National HIV Nurses Association

11th Annual Conference National HIV Nurses Association

Abstracts 2009

• Oral Abstracts
• Poster Abstracts

01 - Customer care questionnaire.
02 - HIV and attitudes to employment: Survey findings from a London clinic.
03 - Think about it! HIV/AIDS.
04 - ‘Twenty-five not out!’ A brief history of haemophiliacs coinfected with HIV and HCV
05 - Developing antenatal classes specifically for HIV-positive pregnant women.
06 - Non-disclosure of HIV-positive status in Black African women to their sexual partners in the UK. A literature review.
07 - An eight-year review of the management and outcomes of pregnancy in an Irish cohort of intravenous drug users (IVDU) from an HIV nurse specialist perspective.
08 - Do HIV-positive pregnant women, wishing to have a vaginal delivery, achieve their delivery choice?
09 - Understanding HIV-risk behaviour in HIV-serodiscordant couples – a novel approach
10 - Defining the patient pathway for HIV-patients receiving treatment for Hepatitis C
11 - Hepatitis C (HCV) coinfection: using an audit of patient experience to identify and address nursing competencies.
12 - Introduction of a nurse-led sexual health service for HIV-positive men.
13 - Challenges to adherence to highly active antiretroviral therapy (HAART).
14 - Personal beliefs, mixed feelings and anticipated adherence to HIV antiretroviral combination therapy.
15 - The effectiveness of a dedicated nurse-led PEPSE clinic in an inner London hospital
16 - Introducing a PGD for the initiation of HIV PEP.
17 - A study of the cardiovascular disease risk of our patient cohort.
18 - Cardiovascular risk assessment and management guidelines for HIV – what are we using?
19 - Three cases of late adverse events with poly-l-lactic acid treatment in a nurse-delivered service: recommendations for practice.
20 - ‘Lost to follow-up’ – which patients disengage from HIV services and why?
21 - Assessment of the impact of a home delivery service on the virological outcome of patients with the human immunodeficiency virus (HIV).
22 - Challenges in addressing counselling needs of MSM in highly stigmatized contexts: results of a qualitative study from Kenya.
23 - Conflicting needs: investigating patient preferences in the design of a newHIV/sexual health clinic serving an ethnically diverse population.
24 - Crossing the divide: transitional care for young adults with HIV – their views.
25 - Housing and HIV: the impact of housing on the health and well-being of people living with HIV – an analysis.
26 - Promotion of sexual health services to men who have sex with men, offering Hepatitis B vaccinations in known gay venues.
27 - Targeting hard-to-reach groups: moving outside the HIV clinic.
28 - What do court transcripts reveal about judges’ understanding of the medical impact of HIV infection and what are the implications for healthcare professionals giving advice to the court?
29 - Patient acceptability of atazanavir formulations: size versus pill burden.
30 - Simplifying to Atripla: not always simple?
31 - Reaudit on sexual health and hepatitis screen in HIV-positive patients – completion of audit cycle.
32 - The acceptability and effectiveness of home-sampling for sexually transmitted infections in HIV-positive men who have sex with men.
33 - Preconceptions about pre-conception? Development of a dedicated pre-conception clinic for people living with HIV.
34 - Cardiovascular risk assessment and reduction in patients on abacavir.
35 - Positive HIV tests in a south London hospital: Who did the test and what happened next?
36 - ‘Sex, love and one-night stands: getting the relationship you want’: evaluation of a European sexual health workshop for HIV-positive young people.
37 - Safe or sorry (SOS) sauna outreach project, are we doing enough to diagnose the undiagnosed?
38 - ‘Testing the children’ – are we diagnosing the undiagnosed?
39 - The importance of providing voluntary sector advocacy and peer-support workers in HIV clinics.
40 - Care of HIV-positive lady’s during pregnancy at Heart of England Foundation Trust.

Abstract P1

Customer care questionnaire

C Cody, J Brolan, D Davidson Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, UK

Background:
Due to the increasing numbers of patients attending clinic during the last couple of years, and the continuing rise we are experiencing, it was felt that it was necessary to compile an anonymous questionnaire, for our patients regarding the care they receive in our department, to ascertain from a patients point of view as users of the service we provide, as to which areas of care they would like to see improved or changed.

Methods:
As stated the questionnaire was completely anonymous, and filled in voluntarily by the people who access our service. The questionnaire was devised simply and kept short, due to the fact that we cater for many nationalities, some of which English not being their first language. It was also decided that due to the large volume of people who access our service it was also decided that a ten per cent snap shot, would give the department team a good idea of what kind of service our patients would like to receive.

Results:
The following will provide a brief outlook of the results from the questionnaire, we have to date. These results we have so far equate approximately to six per cent of the ten per cent target aimed for.

• 70% of people said they were happy with current clinic times.
• 30% said they were not. 65% said they would prefer an early morning bloods appointment.
• 35% said they would not 51% said they would prefer an evening doctor and bloods appointment.
• 49% said they would not.
• 98% said they felt welcomed when they attended the department.
• 2% said they did not.
• 99% find the clinic staff friendly and helpful.
• 1% does not.

Conclusions:
The results of the questionnaire we have so far, have led to the development and implementation of an early morning blood taking clinic, and an evening doctor and blood taking clinic, both will be held on aWednesday, hopefully due to commence in August.

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Abstract P2

HIV and attitudes to employment: Survey findings from a London clinic

T Fernandez, A Bartley, S Bhagani, N Brecker, A Rodger The Royal Free Hampstead NHS Trust, London, UK

Introduction:
Developments in treatment of HIV have significantly improved survival in affected individuals, increasing the potential for remaining in or returning to work following diagnosis. However, many people with HIV remain symptomatic, or fearful of stigma, which can affect their experiences of engagement with work. Employment is one of the key determinants of health, and can protect from poverty and social exclusion.With this in mind, we surveyed patients attending a major centre in North London offering support and treatment for people with HIV.

Method:
A self-completed questionnaire was devised between the HIV, public health and occupational health teams. This included employment status, attitudes to work, perceived barriers to entering, returning to or remaining in work, reasons for leaving work and where patients would like further employment information or support. These employment issues were then related to health and social demographics. The survey ran over three months during which 750 completed questionnaires were returned (approximately 35% of the current patient population).

Findings:
Over 24% of respondents were unemployed, compared to a national average of 2.5%. 28% of those not working had concerns around stigma because of their status, compared to 6% of those working; 33% of those not working thought work would interfere with their hospital appointments compared with 20% of those currently in employment. Around 50% of responders mentioned mental and/or physical health and 20% cited lack of confidence, skills gap or length of time out of work as barriers to employment. In selecting options for delivery of information and advice on employment, 65% preferred this in the HIV clinic setting to other settings, with the majority wanting individual employment counselling.

Recommendations:
This work also highlights opportunities for NHS HIV services to work with occupational health services to improve patients‘ experiences of rehabilitation to work. Implications for the HIV service include a role in helping patients remain in work, offering employment advice, scheduling appointments to suit working times and addressing patients‘ perceptions around stigma and confidence

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Abstract P3

Think about it! HIV/AIDS

J Reid, T Moyo, N Mazibuko Centre for African Families Positive Health (CAFPH), UK

Introduction:
We have two poems written by women, one has been adapted to have men and youth versions of it.

The second one is in its raw state and is about a woman’s journey in life and finding out about her HIV/AIDS status and her perception of stigma in relation to HIV/AIDS.

Objectives:
To express the experience of people living with and affected by HIV/AIDS and how they deal with living with a condition that is highly stigmatized; to stimulate debate/discussion on HIV/AIDS and stigma; to inspire people living with HIV/AIDS to look at HIV/AIDS in a different perspective; to show the underlying impact of stigma for people living HIV/AIDS and the daily struggle.

Results and conclusion:
CAFPH has always strived to fight against HIV stigma and to motivate and inspire people living with and affected by HIV/AIDS to live a better, productive and positive lives inspite of HIV. This year CAFPH is embarking of a campaign against HIV stigma drawing on the experiences of PLWHA’s and the way they deal with living HIV/AIDS and the stigma and how they respond. The poster represents the poems that have been written and adopted from peoples’ experiences and feelings.

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Abstract P4

‘Twenty-five not out!’ A brief history of haemophiliacs coinfected with HIV and HCV

TM Dunkley, M Simmons West Midlands Adult Comprehensive Care Haemophilia Unit, Queen Elizabeth Hospital, Birmingham, UK

Haemophilia A, a deficiency or absence of factor VIII, is an inherited, lifelong bleeding disorder. Affecting 1 in 5000 males in the UK, haemophilia is carried by females and passed on to sons (Collins1995, Haemophilia Society 2008)

This condition is treated with replacement factor VIII concentrate. From the late 1970's factor VIII concentrate was developed from donations of pooled plasma. Screening and viral inactivation of factor VIII did not become available until 1985 (Haemophilia Society 2002). This enabled HIV to enter the donor pool and into factor concentrate production. Of the 5000 haemophiliacs in the UK, 1200 were infected with HIV. Many of those infected were children (Fisher 2009). Of the 1200, five were women with inherited bleeding disorders who also received clotting factor. Prior to diagnosis at least 50 females were infected with HIV by their haemophiliac partner (Fisher 2009). To date 342 are long term survivors of which 4 are women (Fisher 2009). Factor VIII is now produced recombinantly. There are many extended families with haemophilia. The impact of HIV within these families was devastating. Several generations of males within the same family were lost to HIV. Initially, this cohort was not expected to survive more than a few years. This belief was reinforced by the deaths of brothers, uncles, cousins and peers who contracted HIV at the same time and died. A test for hepatitis C in the 1990s confirmed that the majority of these haemophiliacs were also infected with HCV (hepatitis C virus), and are also now classified as being in the 'at risk group' for vCJD. With the advent of protease inhibitors, an unexpected side effect in haemophiliacs occurred. Many reported unusual bleeds which did not always respond well to usual treatment (Yee 1997, Wilde 1999). As HIV treatments have become more sophisticated and varied, their HIV has stabilised. However, HAART can accelerate the degeneration of joints and exacerbate arthropathies in haemophiliacs. In recent years, as is the nature of the hepatitis C virus, there has been a progression to hepatoma, resulting in for some, the need for liver transplantation and for many, death. The majority of deaths in recent years for this cohort have been HCV related.

