ACTION PLAN HIV QUEENSLAND - Queensland Health - AWS

 
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Queensland Health

QUEENSLAND

HIV
ACTION PLAN 2016–2021
Foreword                                                                                HIV
                                                                                                               at a glance

In the past few years, there has been
unprecedented progress in the prevention
                                                       elimination of HIV transmission. Consultation with
                                                       primary healthcare providers, community-based
                                                                                                            HIV                        AIDS
and treatment of HIV across the world and the          organisations, specialised sexual health and HIV
                                                                                                            The human immunodeficiency virus (HIV) is the
ability to end the world-wide epidemic is              services, and key stakeholder communities has        virus that can result in Acquired Immune Deficiency
                                                       identified the following priority actions:           Syndrome (AIDS) if left untreated. People who are
now a real possibility.
                                                                                                            infected with HIV are said to be HIV positive,
                                                                                                            even if their infection has not resulted in AIDS.
                                                       •    transforming HIV prevention by taking a
This action plan reflects the Queensland
                                                            combined approach of promoting safer
Government’s commitment to the new
                                                            HIV prevention practices, together with
overarching goal, endorsed by the Australian
Health Ministers’ in the 20th International
AIDS Conference Legacy Statement, of working
                                                            improving access to HIV medication as a
                                                            preventive measure                                                      17%
                                                                                                                                    decrease in new
towards the virtual elimination of new HIV             •    prioritising voluntary testing, including                               diagnoses in 2015

transmissions in Australia by 2020. To achieve              community based testing
                                                                                                            In 2015, there were 203 new diagnoses of HIV in
this, the Queensland Government is committing          •    providing support for those newly diagnosed     Queensland, representing a 17 per cent decrease
to a comprehensive approach to prevention,                  with HIV to engage in treatment and care        from 245 new diagnoses in 2014.

testing and treatment focused on meeting the           •    promoting access to immediate treatment
United Nations 90-90-90 targets that: 90% of                after an HIV diagnosis and support to adhere
people living with HIV know their status, 90% of            to treatment
                                                                                                            The majority of the
people diagnosed with HIV are on treatment and
                                                       •    taking a zero approach to stigma and            recently acquired                HIV+
90% of people on treatment have a suppressed                                                                infections in 2015 were
                                                            discrimination.                                 in men who have sex with
viral load so their immune system remains strong
                                                                                                            men or bisexual men.
and minimises the risk of transmitting HIV.            This action plan will be enhanced by statewide
                                                       campaigns and supported by research and
As community ownership is essential for this           surveillance. It aligns with both the Queensland
fast-track approach to the 90-90-90 targets,           Sexual Health Strategy 2016–2021 and the
the Queensland Government is committed to              Seventh National HIV Strategy 2014–2017 to
supporting strong relationships between partner        improve health outcomes for all Queenslanders.
agencies in order to achieve the goal of the virtual

                                                                                                            Modern antiretroviral treatment (ART) is so
                                                       The Hon Cameron Dick MP                              effective at suppressing HIV within a person’s
                                                                                                            body, that people consistently using ART are
                                                       Minister for Health and                              unlikely to ever develop AIDS.

                                                       Minister for Ambulance Services

Success factors
Achieving the United Nations 90-90-90 targets:
•    90 per cent of all people living with HIV (PLHIV) will know their HIV status
•    90 per cent of all people diagnosed with HIV will receive sustained antiretroviral therapy

                                                                                                                       90-90-90
•    90 per cent of all people receiving antiretroviraltherapy will have durable viral suppression.
QUEENSLAND HIV
                     ACTION PLAN 2016–2021

                Working with the community to minimise the personal and social impact of HIV and
GOAL            achieve the virtual elimination of new HIV transmissions in Queensland.

