Trends in practice: attitudes and challenges in the diagnosis, treatment and management of HIV infection in Australia

• Published in: Internal medicine journal Vol. 50; no. S5; pp. 5 - 17
• Main Authors: Smith, Don E., Woolley, Ian J., Russell, Darren B., Bisshop, Fiona, Furner, Virginia
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.12.2020; Wiley Subscription Services, Inc
• Subjects: Accreditation; Adult; Attitude of Health Personnel; Australia; Clinical Competence; Diagnosis; Disease Management; Drug therapy; Family physicians; Female; general practice; General Practitioners - psychology; Health Knowledge, Attitudes, Practice; HIV; HIV Infections - diagnosis; HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Infections; Life span; Male; management; Mental disorders; Mental health; Middle Aged; Practice Patterns, Physicians' - trends; Sexual health; Surveys and Questionnaires; treatment; Australia; treatment; diagnosis; sexual health; Australia; management; general practice
• ISSN: 1444-0903; 1445-5994
• DOI: 10.1111/imj.15129

As life expectancy for people living with human immunodeficiency virus (HIV) (PLWHIV) increases, management models for HIV infection are changing. To understand approaches to practice within this shifting climate and across different medical settings, in 2017 we conducted a baseline survey among the main medical practitioner groups responsible for HIV‐infection care in Australia: hospital‐based physicians (HBP), sexual health physicians (SHP) and ‘accredited general practitioners’ (referred to in 2017 study as ‘s100 GPs’), who are GPs authorised to prescribe HIV therapies after completing accredited national training. The follow‐up survey presented here explores any changes in approaches, attitudes and challenges associated with HIV‐infection management among the same practitioner groups: 17 HBP, 15 SHP and 69 accredited GP (referred to throughout as GP; includes those with sexual health diploma). Analysis of survey results showed practices remained largely similar between surveys, with a few notable exceptions. Greater consistency in attitudes, knowledge and approaches was observed between the practitioner specialty groups, with only small differences between modes of practice. A trend towards earlier initiation of HIV treatment was also identified, with a higher proportion of practitioners than baseline reporting they were comfortable beginning therapy on the day of HIV diagnosis. The impact of the introduction of two‐drug therapy in Australia was also explored. Although the majority of survey respondents (and SHP in particular) expressed greater preference for three‐drug compared with two‐drug regimens, interest in two‐drug regimens appears to be growing and may influence future prescribing practices. Addressing mental health issues for PLWHIV was again highlighted as a major priority, with practitioners overwhelmingly reporting mental health management as among their most difficult clinical challenges. Reduction in stigma/discrimination and better access to substance dependency programmes were also identified as unmet needs for this patient cohort. Consistent with our baseline survey, it appears targeted interventions and supports appropriate to this population are still required to improve overall wellbeing for PLWHIV.