During the 80's when HIV was claiming many of their lives, life expectancy was unpredictable. Today the UK now has an aging population of haemophiliacs, some of whom are also co infected with HIV/HCV (Dolan, 2009). These challenges present unchartered waters for both patients and haemophilia treatment centres.

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Abstract P5

Developing antenatal classes specifically for HIV-positive pregnant women

C Wood1, K Francis1, J Rwami2, M Muheki2, A Govind3 1North Middlesex University Hospital, London, UK 2PASCH – Pan African and Caribbean Sexual Health and HIV, London, UK 3North Middlesex University Hospital, London, UK

Background:
In our HIV unit we manage between 30 and 45 HIV-positive pregnancies per year. We have become increasingly concerned that these HIV-positive pregnant women have not had the option to attend routine antenatal classes in our hospital. Antenatal classes are regarded as worthwhile and NICE (National Institute for Clinical Excellence) recommends that all pregnant women in the UK be offered antenatal classes. We decided to explore the opinions of some of our HIV-positive women and HIV-positive mothers regarding the issue, and to review the content of our local antenatal classes.

Methods:
We had a consultation process including our antenatal HIV multidisciplinary team including a Voluntary sector advocate, HIV peer-support worker (an HIV-positive mother herself) and HIV-positive pregnant women and mothers. We systematically reviewed the content of our local ‘general’ antenatal classes with a view to redesigning them specifically for HIV-positive pregnant women.

Results:
There was overwhelming support for the idea of antenatal HIV classes specifically for HIV-positive women. Almost all HIV-positive pregnant women felt uncomfortable with the idea of going to generic antenatal classes. There are many specific issues relevant to HIV-positive pregnant women, which are not addressed in generic antenatal classes, such as disclosure, discordance and detailed discussion on mode of delivery. HIV-positive women focused on practicalities of bottle-feeding and the stigma of bottle-feeding in social situations. They were also very keen to have yoga classes.

Conclusions:
Our research has shown a very significant gap in the provision of optimal antenatal care for HIV-positive women. As far as we are aware these are the first antenatal classes developed specifically for HIV-positive pregnant women, at least in the UK.We have now developed a programme of antenatal classes tailored for women with HIV and are currently refining this in an ongoing process of consultation. We hope that this will be useful in other antenatal HIV settings. We would encourage other units to explore the issue in a similar way.

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Abstract P6

Non-disclosure of HIV-positive status in Black African women to their sexual partners in the UK. A literature review

A Waters North Middlesex Hospital, UK

Objective:
The non-disclosure of HIV positive status amongst Black African women to their sexual partners in the UK was evaluated using a literature search. How nurses and the multidisciplinary team can help clients in this difficult situation was also reviewed.

Method:
A literature search was conducted using a variety of databases: Ovid, CINAHL, MEDLINE, British Nursing Index, Blackwell-Synergy.com and IngentaConnect, as well as Google and Google scholar.

Results:
The literature reviewed suggests that Black African women have lower disclosure rates than Caucasians. 60–65% of Black African women in the UK report discloser to current partners compared to 86.25% of Caucasian gay males (Anderson and Doyle 2004; Elford, Ibrahim, Bukutu and Anderson 2008). Other studies also showed a lower overall disclosure rate for Black Africans than Caucasians, (Petrak, Doyle, Smith, Skinner and Hedge 2001; Erwin, Morgan, Briteen, Gray and Peters 2002)

The World Health Organisation (WHO) reviewed all published articles on HIV disclosure over a 10-year period and reported a number of findings: a lower rate of disclosure in the developing world, a small number of women who do not disclose to anyone, and cultural factors associated with non disclosure.

Fears of rejection, stigma, discrimination and how they will be viewed as a wife and mother were reported as reasons for lack of disclosure in Black African women (Anderson et al 2004; Calin et al 2007; Erwin et al 2002; Dlamini et al 2007; Green, Derlega, Yep and Petronio 2003; Dodds et al, 2004; Flowers et al 2006; Petrak et al 2001).

Several theoretical disclosure theories were evaluated in the context of HIV disclosure.

Conclusions:
Lack of disclosure is a health risk to sexual partners. Moreover, knowledge of HIV status may reduce risk of HIV transmission and failure to disclose has implications for the public health. We have a framework for disclosure that identifies barriers to disclosure. The disclosure of one’s HIV status is a process. According to the disclosure theories there are stages and decisions that a person goes through before a final decision to disclose is made. As nurses we can be advocates for disclosure within the multidisciplinary team and we can work to aid the woman through the process of disclosure. This also must be in accordance with the law and within guidelines from professional bodies.

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Abstract P7

An eight-year review of the management and outcomes of pregnancy in an Irish cohort of intravenous drug users (IVDU) from an HIV nurse specialist perspective

D Ward, S Murphy, S Surah, F Lyons GUIDE clinic, St James’ Hospital, Dublin, Ireland

Background:
At the largest adult HIV centre in Ireland, 1679 of 3038 patients are Irish; the majority acquired HIV from IVDU(n=775). Many have a history of poor clinic attendance and treatment adherence. As HIV liaison nurse to the Irish patients my responsibilities include follow up, care, education and support for this group. Pregnancy in this group presents the additional challenge of minimising the risk HIV MTCT.

Aim: To describe management and pregnancy outcome in a cohort of IVDU pregnant women with HIV.

Methods:
Data was obtained from the hospital appointments system, nursing records and pregnancy database in HIV positive women. In pregnancy women are asked to attend at least monthly. At each clinic visit women meet with the HIV nurse specialist for support and education. Multidisciplinary management includes liaison with nurse specialists and social workers in obstetric, paediatric and addiction services. Furthermore each pregnant woman is discussed at the monthly multicentre, multidisciplinary pregnancy meeting. Missed appointments are followed up by the HIV nurse specialist both during and after pregnancy. The number of missed appointments was recorded for 12 months before pregnancy; during pregnancy and 12 months after delivery.

Results:
From January 2000-December 2008, 323 women had 484 pregnancies; 60(12.35%) in 45 women with IVDU as HIV risk. Median maternal age =30 yrs(range 20-40). Active drug and/or alcohol abuse was documented in 26(43.3%). The majority(68%) were aware of their HIV diagnosis before pregnancy. 32/45(71%) were hepatitis C coinfected. Baseline median CD4 396×106/L(range 24–940) and baseline median HIV VL 8619copies/ml(49–356493). 10 pregnant women with IVDU(A) were randomly selected and compared with 10 pregnant Irish women with no history of IVDU(B). Missed appointments (median, range); 12 months prepregnancy A=4(2–11), B= 1(0-3); during pregnancy A=5(0–11), B=1(0–4); 12 months after pregnancy A=4(1–8); B=3 (0–9). Despite the high number of missed appointments, 59(98 %) women received antenatal antiretroviral therapy and the median predelivery HIV VL =49 copies/ml(range 49-25,693copies/ml). Median gestation at delivery and birthweight: 39 weeks (range 25–42) and 2.64kg( range 0.65–4.5) respectively. Mode of delivery: 27(45%)SVD; 31(51.6%)CS. 3 babies (5%) received no drugs after delivery, including two stillbirths. There was one vertical transmission in a woman who seroconverted in pregnancy and screened HIV positive at 35 weeks.

Conclusion:
The HIV specialist nurse is integral to preventing MTCT in IVDU HIV positive women. An understanding of the addiction issues experienced and a willingness to offer flexible, individualised care is imperative.

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Abstract P1

Do HIV-positive pregnant women, wishing to have a vaginal delivery, achieve their delivery choice?

EA Breadner Southampton City Primary Care Trust, UK

Background:
The audit took place in an area with a large teaching hospital with a mean of 5350 births per annum; the local incidence of HIV in pregnancy is 0.17%. In 2008 uptake of HIV testing during pregnancy was 97% .The mean for unassisted vaginal deliveries in the local pregnant population is 63.5%. Standard practice is to offer HIV positive women the choice of a vaginal delivery provided the viral load is undetectable at 38 weeks of pregnancy and there are no obstetric contra-indications.

Aims:
1. Evaluate outcomes in HIV pregnancies over 5 years, 2004–2008. 2. Identify whether HIV positive women choosing a vaginal delivery were able to achieve their delivery choice.

Method:
An audit was undertaken by analysis of the notes of all HIV positive pregnant women attending for care (2004–2008). Planned mode of delivery and actual mode of delivery were identified. For women not achieving planned mode of delivery the cause was ascertained. Other information collected included, HIV status of the babies, viral load measurements at 36 weeks, ethnicity and recourse to public funds.

Results:
There were 47 pregnancies beyond 12 weeks, in 40 women resulting in 43 live births and 2 intrauterine deaths. 20 women were diagnosed HIV antibody positive in pregnancy and 26 diagnosed prior to pregnancy; one woman presented in labour being diagnosed post-delivery. No women went into spontaneous labour prior to 37 weeks. 2 women moved out of area during pregnancy.

To date 95% of babies have completed their care pathways, with no cases of HIV maternal transmission. I baby was lost to follow up. Of the 43 live births there were 24 spontaneous vaginal deliveries (58.1%) – 78% of women who had planned a vaginal delivery achieved one. 9 women had a change of mode of delivery; 3 due to fetal distress in labour, 2 pre-eclampsia, 1 reduced fetal movements in 3rd trimester and 1 had a late rise in HIV viral load.