Outcome       1. Implement a                                  2. Increase voluntary                           3. Increase treatment uptake                   4. Increase awareness                            5. Improve surveillance,
              comprehensive preventive                        testing for HIV                                 by people with HIV                             of HIV transmission and                          monitoring, research and
              approach                                                                                                                                       address stigma and                               evaluation
                                                                                                                                                             discrimination

Target        Gay men and men who have sex with men,          Gay men and men who have sex with men           All people living with HIV, including people   Gay men and men who have sex with men            Queensland HIV action plan stakeholders,
              including sexually adventurous men.             including sexually adventurous men.             ineligible for Medicare.                       including sexually adventurous men.              HIV/STI workforce, national HIV/STI strategy
populations   Other target populations: Aboriginal and        Other target populations: Women,                                                               Other target populations: GPs, whole-of-         stakeholders.
              Torres Strait Islander people, culturally and   Aboriginal and Torres Strait Islander people,                                                  population, Aboriginal and Torres Strait
              linguistically diverse people, people who       culturally and linguistically diverse people,                                                  Islander people, culturally and linguistically
              inject drugs, sex workers, young people,        people who inject drugs, sex workers,                                                          diverse people, people who inject drugs,
              people ineligible for Medicare, people in       young people, people in custodial settings,                                                    sex workers, young people, people in
              custodial settings, travellers and mobile       travellers and mobile workers, and people                                                      custodial settings, travellers and mobile
              workers, and people living with HIV.            ineligible for Medicare.                                                                       workers and people living with HIV.

Key           Community, healthcare and                       PHNs, general practitioners (GPs),              PHNs, GPs, authorised s100                     Community and healthcare settings                Community and healthcare settings
              custodial settings                              authorised s100 prescribers, Hospital and       prescribers, HHSs, pharmacies and
settings                                                      Health Services (HHSs), pharmacies and          community-based sites
                                                              community-based sites
Queensland HIV Action plan 2016–2021

Outcome    1. Implement a                                     2. Increase voluntary                             3. Increase treatment uptake                          4. Increase awareness                        5. Improve surveillance,
           comprehensive preventive                           testing for HIV                                   by people with HIV                                    of HIV transmission and                      monitoring, research and
           approach                                                                                                                                                   address stigma and                           evaluation
                                                                                                                                                                      discrimination

