Improving antiretroviral treatment (ART) initiation for people living with HIV in Australia: a realistic and feasible approach?

More than a decade after ART became widely available in Australia, people living with HIV (PLHIV) who are diagnosed and have initiated treatment are surviving longer and staying healthier than in the past. However, morbidity and mortality is still high among PLHIV, particularly among those who are not treated with ART. It is estimated that up to 30–40% of PLHIV in Australia are not receiving ART. There is general consensus regarding commencing treatment for asymptomatic, previously untreated patients before the CD4 cell count drops below 350 cells/mm3. However, the exact point at which to commence ART is subject to continuous debate and review, along with emerging evidence of the risk-benefit ratio of earlier ART initiation (i.e., at CD4 counts of 500 cells/mm3 or at diagnosis). This study consists of multiple components, including desk research and review of data regarding the number and proportion of PLHIV currently on ART and statistical modelling to gauge the impact of changes in uptake and point of initiation of ART. The study also includes qualitative and quantitative research to assess views regarding the uptake and initiation of ART among PLHIV not currently on ART as well as ART prescribers. To date, a first online survey of ART prescribers’ attitudes towards, and practices of, ART prescription has been completed and a resulting paper is in press with a peer-reviewed journal. Group discussions have been undertaken with community treatment officers, and PLHIV not currently on ART are being interviewed; recruitment remains open for new participants.


Publications

Christy Newman, John de Wit, Asha Persson, Martin Holt, Limin Mao, Sean Slavin and Michael Kidd, 2015, 'Why might some people with HIV feel concerned about using treatment as prevention?', HIV Australia, Volume 13, No.2, p.32 (PDF) [295 Kb]

De La Mata, N.L., Mao, L., de Wit, J., Smith, D., Holt, M., Prestage, G., Wilson, P., Petoumenos, K. Estimating antiretroviral treatment coverage rates and viral suppression rates for homosexual men in Australia. Sexual Health (published online first) DOI: 10.1071/SH15037.

Newman, C.E., Mao, L., Persson, A., Holt, M., Slavin, S., Kidd, M.R., Post, J.J., Wright, E., de Wit, J. (2015) ‘Not until I’m absolutely half-dead and have to’: Accounting for non-use of antiretroviral therapy in semi-structured interviews with people living with HIV in Australia. AIDS Patient Care & STDs, 29 (5): 267-278. DOI:10.1089/apc.2014.0301

Newman, C.E., de Wit, J. Persson, A., Holt, M., Slavin, S., Kidd, M.R., Post, J.J., Wright, E., Mao, L. (2015) Understanding concerns about HIV treatment-as-prevention among people with HIV who are not using antiretroviral therapy. AIDS and Behavior, 19 (5): 821-831. DOI: 10.1007/s10461-014-0959-9

Mao, L., Adam, P.C., Kippax, S., Crooks, L., Post, J.J, Kidd, M.R., Slavin, S., Wright, E.J., de Wit, J.B. (2015) Evolving views and practices of antiretroviral treatment prescribers in Australia. Medical Journal of Australia. 16 (5): 258-260. DOI: 10.5694/mja14.00443

Mao, L. de Wit, J.B., Kippax, S.C., Prestage, G., Holt, M. (2015) Younger age, recent HIV diagnosis, no welfare support, and no annual sexually transmissible infection screening are associated with non-use of antiretroviral treatment among HIV-positive gay men in Australia. HIV Medicine, 16, 32-37. DOI: 10.1111/hiv.12169.

Mao, L., de Wit, JBF., Adam, PCG., Post, JJ., Crooks, L., Kidd, MR., Slavin, S., Kippax, SC., Wright, E. (2013) Australian Prescribers’ perspectives on ART initiation in the era of “Treatment as Prevention”. AIDS Care, 25 (11), 1375-1379.


Presentations

'ART use or non-use by PLHIV in Australia' (PDF) by Limin Mao, Christy Newman, John de Wit