82.5% of the women were of black African ethnicity and 66% had no or limited recourse to public funds.

Conclusion:
There were no cases of maternal transmission of HIV infection in babies who had completed their care pathway. The majority of women (78%) wishing to have a vaginal delivery did so.

The overall vaginal delivery rate was statistically comparable in both local HIV and non HIV populations.

(Thanks to Dr E Foley GUM Consultant, Southampton City Primary Care Trust and Anne Gilbert and Karen White, Midwives Southampton University Hospitals Trust for their support in preparing this abstract.)

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Abstract P9

Understanding HIV-risk behaviour in HIV-serodiscordant couples – a novel approach

J Fox1, A Alsop2, G Elam2, J Green3, J Weber3, H Ward3, M McClure3, S Fidler3 1Guy’s and St Thomas’ NHS Trust, London, UK, 2University College London, UK, 3Imperial College NHS Trust, London, UK

Aim:
To explore perceptions about and attitudes towards risk taking behaviour in HIV serodiscordant couples Methods: Thirty-eight HIV-serodiscordant couples were followed up at 3-monthly intervals for 3 years. At each visit both partners were asked about sexual behaviour, perceptions of risk, and knowledge/use of post exposure prophylaxis (PEP). One-off qualitative interviews were carried out, separately with both partners in a couple in a subset of couples.

Results:
Perceptions of HIV-transmission risk varied within couples (in 27/38 couples the infected partner perceived the risk to be higher than the negative partner, P=0.04), and between positive and negative individuals (negative individuals were more likely to associate risk with viral load). Six of 38 (16%) HIV-negative and 12/38 (32%) HIV-infected individuals were aware of PEP (P=0.105) and despite subsequent education, it was utilized only once. Risk taking behaviour did not change over time. The risk of HIV acquisition from outside a relationship was substantial as shown by one HIV acquisition, n=10 incident bacterial STI and high numbers of casual partners. Qualitative interviews identified three key themes related to ongoing risk behaviours: inaccuracies in evaluating HIV transmission risk; a desire to show commitment to a relationship and low anxiety of the consequence of HIV-transmission occurring. These differed within a couple, between couples and broadly between HIV negative and HIVinfected individuals.

Conclusions:
This study represents the largest investigation of HIV-serodiscordant couples undertaken in the UK and provides, for the first time, perspectives from both HIV- negative and HIV-positive individuals within a couple. Differences in perceptions of risk and justifications for risk behaviour within a couple, suggests that tailored couple-counselling to high-risk couples may be beneficial. HIV-positive individuals should communicate their anxieties regarding transmission to partners and HIV-negative individuals need to be educated on the impact HIV has on quality of life.

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Abstract P10

Defining the patient pathway for HIV-patients receiving treatment for Hepatitis C

D Castelnovo1, M Keller2, M Rankin2, C Adams3, D Edmondson1, A Powell4, J Tibble2, M Fisher1, E Nixon1

1HIV Services, Brighton and Sussex University Hospitals, 2Digestive Diseases Unit, Brighton and Sussex University Hospitals, 3HIV Community Specialist Team, Sussex Partnership, 4Sussex Beacon, Brighton, UK

Introduction:
HIV patients undertaking 48 weeks of Hepatitis C treatment with Interferon and Ribavirin have a number of complex health needs and often find it difficult to navigate appointments and services they need to access. This paper outlines the development of a defined pathway and will illustrate the patient journey through HIV and hepatology services.

Aim:
The aim of establishing the HIV/Hepatitis C pathway was to clarify roles across multiple teams and ensure patient needs were met with regard to appropriate ARV therapy, side effect management, nutrition, social and mental health support.

Method:
A multidisciplinary group was established to identify core aspects of the patient pathway.

The group included:

• Hepatitis C nurse specialists
• HIV community mental health nurse
• Senior nurses from HIV outpatient services
• HIV dietician
• Senior nurse from HIV continuing care
• HIV and Hepatology physicians

Baseline assessments were agreed with particular regard to nutritional evaluation and mental health assessment tools. Criteria for referral were negotiated across the teams and link roles identified for each stage of the pathway. Time periods for interventions and frequency of monitoring were specified.

Conclusion:
There is considerable evidence for the successful use of pathways for patients accessing multiple services. This pathway for HIV patients receiving treatment for Hepatitis C has assisted in improving communication across a number of teams and in providing more co-ordinated care. The process has benchmarked current interventions and care that will be a useful tool in measuring effectiveness in meeting the complex needs of these patients.

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Abstract P11

Hepatitis C (HCV) coinfection: using an audit of patient experience to identify and address nursing competencies.

N Ault, D Scott Barts and the London NHS Trust, UK

Objectives:
Using audit to identify relevant competencies for nurses in HIV clinics at all bands in relation to HCV coinfection.

• transmission risks of patients presenting with HCV co-infection in an inner London clinic.
• Importance of transaminaise monitoring and interpretation
• the range toxicities reported.
• the range of health promotion issues that present.

Methods:
A retrospective case notes audit of patients attending for Hepatitis C (HCV)/HIV co-infection from January 2007 to present.

Results:
34 man and 1 women (mean age 42 – range 28–58) presented with HCV coinfection (13/35 with acute infection). Time range to HCV diagnosis was 1–15 years after HIV diagnosis (median 6.5years). Exposure risks for HCV acquisition in this cohort were high risk MSM sexual activity, snorting recreational drugs and intravenous drug usage (IVDU). Given the time to diagnosis of HCV this highlights the importance of prevention messages as all of these diagnoses could be seen as being preventable. This is discussed in relation to appropriate competencies for HIV nurses.

Initial diagnosis is usually via abnormal liver function tests. In the acute arm of the audit ALT abnormalities ranged from 57 to 1820, whilst the chronic arm ranged 32–497 (Median 91). This shows the need for vigilance in interpreting and understanding transaminaise levels as these can be only mildly raised and acting appropriately with further education and investigations

In this clinic the support for HCV treatment is via a nurse-led clinic. After initiation approximately 33% of patients presented with a range of adverse events (thrombocytopenia, anaemia, neutropenia etc) and side effects ( both physical and psychological). These are discussed in relation to competencies for band 5 to band 7 level nurses in identification and support of these issues.

Conclusions:
Hepatitis C infection is increasing both as a single diagnosis, but also as a co-infection with HIV. It is a preventable diagnosis, and has a significant impact if acquired on both physical and psychological well being. This audit helps identify appropriate competencies for band 5 to band 8 nurses including prevention, identification and treatment of HCV co-infection. Finally, the NHIVNA competencies are discussed in relation to these findings with recommendations being made for future development and inclusion.

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Abstract P12

Introduction of a nurse-led sexual health service for HIV-positive men

P Davis, K Forbes, L Sarner Barts and The London NHS Trust, UK

Objectives:
To improve the uptake of sexual health screening, a nurse led clinic offering STI screening to symptomatic and asymptomatic men within an existing HIV outpatient service was created in 2007 This is a review of the first six months of the service.

Method:
A retrospective case-note review of review of men having a sexual health screen between June and December 2007. Information regarding adherence to local and national standards for STI screening were examined as well as the frequency on sexual health assessment.

Results:
125 men attended, 69 at the booked clinic, 30 after a medical appointment and 26 after phlebotomy. 7 were heterosexual, 1 bisexual and 112 were MSM 110 men had one check and 15 had two or more checks. 10 were contact of an infection and 41 reported symptoms of infection. 71 MSN reported unprotected anal intercourse within the last three months.

6 had asymptomatic Chlamydia infection and 2 had asymptomatic gonorrhoea infection.

Microscopy was performed in 118 men, 5 presumptive gonorrhoea diagnoses were made and 11 non specific urethritis were made.

5 had infectious syphilis and 2 new hepatitis C infections were detected.

Conclusion:
The nurse led clinic was mainly utilised by British Caucasian MSM who were asymptomatic on antiretroviral therapy and reporting recent unprotected anal intercourse. Asymptomatic infections were diagnosed leading to earlier treatment and partner notification potentially reducing complications and onward infection. The high prevalence of both HCV and syphilis infection illustrates the need for clinical management strategies to ensure patients are tested annually for HCV and quarterly for syphilis as part of their routine care.

The high proportion of asymptomatic MSM accepting screening suggests that integrating sexual health services into HIV care is acceptable to patients.We suggest that introducing a nurse led sexual health clinic within our HIV services has helped to achieve national standard on sexual health screening in HIV positive men and improved the sexual health of our patients.

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Abstract P13

Challenges to adherence to highly active antiretroviral therapy (HAART)

N Anin Mildmay UK

Background:
In the author’s workplace, most of clients admitted need support around adherence to HAART. HIV is treated with HAART. HAART refers to a combination of drugs that slow down the rate at which HIV is reproduced. HAART offers new hope, delays AIDS diagnosis and improves the quality of life.

Aims:
This study looked at the successes and failures with regards the adherence of clients we have supported. I took a look at 10 clients who had adherence as one of their goals for admission.

Methods:
The 10 clients were chosen from various backgrounds and made up of 6 women and 4 men. We see success with adherence when the client is able to self medicate with support or without support.We see a failure when the client is unable to self medicate and would require supervision from community nurses to monitor them. We also found failures in clients who were erratic in taking their medication.

Results:
Of the 10 clients the author concluded that we had 8 successes. Of these 8, 4 become completely independent with managing their medications, they were either self medicating form medication packets or from dossette boxes. Those self medicating form dossette boxes were filling the boxes themselves without supervision. The other 4 though they left self medicating from a dossette box, they were going to need their Community nurses or pharmacists to fill them in for them. I will highlight the challenges we faced with 2 clients we found challenging and concluded as being failures as far as getting them to adhere to HAART. Mrs B. came to us and required support with adherence; she would take the medicines off the nurses but would not take them. There was a time when she even concluded that she was not HIV positive and so she would not take her medicines. We continued to educate and encourage her but we only managed to get her to take her HAART but she takes them when she wants. Mr A was also admitted for adherence, he had a Percutaneous Endoscopic Gastrostomy (PEG) tube. He was challenge because he would keep asking to come back later to give the medication as he was not ready to have them yet. He later decided he did not want the HIV drugs anymore.

