hospital (RPH) HIV Outpatient Service and a non-government community based health service in Western Australia.
Chaotic lifestyle, substance abuse and mental health issues can impede access to health services and impact on adherence to medical care. In HIV infection failure to access treatment and/or inadequate adherence to therapy contribute to poor clinical outcomes. At RPH it was recognized that a number of individuals were failing to receive adequate medical care despite free universal access to ART and social support services within the hospital.
Methods: Community Health Support Workers (CHS) deliver direct psychosocial support to clients in the community. Consenting patients are referred by HIV physicians and allied health professionals. CHS assist their clients with financial planning, independent living and engagement with medical and community health services including accompanying clients to appointments. Monthly meetings between CHS, RPH HIV physicians, social workers, clinical psychologist and liaison nurses provide a case management forum for evaluation.
Results: Between 2004 and 2005 18 patients (12 m/ 6 f) were enrolled and three patients refused consent. Five patients have received uninterrupted care via the service since enrolment. The primary reason for referral for all patients was chaotic lifestyle that impeded access to HIV treatment and health care services. 13 were receiving ART at the time of referral. The median adherence level of the treated patients (n = 10 available for analysis) at entry to the program was 95%. Median log10 VL and CD4 in the year before referral were 3.79 and 223, respectively compared with 3.31 and 286 at approximately one year following enrolment (p=0.1 and 0.04, respectively, for median differences).
Conclusions: Community support for HIV infected individuals with complex lives will promote access to ART and health services necessary to prevent morbidity and mortality.
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