Priority   1.1. Promote and encourage provision and           2.1. Increase access to and uptake of             3.1. Investigate options to improve timely delivery   4.1. Address stigma and discrimination       5.1. Develop and implement a monitoring
                uptake of HIV medication as a preventive           voluntary HIV and other STI testing that          of baseline HIV testing results to improve            through implementing whole-of-               and surveillance plan aligned with the
actions         measure for those at high risk of                  facilitates early diagnosis, including            access to early treatment.                            population and targeted HIV awareness        National HIV Strategy.
                contracting HIV, through the provision of          conventional and point-of-care testing       3.2. Improve uptake of HIV treatment by newly              campaigns with a focus on:
                                                                                                                                                                                                                   5.2. Develop and implement a
                pre-exposure prophylaxis (PrEP).                   across the healthcare system and                  diagnosed PLHIV through: targeted education
                                                                   community-based sites to encourage                                                                      • awareness of HIV transmission              coordinated Queensland HIV and
           1.2. Promote and improve timely access to HIV                                                             campaigns that promote the individual
                                                                   regular testing for HIV and STIs as                                                                     • prevention and testing with                STI research strategy across all
                medication for those who may have been                                                               health benefits and reduced risk of further
                                                                   clinically indicated.                                                                                     high risk groups                           relevant disciplines including social,
                exposed to HIV through the provision of                                                              transmission, promotion of training to
                post-exposure prophylaxis (PEP).              2.2. Increase the number of health                     become authorised s100 prescribers and                • LGBTI communities                          behavioural, epidemiological and
                                                                   practitioners and peer educators able to          associated training and mentoring programs,                                                        clinical disciplines.
           1.3. Increase access to and promote and                                                                                                                         • Aboriginal and Torres Strait
                encourage other HIV preventive                     carry out HIV and STI testing.                    and implementation of PLHIV peer-based                  Islander related issues               5.3. Identify and improve data for key
                activities, including the use of condoms      2.3. Promote regular HIV testing of those              navigation models.                                                                                 populations, such as rural and remote
                                                                                                                                                                           • promotion of treatment with PLHIV
                and water based lubricants and sterile             at high risk of HIV to encourage early       3.3. Support newly diagnosed PLHIV and their                 and healthcare professionals.              areas and Aboriginal and Torres Strait
                injecting equipment.                               detection and address barriers, in line           primary care providers through: information,                                                       Islander people.
           1.4. Implement evidence-based HIV and STI               with the Australian Sexually Transmitted          clinical education, contact tracing, referral    4.2. Support implementation of resilience
                                                                                                                                                                           building programs for PLHIV.            5.4. Extend surveillance systems
                awareness campaigns.                               Infection and HIV Testing Guidelines 2014.        for HIV specialist assessment, case
                                                                                                                     management/care coordination and                                                                   to accommodate scientific and
           1.5. Implement comprehensive evidence-             2.4. Implement routine HIV testing in targeted                                                          4.3. Provide information and support for
                                                                                                                     peer-based support.                                                                                technological advances and
                based peer education and outreach HIV              GP settings in areas of high prevalence.                                                                people who have experienced HIV-
                                                                                                                                                                           related stigma and discrimination.           innovation.
                and STI risk-reduction programs, and          2.5. Investigate access to testing models         3.4. Examine and advocate the removal of
                activities for key populations.                    which address the wide diversity of               barriers to HIV treatment access.                4.4. Support improvement of the legal        5.5. Explore improved and innovative
                                                                   cultural and sexual behavioural needs,       3.5. Examine and improve models of treatment               literacy of PLHIV.                           approaches to measuring testing
           1.6. Implement peer-based strategies to
                enable sexually adventurous men to                 including among Aboriginal and Torres             and care to support the management of HIV        4.5. Address barriers to evidence-based           and treatment rates among priority
                maintain personal health and safety,               Strait Islander people.                           in the community by: continuing existing              prevention, treatment and care               populations.
                including addressing the interaction          2.6. Promote personal and public health                specialist HIV capacity through sexual                strategies.                             5.6. Investigate and implement systems
                between alcohol and other drug use and             benefits of early diagnosis and the               health and infectious disease clinics while
                                                                                                                                                                      4.6. Support improved awareness of HIV            for monitoring treatment uptake,
                risky behaviours to support safer sexual           testing options available through                 reviewing case management and shared care
                                                                                                                                                                           and associated legal issues among            ongoing clinical monitoring and viral
                decision making.                                   targeted health promotion, marketing              arrangements between the treating clinician,
                                                                                                                                                                           PLHIV, healthcare providers, police,         suppression.
                                                                   activities and clinical engagement.               GPs, other medical specialists, nurse
           1.7. Promote the public and personal health                                                                                                                     lawyers, HIV and legal support
                                                                                                                     practitioners, pharmacists and community-                                                     5.7. Investigate research to measure
                benefits of HIV testing and early treatment   2.7. Promote routine HIV testing for all                                                                     organisations and media.
                                                                                                                     based organisations.                                                                               the health impact of stigma and
                as a prevention strategy.                          pregnant women.
                                                                                                                3.6. Implement strategies to improve the health                                                         discrimination on priority populations.
                                                                                                                     and well-being of PLHIV to: increase the
                                                                                                                     number of PLHIV who are under the care of
                                                                                                                     a primary care health team, increase the
                                                                                                                     number of PLHIV engaged in specialist HIV
                                                                                                                     care, adherent to treatment and maintain
                                                                                                                     an undetectable viral load, re-engage those
                                                                                                                     PLHIV disengaged from HIV care, manage
                                                                                                                     PLHIV who pose an HIV transmission risk
                                                                                                                     to others and improve the health literacy of
                                                                                                                     PLHIV through peer education and support.
                                                                                                                3.7. Deliver training to HIV service providers to
                                                                                                                     support culturally appropriate evidence-
                                                                                                                     based clinical practice.
Queensland HIV Action plan 2016–2021

Outcome            1. Implement a                                    2. Increase voluntary                         3. Increase treatment uptake                       4. Increase awareness                      5. Improve surveillance,
                   comprehensive preventive                          testing for HIV                               by people with HIV                                 of HIV transmission and                    monitoring, research
                   approach                                                                                                                                           address stigma and                         and evaluation
                                                                                                                                                                      discrimination