Conclusions:
Clients should be made aware that HAART for HIV is a lifelong endeavour.

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Abstract P14

Personal beliefs, mixed feelings and anticipated adherence to HIV antiretroviral combination therapy.

AP Marshall The Sussex Beacon / University of Sussex, UK

Abstract:
This cross-sectional, questionnaire-based study explored the behavioural beliefs, attitudes and ambivalent thoughts and feelings of a group of twenty male HIV positive people regarding their adherence to HIV antiretroviral combination therapy. The relationship between these variables (attitude & ambivalence) and two measures of anticipated future adherence (intended and subjective expected adherence) was investigated. Results demonstrated significant correlations between attitude, ambivalence and subjective expected adherence, and indicated that ambivalence moderates the relationship between attitude and subjective expected adherence. Additionally, the perceived importance and perceived ease of adherence were associated with subjective expected future adherence. The study also presents a wealth of qualitative data and provides a unique insight into individual perceptions of the challenge of adherence.

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Abstract P15

The effectiveness of a dedicated nurse-led PEPSE clinic in an inner London hospital

N Ault, D Scott, S Thomas William, L Sarner Barts and the London NHS Trust, UK

Aims:
To evaluate and compare the effectiveness of a dedicated nurse led PEPSE clinic to a regular GU medicine clinic in the provision and follow up of patients started on PEPSE

Methods:
A retrospective case-note review of patients attending the Nurse led PEPSE clinic from September 2007 to March 2008. Standards were based on the BASHH guidelines for PEPSE. Data collected was compared with a similar PEPSE audit carried out in the same department in 2004/05 before the establishment of a dedicated PEPSE clinic.

49 patients attended the nurse led clinic within the specified time period compared with 44 in the previous audit.

Results:
Compared to the previous audit, 96% were within recommendations for PEP. 100% had PEP within 72hours and had baseline HIV tests, while 95% had STI screen at 2–4 weeks and 84% (41/49) completed the 4 week course in 2007/8. Of the remaining 8 patients, 1 diagnosed HIV positive at baseline, 1 source was proven HIV negative, 2 were low risk and not in need of PEPSE, 3 were due to severe side effects and 1 was unknown reason. Therefore the 4 week completion rate was 92% (45/49) in the nurse led clinic compared to 39% in the previous audit.

The 3-month follow up for HIV testing was nearly the same (39% vs. 30%) in both audits. The 6 month follow up rate for HIV testing was 31% in this audit.

The nurse led clinic achieved all the standards except the 3 and 6 month follow- up. For the initial 3 months of the nurse led service, 3 and 6 month follow-up was passed back to the GU service and may therefore explain why patients were lost to follow-up and the standards missed.

Conclusions:
A significant improvement was seen in the 4 week completion rate ( 92% vs 39%) in the nurse led clinic, despite the high incidence of reported side effects. This may be due to the continuity provided by seeing one practitioner throughout the course of PEP, allowing non-attendance to be addressed promptly (the GU based service did not provide this). The apparently low incidence of toxicities in the previous audit could be due to inadequate documentation and the reduced follow-up and completion rates.

Overall the nurse-led PEPSE clinic showed significant improvement in the management and follow-up of patients presenting for PEPSE particularly in 4 week completion rates despite a high level of reported drug side effects.

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Abstract P16

Introducing a PGD for the initiation of HIV PEP

G Lawrenson, E Nixon, C Richardson, M Fisher Lawson Unit/Claude Nicol Clinic, Brighton and Sussex University Hospitals, UK

Introduction:
HIV Post Exposure Prophylaxis (PEP) may be provided in either a GUM or HIV setting depending on local service provision. Undertaking risk assessments and initiating PEP can be time-consuming and often involves a number of healthcare professionals. The number of people presenting for PEP, in particular after sexual exposure, continues to increase. This can impact on waiting times within clinics and on capacity to deliver other essential services.

This paper aims to describe the development of a Patient Group Direction (PGD) for HIV PEP within a GUM setting and to highlight the competencies required to assess and administer a 5-day PEP PACK for both occupational and sexual exposures.

Process:
A multidisciplinary working group was established to identify which part of the PEP patient pathway met the criteria for the NHS PGD framework. The risk assessment for and initiation of PEP fulfilled the criteria for a specific treatment episode that is largely predictable.

Although antiretrovirals (ARVs) are not currently licensed for this indication, their use in PEP is accepted as best practice and therefore this was not an obstacle to approving the PGD through Trust structures. The baseline competencies to undertake the PGD are registered nurses at Band 6 or above, sexual history taking and HIV testing. PEP specific competencies focus on assessing the exposure risk and the source HIV status in line with national guidelines. The health advisor role has been elected as the pilot for this project based on local service configuration. Patient exclusion criteria were identified as follows:

• <18 years of age;
• known cardiac, renal, liver conditions;
• pregnancy;
• sexual assault;
• exposures that occurred >72 hours ago;

Outcomes to date:
Two team members have been assessed as competent to initiate PEP following a period of supervised practice. Further health advisor team members have been identified to undertake PGD training.

Conclusion:
Although the impact of this PGD is yet to be established in terms of clinic waiting times and patient experience, this pilot has demonstrated the use of antiretrovirals within a PGD and has potential for further development. The use of health advisors may raise debate for clinic nursing roles, but also represents the application of NHIVNA competencies to broader roles that contribute to meeting increasing demand on GUM and HIV services.

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Abstract P17

A study of the cardiovascular disease risk of our patient cohort

E Bittleston Blanche Heriot Unit, St Peter’s Hospital, Chertsey, UK

Background:
In this relatively small GUM/HIV department we needed accurate and timely research assessing the cardiovascular risk of our HIV positive patients. We have gathered evidence over the years but have not until now been able to look at the evidence in a way which would inform our practise, having historically always managed the patients on an ad-hoc basis.

Aims:
This poster will show the estimated risk of our HIV positive patients of experiencing a Cardio Vascular incident whilst under the care of the Blanche Heriot Unit.

Methods:
Research was undertaken using the Framingham calculator available on the internet to measure all our patients’ estimated risk. The most recent blood test results were used and a search of the notes undertaken to establish smoking history, blood pressure and other risk factors. This will be shown in a chart format.

Results:
Extra information was obtained during this research which gives us some interesting demographic information relating to our patient cohort, for example the average age, gender and sexual orientation split, ethnicity, which we hope will inform our future practise by contributing to business case submissions for gender and skill mix within the department.

Conclusion:
I will show that the majority of our patients are well managed and on the correct HAART regimen relative to their cardiovascular disease risk, but also the impact of gender and ethnicity on using this tool.

Is the Framingham Tool the right one for our patient cohort or should we be using a different one that takes into account ethnicity, gender and the impact of HIV infection itself?

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Abstract P18

Cardiovascular risk assessment and management guidelines for HIV – what are we using?

T Russell1, LA Burns2 1Western General Hospital, Edinburgh, 2Gartnavel General Hospital, Glasgow, UK

Background:
Various guidelines are available on cardiovascular risk assessment and management, some have been adapted for the HIV population. Some are guidelines on risk assessment only, others provide management guidance to various degrees, including use of statins, targets for monitoring, diet and lifestyle advice.

Aim:
To investigate which cardiovascular risk assessment tool and management guidelines are used by Dietitians working with HIV patients

Method:
A questionnaire was sent to Dietitians of the DHIVA (Dietitans in HIV/AIDS) group of the BDA (British Dietetic Association). Questions included; – which cardiovascular risk assessment tool is used, if an online tool is used, which management guideline is used for diet and lifestyle advice, what lipid targets are used for monitoring, and any comments.

In addition an audit of 5 risk assessment tools was carried out on n=100 patients.

Results:
43 questionnaires were sent – response rate of 33% (n=14) 79% used a risk assessment guideline; A mixture of risk guidelines were used. Approximately 44% used the one recommended by BHIVA (British HIV Association); 57% do not use an online tool.11.3; 86% use a management guideline for dietary and lifestyle advice; 100% monitor for lipid targets – aims varied; There were a variety of comments.

Score	Framingham	ASSIGN	JBS2	Q-Risk	Total Chol: HDL Ratio
Mean % risk	8.1	6	8	3	4.1
Median % risk	11.3	8.4	11.4	5.4	4.54
No of people at high risk (Risk score ≥20% or ratio ≥6)	20	9	21	4	16

 

Various tools give different results. 50% identified as high risk using total chol:HDL ratio ≥6 were not identified as high risk using a percentage risk.

Discussion:
Assessment of cardiovascular risk and referrals to the Dietitian can be adhoc in many clinics throughout the UK. The audit suggests that the varied risk assessment tools produce different results, the consequence of which may be a failure to identify and treat those at highest risk.

Conclusion:
There is no consensus of opinion among Dietitians as to which CV risk and management guidelines are used in the HIV population; The use of guidelines may depend on geographical location, policies within lipid teams or HIV units; Are agreed local guidelines better for optimal CV risk assessment and management using both a risk score and a total chol:HDL ratio?

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Abstract P19

Three cases of late adverse events with poly-l-lactic acid treatment in a nurse-delivered service: recommendations for practice

E Castro Sanchez, A Armstrong Mortimer Market Centre, Camden PCT, London, UK

Introduction:
HIV-associated facial lipoatrophy remains a concern for individuals with HIV, with implications on self-image, self-esteem and disclosure. Facial filler therapy with poly-L-lactic acid (PLA) is recommended by the British HIV Association to reduce lipoatrophy impact. Although serious adverse events are rare, it is essential that nurse-delivered services have mechanisms to handle them.We present 3 cases of patients with delayed granulomatous foreign-body reactions and their management after referral.

