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Removal of BARRIERS to Treatment

Removal of BARRIERS to Treatment. Dr Mark Bloch Holdsworth House Medical Practice. Perspectives on Approaches to Initiation of ART. Evidence-based Medicine Public Health Individual Patient. Perspectives on Approaches to Initiation of ART.

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Removal of BARRIERS to Treatment

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  1. Removal of BARRIERS to Treatment Dr Mark Bloch Holdsworth House Medical Practice

  2. Perspectives on Approaches to Initiation of ART • Evidence-based Medicine • Public Health • Individual Patient

  3. Perspectives on Approaches to Initiation of ART • Evidence-based Medicine – Hospital specialist/academic • Public Health – Sexual Health/state health/academic • Individual Patient - GP

  4. Treatment Perspective • Management of an diagnosis/illness in a patient • Management of a patient or person with an illness

  5. Treatment Perspective • Management of an diagnosis/illness in a patient = specialist/sexual health physician • Management of a patient or person with an illness = GP/primary care

  6. Problem we had with with CD4>500 “with symptoms” • Definition of “symptoms” unclear and open to interpretation which made some Doctors afraid of initiating ART which may be outside reimbursement criteria

  7. 2013 Antretroviral Treatment Guidelines (Australian Commentary)*: when to start therapy? Principles We propose four overarching principles regarding when to start ART: • All people with HIV should consider commencing ART. • Clinicians should regularly discuss the current state of knowledge regarding when to start ART with all individuals with HIV who are not yet on treatment. • All decisions to start ART should be made by the individual with HIV, in consultation with their health care providers and on the basis that they are fully informed and supported in their decision making. • The decision to start ART should take into account both personal health benefits and risks, and reduction in transmission risk. *http://ashm.org.au/

  8. Public Summary Document (PBAC) The PBAC considered there to be an advantage to patients associated with being able to have greater choice, together with their prescribers, of when to initiate therapy with ART. The PBAC considered this greater choice to represent good Quality Use of Medicines.

  9. Implications of Removal CD4 Barrier to ART Initiation Empowerment Of doctor and patient to best address the individual person with HIV’s needs Of best meeting Australian Guidance Principals Of meeting PBAC definition of Good Quality Use of Medicines

  10. Removing the Barriers to Treatment So removing the barriers to treatment involves • Understanding the motivation of the prescriber • Addressing their perspective

  11. Removal of CD4 barrier to treatment: the operating environment No-one with an undetectable viral load, gay or heterosexual, transmits HIV in first two years of PARTNER study…. Implications?

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