Indicators         Proportion of men who have condomless             Type of HIV tests available                   CD4 count at HIV diagnosis                         Number of targeted campaigns to raise      Weekly, year-to-date and annual
                   anal intercourse with casual male                 and HIV test settings                         Source: Communicable Diseases Branch,              awareness of HIV in specific settings or   reporting of HIV notifications
                   partners in the previous six months               Source: Communicable Diseases Branch,                                                            among specific populations                 Source: Communicable Diseases Branch,
                                                                                                                   Department of Health Frequency: Annual
                   Source: Queensland Gay Community                  Department of Health                                                                             Source: Funded service provider reports    Department of Health Frequency: Weekly,
                   Periodic Survey, Centre for Social Research       Frequency: Annual                             Proportion of people who commence treatment        Frequency: Annual                          annual
                   in Health Frequency: Annual                                                                     within six weeks, three months and six
                                                                     Number of HIV tests undertaken, including     months of HIV diagnosis                                                                       Number and type of research activities
                   Amount of sterile injecting                       rapid point-of-care tests—with a particular   Source: Communicable Diseases Branch,                                                         undertaken as part of a coordinated
                   equipment distributed                             focus on monitoring the number of HIV tests   Department of Health* Frequency: Annual                                                       HIV research strategy
                   Source: Queensland Needle and Syringe             undertaken by men                                                                                                                           Source: HIV/STI Professorial Chair,
                   Program, Communicable Diseases Branch,            Source: Communicable Diseases Branch,         Proportion of PLHIV who report adherence to                                                   University of Queensland
                   Department of Health Frequency: Annual            Department of Health                          treatment with suppressed viral load                                                          Frequency: Annual
                                                                     Frequency: Annual                             Source: Communicable Diseases Branch,
                   Proportion of people who inject drugs                                                           Department of Health* Frequency: Annual
                   reporting re-use of a needle previously used      Proportion of gay men and MSM who
                   by someone else in the previous month             have been tested for HIV in the
                                                                                                                   Number of people ineligible for Medicare-
                   Source: Australian Needle and Syringe             previous 12 months
                                                                                                                   subsidised HIV antiretroviral therapy who
                   Program Survey, The Kirby Institute               Source: Queensland Gay Community              are able to be maintained on medication,
                   Frequency: Annual                                 Periodic Survey, Centre for Social Research   with a suppressed viral load
                                                                     in Health Frequency: Annual                   Source: Communicable Diseases Branch,
                   Number of occasions people access HIV PEP                                                       Department of Health* Frequency: Annual
                   Source: Communicable Diseases Branch,
                   Department of Health Frequency: Annual                                                          Proportion of PLHIV who report their general
                                                                                                                   health status and wellbeing as excellent or good
                   Number of people on PrEP                                                                        Source: HIV Futures Study, La Trobe University
                   Source: Cairns and Hinterland Hospital and                                                      Frequency: Biennial
                   Health Service Frequency: Annual
                                                                                                                   Number of health professionals authorised
                   Proportion of people on PrEP undertaking                                                        as HIV community-prescribers
                   three-monthly STI testing                                                                       Source: Communicable Diseases Branch,
                   Source: QPrEPd Annual Report, Cairns and                                                        Department of Health Frequency: Annual
                   Hinterland Hospital and Health Service and
                   HIV/STI Professorial Chair, University of                                                       *Work is in progress by Communicable Diseases Branch, Department of Health to
                   Queensland Frequency: Annual                                                                    identify data sources for these indicators to enable standardised reporting

  In monitoring the effectiveness of this action plan, priority will be given to those
  indicators required for reporting against the 90-90-90 targets.
QH 845 1611

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HIV Action Plan 2016–2021
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(Queensland Health), November 2016
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For more information contact:
Strategic Policy Unit, Department of Health,
GPO Box 48, Brisbane QLD 4001
strategicpolicy@health.qld.gov.au
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