Case 1:
A 43 years old HIV-positive man who received PLA in the zygomas (23.5 mL right/25.5 mL left) presented nine months after discharge complaining of a firm, painless 2 cm mass on the left cheek. He was HIV-antibody positive in 2000 and now stable on antiretroviral treatment (ART). He was referred and seen 4 months later by the plastic surgeon, who confirmed the nodule as late foreign-body reaction and suggested intralesional steroids. He declined that treatment and preferred to continue with massaging.

Case 2:
A 45 years old HIV-positive man was given PLA over six months (26 mL left cheek, 24 mL right cheek). He presented 4 months after discharge with a hardened, non tender area on the left zygoma. He had been diagnosed with HIV infection for 22 years and was stable on ART. He had been previously treated in another centre with an unknown amount of dermal filler. Examination by the plastic surgeon confirmed the nodule as a foreign-body reaction, with further satellite lumps noted. The patient received intralesional steroid injections with limited response and thus an excisional biopsy was recommended.

Case 3:
A 43 years old HIV-positive man presented to his GP eight months after receiving PLA, complaining of a firm, non mobile, non tender nodule on the left zygoma, where he had received 7.5 mL of PLA over 2 months. His GP requested an ultrasound scan which suggested a late foreign-body reaction, a diagnosis confirmed by the plastic surgeon after referral. However, at the time of review the nodule had decreased considerably following massage, and further PLA treatment was allowed.

Conclusion:
Until April 2009, 251 patients had been given 1274 PLA treatments, and three individuals had been diagnosed with late foreign-body reactions (comparable to previous studies). The cases highlight some of the management options for late foreign-body granuloma reaction and the diagnostic challenges for nurses administering PLA. Furthermore, this audit stresses the need for adverse events surveillance and referral mechanisms.

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Abstract P20

‘Lost to follow-up’ – which patients disengage from HIV services and why?

A Osborne, S Kegg Queen Elizabeth Hospital, London, UK

Background:
We serve an expanding and largely black African HIV population in south-east London. Our population is mobile and therefore our attrition rate is high.We sought to determine the risk factors and reasons for disengagement in the 6 months after the 2007 part 2 SOPHID census.

Methods:
Interrogation of clinic database with subsequent phone and letter contact with patients.

Results:
Sixty-four patients appeared on the 2007 part 2 SOPHID census but did not attend for care in the subsequent 6 months. This wasmore likely if the patient was black African (P=0.029) or not receiving ART (P<0.0001). However within 6 months 22/64 (34%) of these patients had returned for care. Twelve (19%) patients were accessing services elsewhere. A small number had died (3%) were overseas (3%) or in prison (7%). Of the 21 patients inwhomoutcomes were unknown, 14 (67%) were female, 19 (90%) were black African and 18/21 (86%) were not taking ART (CD4 range 139–645). Eleven of 21 (52%) had failed to attend for their last appointment. Twenty of 21(95%) had given consent tophone contact,17/21 (81%) allowed letter contact and in 10/21 (48%) their GP was aware of the HIV diagnosis.

Despite having no contact with HIV services 5/21 (24%) had contact with other departments in the hospital. Phone contact was successful in providing 5/20 (25%) patientswith a clinic appointment. Twopatients informed us that they were not accessing care elsewhere but declined an appointment. Only one patient had been out of the UK.

Conclusions:
Black African patients and those not taking ART are most likely to disengage from services. Loss of contact with services or movement to other centres appears to be largely voluntary and not driven on by dispersal or deportation. A number of patients re-engage with services within 12 months and although this can be encouraged by proactive contact, mobile phones do not provide a durablemeans of contact with these patients.

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Abstract P21

Assessment of the impact of a home delivery service on the virological outcome of patients with the human immunodeficiency virus (HIV)

H Papineni1, S Castelino2, C Jones1 1Pharmacy Department, King’s College London, UK 2Pharmacy & HIV Unit, Guy’s & St Thomas’ NHS Foundation Trust, London, UK

Background:
Successful treatment of HIV requires a high level of patient adherence to anti-retroviral (ARV) therapy. Compliance is likely to be improved by making treatment more convenient. Since 2005 a home delivery of HIV medicines service that enhanced patient convenience has been available for registered patients at a HIV unit. This study assesses its impact on patient outcome as indicated by HIV viral load.

Methods:
Retrospective analysis of case notes from a random sample of 500 patients. Patients were categorised into 5 groups based on their home delivery status: (1) on home delivery; (2) put on hold because of virological or clinical instability; (3) offered the service but declined; (4) never offered the service and (5) withdrawn from the service. Data collected included: gender, age, year of registration with the clinic, current ARV therapy, HIV viral load, prescriber details and type of HIV treatment regime. Data collected was analysed statistically using the Chi-squared test.

Results:
Sixty-eight percent (n=341) of the sample were male with the age of patients included having a negative skewed distribution. The year of registration with the clinic was significantly associated with their home delivery status (P=0.01). Sixty-seven percent of patients on the home delivery service registered with the clinic more than 5 years ago. Ninety-three percent of the patients on the home delivery service had been on the same ARV treatment regimen for 3–6 months, a required

criterion for inclusion on the service. More than half of the patients sampled (54%, n=268) were on a nucleoside reverse transcriptase inhibitor and non nucleoside reverse transcriptase inhibitor combination. There was a significant association between patients home delivery status and detectable HIV viral load in the past year (P=0.001).

Conclusions:
The study found that there was no significant difference in the HIV viral load between patients who had their AVR medicines home delivered and patients that were suitable but declined to join the service, indicating they have similar patient outcomes.

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Abstract P22

Challenges in addressing counselling needs of MSM in highly stigmatized contexts: results of a qualitative study from Kenya

M Taegtmeyer1, A Muhaari2, A Davies2, M Mwangome2, EM van der Elst2, SM Graham3, EJ Sanders4

1Liverpool School of Tropical Medicine, Liverpool, UK, 2Centre for Geographic Medicine Research-Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya, 3University of Washington, Seattle, USA, 4Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK

Background:
The role of men who have sex with men (MSM) in the African HIV epidemic is gaining recognition but capacity to address HIV prevention needs of this group is limited. We set out to assess the skills and attitudes of a group of Kenyan counsellors working with MSM and identify training and supervision needs.

Methods:
Qualitative in-depth interviews were conducted with 16 participants with experience counselling high risk MSM in Mombasa, Kenya in July 2008. Opened ended questions were asked that allowed exploration of the impact of personal and cultural value systems on the ability to conduct effective counselling. Data were transcribed and analysed using a framework approach.

Results:
Participants expressed a range of attitudes to MSM from affirmation through tolerance to negative and stigmatizing, with some expressing that gayness was a disease that good counselling could change. All said that they lacked skills to conduct effective riskreduction counselling. Most had learned all they knew about MSM from male sex workers and mentioned triggers such as poverty, alcohol and drugs. Few linked risk taking behaviour with life issues, self worth and stigma. As a result counsellors knew about the complex issues faced by high risk MSM but few described this impacting on their approaches to risk-reduction counselling. Similarly, counsellors said they were non-judgemental yet our data reveal many had strong social constructs and were unable to ‘put aside their values’.

Conclusions:
Counsellor training must challenge judgmental attitudes, as well as improving risk reduction skills, and link to on-going support supervision. On-going exposure, discussion and the presence of counsellors who themselves identified as MSM were powerful promoters of attitudinal change in counsellors which in turn impacted positively on the quality of risk reduction counselling. We will present the findings from this rich data to give a deeper understanding of the breadth and subtly of training and supervisory needs required to provide HIV prevention services to this highly stigmatized group in Africa.

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Abstract P23

Conflicting needs: investigating patient preferences in the design of a new HIV/sexual health clinic serving an ethnically diverse population

V Harrison, M Fadojutimi, J Anderson, I Reeves Homerton University Hospital, London, UK

Background:
Patient involvement in the planning and delivery of services is a priority for the health service. Historically, HIV services have grown within pre-existing services as patient cohorts develop. Our objective was to conduct a patient survey to help design a planned new HIV/Sexual Health clinic at our site, serving an ethnically diverse, socioeconomically deprived population.

Methods:
Patients attending the existing HIV service were asked to complete a questionnaire investigating preferences concerning clinic environment and service provision. Questions were designed to probe issues around stigma and confidentiality, and most used a Likert scale to indicate degree of agreement with statements.

Results:
Fifty-nine patients provided responses of which 38% were African. Ninety percent agreed the building/environment should maintain their confidentiality, whilst 51% did not want separate entrances/services for HIV and GUM. The majority agreed building name should not relate to department work (59%) and waiting areas/receptions for HIV and GUM should not be separated (59% and 71% respectively). In contrast 65% wanted to access HIV information in waiting areas, 43% want to talk to other patients in waiting areas and 75% preferred them divided by gender. There was a strong preference for additional service provision in the clinic. At least 54% wanted extra clinical services and 68% or more non-clinical services e.g. immigration advice.

Conclusions:
Patient preferences were conflicting as they stressed the importance of maintaining confidentiality through environmental design e.g. joint entrances/waiting areas, yet they also wanted to access HIV specific information and talk to other patients within this space. The positive response to the provision of non-clinical services e.g. housing advice and waiting areas separated by gender highlights the social need and diversity of this population, where HIV is only part of a complex of needs. These findings indicate the importance of involving patients and understanding their needs within service design.

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Abstract P24

Crossing the divide: transitional care for young adults with HIV – their views

H Bundock1, G Tudor-Williams1, S Fidler1, S McDonald2, C Foster2 1Imperial College London, UK, 2Imperial College Healthcare NHS Trust, London, UK

Background:
Children with perinatally acquired HIV infection are surviving into adolescence and transitioning to adult services. Transfer in other chronic diseases of childhood has been associated with poorer attendance and increased morbidity.We explore transitional and current healthcare experiences of young adults who transfer from paediatric to specialized adult services.

Methods:
Perinatally infected adults attending a dedicated young persons’ service over a 2-month period rated transitional, inpatient and outpatient care characteristics and service provision using a piloted Likert scale questionnaire.

Results:
All 21 adults attending in the study period participated. Thirteen (62%) were female, 67% black African, median age 19 years (range 17–21) and had transferred at a median of 23 months (range 4–34) previously. All ‘strongly agreed/agreed’ they were satisfied with their outpatient care. Fifteen of 21 (71%) strongly believed the service was more appropriate than standard adult clinics. Being treated as an individual, comprehensive management explanation and encouragement to develop independence were ‘strongly important’ to 17/21 (81%), 17/ 21 (81%) and 16/21 (76%) respectively. A quarter (5/21) thought meeting other young people with HIV was ‘neither important/unimportant’ and 9/21 expressed no interest in peer support. Eighteen of 21 had found transitional care an ‘easy process’ and 13/21 (62%) ‘strongly agreed/agreed’ that transition had a positive effect on their health/wellbeing. Nine of 21 (43%) had previous adult inpatient experiences; 5/9 (56%) were only slightly satisfied/not satisfied with their care. Sixteen of 17 (94%) ‘strongly agreed/agreed’ that a separate ward for young peoplewould be preferable.

Conclusions:
The views of young people living with chronic disease are important in developing transitional care services. This study illustrates that careful transition to a specialized adult service can be a positive event for young people born with HIV. However, the adult ward did not meet some of their healthcare needs and dedicated inpatient services for young people are required.

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Abstract P25

Housing and HIV: the impact of housing on the health and well-being of people living with HIV – an analysis

Y Azad, J Anderson NAT, London, UK

Background:
Although housing is known to be a key concern for people living with HIV, particularly those experiencing poverty, there is little data on the scale or impact of this in the UK. A survey of people living with HIV in 2002 found that almost a quarter of respondents had experienced housing related problems during the previous 12 months. To further explore the relationship between HIV and housing and assess the impact of poor housing on the health of people with HIV an analysis of the current situation has been carried out by NAT and Shelter.

Methods:
The existing literature (peer reviewed and grey) on HIV, housing and homelessness was reviewed. Representatives of organizations providing housing support to people with HIV were interviewed either by telephone or face-to-face. Interviews were conducted with individuals from ten specialist organizations.

Results:
The analysis demonstrated that people living with HIV have particular needs which put them at greater risk of ill-health when their housing needs are not met; too often these needs are neglected or misunderstood by housing professionals. The themes that emerged from the analysis reinforced the undermining impact of poor quality, inappropriate housing on an individual’s health. Examples included the ways in which poor housing made adherence to treatment difficult, increasing individual vulnerability to TB, predisposing people to ill-health and associated detriment in immune function, and acting as a major cause of stress and depression with an impact on treatment success. The findings form the basis of a recent report published by NAT and include recommendations for local authorities and the government to ensure that the housing needs of people living with HIV are met.

Conclusions:
HIV is an issue that needs to be on the housing agenda and vice versa. NAT and Shelter are using the data from this analysis to develop guidance for housing professionals on HIV and its impact on housing needs. This guidance will be published and disseminated in the first quarter of 2009.

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Abstract P26

Promotion of sexual health services to men who have sex with men, offering Hepatitis B vaccinations in known gay venues

S Toomer, J Sweeney, W Wasef Blackpool PCT, Blackpool, UK

Background:
Sexual health promotion is vital for prevention of sexually transmitted infections (STIs) particularly among high-risk population. An outreach project of accelerated courses of Hepatitis B vaccination programme took place to raise sexual health awareness in gay bars and to promote Hepatitis B vaccination.

Methods:
The vaccination programme was implemented in a town centre bar over a thirteen week period. The team consisted of one HIV specialist nurse, one health advisor, one health care assistant and two volunteers from a local HIV organization. The volunteers visited local gay bars every Thursday evening to promote the service. Each client was given clinical information sheet and an evaluation questionnaire.

Results:
Fifty-eight clients completed the evaluation sheet from which forty (84%) completed the full vaccination course. Eight had prior vaccination so received booster injection whilst ten didn’t complete the vaccination course. Additionally, seventeen clients also requested information about HIV, four of which booked appointments for HIV testing. Sixteen clients requested more information about STIs whilst one booked an appointment for sexual health screening. Ten requested more information regarding safer sex. Ninety-eight percent of clients said that they would like to see this type of service extended.

Conclusions:
This study showed that sexual health promotion could be improved by delivering services in the community especially amongst a high-risk population.

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Abstract P27

Targeting hard-to-reach groups: moving outside the HIV clinic

S Creighton Homerton University Hospital, London, UK

Background:
Teenagers and intravenous drug users with HIV can find it difficult to attend clinic appointments due to a variety of psychological, social and physical problems. This study describes two community-based HIV clinics aimed at increasing access to HIV care in these two groups.

Methods:
A community-based adolescent centre, offering support for a wide range of social, emotional and physical issues affecting teenagers, established an HIV clinic in January 2008. An HIV consultant worked in conjunction with a range of non-clinicians and general physicians and delivered the full range of outpatient HIV care in a community setting. A similar model was adopted in the substance abuse unit, where an HIV consultant and drug workers worked together to provide complete outpatient HIV care, including directly observed therapy of antiretrovirals alongside methadone replacement therapy.

Results:
The client numbers accessing the service (No), those fulfilling BHIVA criteria for commencing antiretroviral treatment (Need ART), those receiving HAART (On ART) and those lost to follow-up (Lost) are shown in the table. Illustrative case histories will be provided.

Prior to community clinic					After community clinic
	No	Need ART	On ART	Lost	No	Need ART	On ART	Lost
SAU	38	19	8	14	47	2	20	3
teens	16	8	5	8	19	8	7	4

 

Conclusions:
The community-based clinics were successful at engaging hard to reach individuals and attracted additional clients. The number of clients appropriately starting ART rose from 13/27 to 27/30, and those lost to follow-up reduced from 22 to 7. Although labour-intensive, it appears that offering a holistic model of care by a multi-disciplinary team including

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Abstract P28

What do court transcripts reveal about judges’ understanding of the medical impact of HIV infection and what are the implications for healthcare professionals giving advice to the court?

R James Birchgrove, Brighton, UK

Aims:
To compare the understanding of judges about HIV in the cases of alleged criminal transmission of HIV with available medical knowledge. To identify what medical information is provided to courts about defendants, complainants and HIV itself.

Methods:
Transcripts from 13 of the 16 trials for reckless HIV transmission and the two Appeal Court judgments in England and Wales were analyzed for judges’ descriptions of the impact of HIV infection and the routes and likelihood of HIV transmission.

Results:
Judges’ beliefs about HIV are generally out of date, seeing HIV as a fatal disease with highly complex, arduous and/or purely palliative treatments. Diagnosis with HIV of complainants is perceived as a traumatic event generally leading to a life of ill-health while awaiting death. There is little consideration of the physical, psychological and behavioural impacts of an HIV diagnosis on the defendant.

Conclusions:
More must be done to provide judges and courts with balanced and up-to-date information on all aspects of HIV. This can be achieved both through interventions by the Judicial Studies Board but also by careful explanation from healthcare professionals when asked to advise or give evidence in such cases.

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Abstract P29

Patient acceptability of atazanavir formulations: size versus pill burden

DA Ogden, ST Sadiq St. George’s Healthcare NHS Trust, London, UK

Background:
Atazanavir is licensed to be taken in a dose of 300 mg with ritonavir 100 mg. In 2008, a 300 mg atazanavir capsule was licensed which is similar in length, but smaller in volume, compared to ritonavir 100 mg capsules. Prior to this, patients took two smaller 150 mg atazanavir capsules with ritonavir 100 mg. We aimed to evaluate patient acceptability of the new formulation.

Methods:
Patients already receiving combination therapy with atazanavir/ritonavir (300/100) were included. Between November 2008 and January 2009 all patients presenting prescriptions for atazanavir/ritonavir to pharmacy (300/100) were invited to participate. Patients were shown samples of both atazanavir formulations with ritonavir and asked to choose which they preferred to take. Reasons for remaining on 150 mg capsules were recorded.

Results:
Ninety-five patients participated. Median age 41 (range 22–74); Male (46%) Female (54%). Most were Black African (54%) followed by White (36%) and other ethnicities (10%). Seventy-seven of 95 (81%) patients selected the 300 mg capsule and 18/95 (19%) chose to remain on the 150 mg capsules. Age, gender or ethnicity were not associated with choosing the 150 mg formulation (P>0.05). Fifteen of 18 (83%) gave reasons for choosing 150 mg capsules: 6/18 (33%) felt the size of the 300 mg capsule was ‘too big’ or that ‘ritonavir was already too big’; 6/18 (33%) felt that they ‘didn’t want to change’; 1/18 (6%) had pill-box size limitations; 1/18 (6%) had swallowing difficulties and 1/18 (6%) would ‘switch next time’.

Conclusions:
In this mixed cohort, the majority of patients felt size was not an issue in choosing the 300 mg capsule. A minority chose the higher pill burden with 150 mg capsules despite the new formulation being no bigger than the ritonavir capsule. This was an effect seen across age, gender and ethnicities. Potential increased patient acceptability with reduced pill burden regimens may be offset by increases in pill size in some patients. Clinics should be mindful of formulation changes where size increases with lower pill burden.

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Abstract P30

Simplifying to Atripla: not always simple?

E Castro-Sanchez1, SG Edwards1, J Minton2, PD Benn

1 1Mortimer Market Centre, Camden PCT, London, UK, 2University College Hospitals NHS Foundation Trust, London, UK

Background:
The availability of Atripla since December 2007 in the UK has afforded HIV+ patients a one pill once a day regimen. We undertook an audit to determine the reasons for and outcomes of individuals switching to Atripla.

Methods:
From the electronic pharmacy information system (PIMS) we identified HIV+ patients who commenced Atripla between 1 February 2008 and 30 June 2008. Information regarding demographics, disease stage, antiretroviral therapy (ART) and outcomes following the switch was obtained from a retrospective case notes review.

Results:
A total of 177 patients (157 men, 20 women) were identified. The majority were Caucasian (63%), 18% Black African. At the time of switch the median (range) age was 42 years (24–69), CD4 count; 435 (170–1710) and HIV viral load (VL) <50 (<50–1200 copies/mL). Patients switched from the following regimens: 83% from truvada and efavirenz (EFV), 10% from EFV and two nucleosides (combivir n=7, kivexa n=11), 4% from a boosted protease inhibitor regimen (rPI). One person switched from trizivir to Atripla. Fourteen of 17 who were taking abacavir switched due to concerns regarding cardiovascular risk. Outcomes following switching include continuing Atripla with no side effects (S/E) (86%), continuing Atripla but reporting increased/new S/Es (5%). Seven of nine had previously received EFV for a median of 10 months, discontinued EFV after experiencing S/Es after a median of 8 weeks (8%). Twelve of 14 had previously received EFV for a median of 10 months and one individual stopped due to difficulty swallowing Atripla. Of those individuals reporting S/Es after switching from EFV to Atripla 65% had increased central nervous system S/Es. Viral rebound occurred in one patient which was attributed to pre-existing resistance.

Conclusions:
We report a surprisingly high level of discontinuation of Atripla among our patients despite many having previously tolerated both truvada and EFV. Furthermore simplification to Atripla was uncommon in patients stable on a boosted PI regimen.

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Abstract P31

Reaudit on sexual health and hepatitis screen in HIV-positive patients – completion of audit cycle

M Pammi, IH Ahmed Nottingham University Hospitals NHS Trust, Nottingham, Nottinghamshire

Background:
Management and screening for sexually transmitted infections and hepatitis is important for preventing onward transmission of sexual infections (STI) as well as HIV. BHIVA recommends that sexual health screen is offered at first visit and every 6 months and outcome documented in the notes. All patients should have syphilis serology testing incorporated in their three monthly bloods. All patients should be screened for hepatitis B and C and those susceptible for hepatitis B should be vaccinated.

Methods:
We conducted a casenote review audit on STI screen and hepatitis B/C monitoring in our HIV outpatients over a period of 1 year involving 256 patients in 2004 and reaudited in 2008 involving 252 patients to complete the audit cycle.

Results:
In 2008, STI screen was recommended in 87% of patients as opposed to 47% in 2004 Fifty-eight percent had syphilis serology (STS) within the last 1 year in 2004 versus 56% in 2008. Hepatitis B screening was not done in 4% in 2004, 6% in 2008. Of the patients who were susceptible to hepatitis B, only 33% were vaccinated in 2004 which increased to 62% in 2008. Sixty-six percent of patients were screened for hepatitis C in 2004 which increased to 83% in 2008.

Conclusions:
Following the initial 2004 audit, clinicians and nurses were educated and awareness about sexual health and hepatitis screening was increased. The reaudit done in 2008 shows significant increase in STI screen, hepatitis B&C screening and hepatitis B vaccination. Increased awareness and an organized protocol will improve the uptake and offering of sexual health and hepatitis screen in HIV patients which might potentially reduce the risk of onward transmission.

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Abstract P32

The acceptability and effectiveness of home-sampling for sexually transmitted infections in HIV-positive men who have sex with men

N Perry1, M Fisher1, S Wayal2, H Smith2, C Ison3, S Alexander3, J Parry3, D Richardson1

1Brighton and Sussex University Hospitals, Brighton, UK, 2Brighton and Sussex Medical School, Brighton, UK, 3Health Protection Agency, Colindale, UK

Background:
It is well recognized that although sexually transmitted infections (STIs) facilitate HIV transmission and that HIV-positive men who have sex with men (MSM) are disproportionately affected, screening for STIs in HIV outpatient clinics is frequently suboptimal. Homesampling kits (HSKs) may provide an acceptable alternative to conventional STD testing, and have previously been shown by this group to be comparable in performance to routine clinical testing methods.

Methods:
HSKs were offered prospectively to HIV-positive MSM attending an HIV outpatient clinic from January 2008 to July 2008 without any symptoms suggestive of an intercurrent STI. Specimens were self collected from the buccal mucosa [using an Orasure device], rectum, pharynx and urine and were tested for syphilis [ICE EIA]; Gonorrhoea (GC) & Chlamydia (CT) [Gen-Probe APTIMA Combo 2 assay nucleic acid amplification test]. Acceptance of the HSK, return rate and any STI diagnoses made were recorded. Rates of uptake and STIs were compared to historical STI screening data for the same time period 1 year previously in this cohort.

Results:
Three hundred and sixty-four HSKs were offered to eligible participants. Uptake of HSKs amongst those offered was 81%, (295/364); HSK return rate amongst accepters was 44.5% (130/295). Seventeen extra diagnoses of STIs were made using HSK (2 syphilis, 4 GC, 11 CT) giving an STI prevalence of 13%. The overall STI testing rate in the cohort with HSK use increased from 12.8% (139/1086) in the previous year to 18.9% (220/1164) during the study period (P=0.0001).

Conclusions:
Home-sampling offers an acceptable alternative to conventional clinic STI testing for some HIV-positive MSM, and significantly increases overall rates of testing for STDs in MSM attending an HIV clinic. A significant proportion were identified with an STI and therefore onward transmission of HIV as well as STDs may be reduced.

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Abstract P33

Preconceptions about pre-conception? Development of a dedicated pre-conception clinic for people living with HIV

AN Jayasuriya, S Thomas-Williams, S Taylor Birmingham Heartlands Hospital, Birmingham, UK

Background:
As the life expectancy of people living with HIV (PLWH) increases, more HIV-positive individuals are choosing to become parents. There is significant inter-clinic variation on the level of expertise and advice available on this issue. Despite the existence of BHIVA guidelines upon which these complex discussions can be based, this is inevitably a time-consuming process requiring a highly individualized approach. Following a needs-based assessment we have established a specific ‘preconception’ clinic for both HIV-positive men and women who wish to have children. As part of this assessment we were able to determine our patients’ current attitudes and understanding of existing parenting options available to them.

Methods:
We surveyed consecutive HIV-positive patients attending general HIV outpatient services by means of an extensive, self-completed questionnaire.

Results:
Ten percent of respondents believed that it was not possible for HIV-positive women to have HIV-negative children and a further 21% were unsure. Only 21% were aware of the magnitude of the risk reduction afforded by appropriate mother-to-child intervention. Twenty-one percent believed that HIV-positive men could directly transmit HIV to their baby. Fifty percent thought that having started antiretroviral medication in pregnancy, a woman would stay on treatment lifelong, regardless of her immune status. Only 40% knew that caesarean section was not mandatory for delivery but 52% were aware that breastfeeding was contraindicated. Only 33% of respondents would consider adoption.

Conclusions:
There is currently a paucity of knowledge and understanding about preconception and parenting options for PLWH. A dedicated preconception service with standardized protocols and written information for patients addressing issues surrounding conception and the sexual transmission of HIV may serve to dispel some of these misconceptions and provide a meaningful service for those who wish to have children.

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Abstract P34

Cardiovascular risk assessment and reduction in patients on abacavir

NS Bulteel, A Wilson, D Wilks, C Leen Western General Hospital, Edinburgh, Scotland

Background:
The use of abacavir (ABV) may be associated with an increased risk of cardiovascular disease and myocardial infarction in HIV-positive patients.

Methods:
Patients on ABV attending the Infectious Diseases Unit from October 2007 to October 2008 were stratified according to predicted 10-year risk of coronary heart disease (CHD), as determined by the Framingham equation. Patients were classified as high (>20%), moderate (10–20%), low (<10%) or unknown risk. The case notes of patients classified as high or moderate risk were reviewed, and data was collected on smoking status, hypertension and dyslipidaemia. Risk reduction was reviewed in terms of provision of smoking cessation advice, anti-hypertensive therapy, lipid-lowering medication and dietary assessment.

Results:
Of the 189 patients identified, eight patients were classified as being at high 10-year risk of CHD and 18 at moderate risk. Of these 26 patients, 17 were classed as current smokers, nine of whom had been counselled regards cessation. Twenty patients were classified as dyslipidaemic, 50% of whom were on lipid-lowering medication. Of those patients with high lipids, 18 had received dietary advice and one had been offered advice but declined. Of the 17 patients classified as hypertensive, nine had been commenced on anti-hypertensive medication. One patient had a myocardial infarction (MI) whilst taking ABV and a further four patients had cardiovascular events. Discussion of the potential increased risk of cardiovascular disease in patients on abacavir was documented in only five of 26 cases, and a change in therapy suggested in three of these cases.

Conclusions:
(1) Cigarette smoking remains a significant risk factor in HIV-positive patients on highly active anti-retroviral therapy. (2) Treatment of hypertension and dyslipidaemia needs to be optimized in patients taking abacavir. (3) More accurate documentation of cardiovascular risk assessment and management is required.

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Abstract P35

Positive HIV tests in a south London hospital: Who did the test and what happened next?

T Welz, L Hamzah, S Moses, M Sudhanva, C Taylor King’s College Hospital, London, UK

Background:
The UK National Guidelines for HIV Testing 2008 recommend routine HIV testing of all patients with specific indicator conditions and in A&E in areas with high HIV prevalence. To improve systems for an anticipated increase in HIV testing, we reviewed the origin and patient outcomes of all Positive HIV tests over a 2 year period at King’s College Hospital, London.

Methods:
The patient details of all Positive and Indeterminate HIV tests performed throughout the hospital between September 2006 and September 2008 were reviewed for any record that the patient was known to have HIV. Individual identifiers for all remaining patients were then checked against the HIV Clinic database to see if they had been linked into the HIV clinic. Hospital notes and electronic patient records for the remaining patients were then individually examined for evidence that they had received their results and had been linked into HIV services elsewhere.

Results:
Three hundred and sixty-five individuals had at least one Positive (339) or indeterminate (26) HIV result. Two hundred and seventy-two (75%) were tested in GUM clinics, 7 (2%) in A&E, 43 (12%) were inpatients, 11 (3%) out-patients, 15 (4%) antenatal attenders, 11 (3%) in ITU and 6 (2%) elsewhere. Nine of 26 indeterminate results were negative on confirmatory testing. Fifty-six (15%) were known HIV positive and 11 (3%) had recently seroconverted. Two hundred and eighty of 356 (79%) remaining patients were linked into the HIV clinic. Of the rest, 12 (3%) left the UK, 22 (6%) were followed up elsewhere and 13 (4%) died. Thirteen (4%) could not be contacted and never received their HIV results. Seven (2%) actively disengaged from care. In nine non-GUM cases, it appears doctors did not receive the result or neglected to inform the patient.

Conclusions:
A significant proportion of patients with newly diagnosed HIV do not receive their results or engage with care. In a small but worrying number of cases, appropriate follow-up was not arranged or results overlooked. HIV results on EPR, centralised follow-up of all Positive results and communication with GPs may reduce these potentially catastrophic losses to follow-up.

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Abstract P36

‘Sex, love and one-night stands: getting the relationship you want’: evaluation of a European sexual health workshop for HIV-positive young people

T Campbell1, H Beer1, R Wilkins2, N Parrett1 1Newham Psychological Services, London, UK, 2Redbridge PCT, London, UK

Background:
A week long residential conference for HIV-positive young people was held in Switzerland in July 2008. Fifty delegates (15 males, 20 females aged 14–19 years: x=17.25 and 11 males, 4 females aged 20–29 years: x=22.5) from 12 European countries attended. They participated in a series of workshops including a 3 hour sexual health workshop aimed at increasing confidence about the negotiation of sexual relationships, increasing skill regarding condom use and strategies about HIV disclosure to sexual partners.

Methods:
The sexual health workshop was focused on the acquisition of new skills regarding disclosure of status to sexual partners and condom use. Aims were to provide information about correct use of condoms by demonstration (using bananas), increase confidence in condom use by giving participants personal experience of using condoms and lubricant (using bananas), explore personal attitudes and skills with relation to condom use employing a story to illustrate challenges to condom use and explore attitudes, competency and appropriacy of HIV disclosure to sexual partners using prepared questions and small group discussion. The workshop was evaluated using an 8 item questionnaire.

Results:
For evaluation purposes responses were separated into two age categories (below 19 years and 20+ years). Generally, participants felt that other people found them attractive, that HIV had not had a negative impact on self-image, and that following the workshop they were more confident about using condoms with sexual partners, having a satisfying sexual life, and talking about sexual feelings with their partners. They were confident that their sexual partners would accept their HIV. They were less confident in their ability to talk about HIV with their sexual partners. Females felt they had learned more than males about condom use (sig. P≥0.05).

Conclusions:
These results reflect the benefits of participation in structured sexual health workshops where there is a strong focus on peer support, development of self-esteem and the normalization of being a HIV+ young person.

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Abstract P37

Safe or sorry (SOS) sauna outreach project, are we doing enough to diagnose the undiagnosed?

S Toomer, J Sweeney, W Wasef Blackpool PCT, Blackpool, UK

Background:
Significant numbers of men attending gay saunas in our region are identified as heterosexual, bisexual or transsexual. This project aimed at providing an outreach service to those who fail to attend sexual health clinics and are unaware of their HIV status.

Methods:
A 12 weeks outreach pilot study was conducted offering HIV and syphilis screening to clients attending gay saunas. Ora-Quick test was used for HIV testing backed up by conventional serology test for HIV and syphilis. Thirty-one clients were seen, of which 28 had both HIV & syphilis screening, one opted for syphilis test only and three declined both tests.

Results:
From the 28 clients tested two (7%) were found to be HIV positive (new diagnosis) and 3 (11%) had positive syphilis serology (one new diagnosis and 2 old treated syphilis). One of the 3 clients who declined HIV test was admitted, 4 weeks later, diagnosed with AIDS defining illness. Pre-study questionnaire showed that over 80% of clients would like having sexual advice, STI screening and hepatitis B vaccination available in the saunas. Post study evaluation forms demonstrated the popularity and acceptance of this type of service delivery and unanimous support for extending the service to other venues.

Conclusions:
Ora-Quick HIV testing had 100% sensitivity and specificity in this study and was found to be highly acceptable and convenient in outreach venues. The study highlights the benefit of delivering sexual health service in gay saunas providing the hard to reach, high risk group with easy accessibility.

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Abstract P38

‘Testing the children’ – are we diagnosing the undiagnosed?

S Schoeman, N Hettarachchai, E Street Leeds Teaching Hospitals Trust, Leeds, UK

Background:
National guidelines recommend testing all children of parents who are HIV-infected.With a recent study showing that young people with vertically acquired HIV infection are surviving childhood without ART and being diagnosed in adolescence, and a similar case within our cohort, we endeavoured to assess the standard of our practice with regard to testing the children of newly diagnosed HIV-positive patients.

Methods:
Casenotes were reviewed of 100 patients who had attended at least 6 months of follow-up between January 2006 and December 2007. Data collected included documentation of the details of patients’ children including current country of residence, age, discussion of their HIV status and subsequent HIV screening.

Results:
A total of 50 female and 50 male patient case notes were reviewed. Fifty-nine percent had children with 104 offspring in total, 69/104 (66%) were under 16 years of age and only 45/104 (43%) children were resident in the UK. In only 11% of cases (all male) parenthood was not documented at all. We documented discussion of HIV testing of children in 29/59 (49%) patients with offspring. In those 32 parents who had offspring resident in the UK we discussed HIV testing of their children with 19/32 (59%) and 16/19 (84%) had their children tested for HIV. Of the 45 children resident in the UK, 19 (42%) were tested and none were found to be HIV-positive. Twenty-six of 45 (58%) children resident in the UK were untested and the discussion regarding their HIV testing had not been had with the majority of their parents.

Conclusions:
To diagnose undiagnosed HIV within this high risk and vulnerable group we must first assess parenthood and then implement discussion of HIV testing. If discussed, the majority of parents agreed to have their children tested. We must standardize our care such that these discussions take place with every patient, regardless of their gender and the age or health of their children, as soon as possible after diagnosis.

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Abstract P39

The importance of providing voluntary sector advocacy and peer-support workers in HIV clinics

M Muheki1, J Rwami1, C Wood2 1PACSH

Pan African Caribbean Sexual Health and HIV, London, UK 2North Middlesex University Hospital, London, UK

Background:
HIV-positive patients may have many different kinds of issues and problems to deal with in their daily life. The voluntary sector (VS) and peer support (PS) workers are uniquely placed to help patients address many of these issues in a non-medicalised way and independently of the medical team. We describe nearly 10 years experience of working closely with VS advocates and PS workers based in our clinic.

Methods:
We reviewed the voluntary sector and peer support activity in our clinic during an 8 month period starting August 2007. We gathered data from a patient survey and feedback from staff.

Results:
160 patients were seen in this 8 months period, either by the voluntary sector advocate or the peer support worker. The issues they dealt with included: housing, immigration; pregnancy, disclosure, stigma, destitution, and emotional support to newly diagnosed patients. They were closely involved with patients requiring intensive adherence support. Patients and staff expressed high levels of satisfaction with the services.

Conclusions:
VS and PS workers have greatly added to services that we are able to provide in our clinic. Immediate access to them has improved the quality of service both from the perspective of healthcare providers and patients. They have been particularly invaluable in complex hard to reach cases relating to denial and non-acceptance of HIV diagnosis, disclosure and poor adherence to therapy. We believe that there should be access to these services for all patients attending HIV services in the UK. We recognize that some clinics may not have voluntary sector support locally. However, peer support workers can be developed in any clinic with appropriate prioritization, this issue should be addressed at national level so that funding is readily available.We believe it is time to recognize the invaluable services that voluntary sectors and peer support workers provide to the statutory sector and the statutory sector needs to take some responsibility to ensure, availability, provision and continuity of these services.

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Abstract P40

Care of HIV-positive lady’s during pregnancy at Heart of England Foundation Trust.

S. Chidzomba, T Zvidi, C Tweedale, Y Dawson, S Scott. Birmingham Heartlands HIV Service, Heart of England NHS Foundation Trust, Birmingham, UK

Objective:
Since the advent of antenatal testing for HIV we are successfully diagnosing and treating the majority of positive women during pregnancy. This allows us to prevent mother-child transmission of cases.

At the Heart of England Foundation Trust’s Heartlands Hospital we are fortunate enough to have Specialist Midwife’s, Paediatric HIV Nurse Specialists and Adult HIV Nurses on site as well as the entire Multidisciplinary Team.

We wanted to examine whether the availability of these experts on site actually translated to policy lead care for HIV positive ladies and their babies.

Method:
A questionnaire was designed and given to the last 15 HIV +ve woman that gave birth at this hospital. The questionnaire was designed to clarify the ladies understanding of the care they received and reason for it as well as the perception of this care. The notes of these ladies were reviewed against national standards (BHIVA) and local guidance. The baby’s notes were also examined to ensure they received the correct medication.

Results:
We are still gathering the information and results are not yet available.We are expecting for there to be some issues for HIV positive lady’s during pregnancy.

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