Clinical information about HIV and AIDS
- HIV Public Health Team
- Pre-Exposure Prophylaxis (PrEP)
- Post-Exposure Prophylaxis (PEP)
- S100 Prescribers
- HIV Testing - Informed consent
- Pre-HIV test discussion
- Post-HIV test discussion
- Undetectable viral load
HIV Public Health Team
The HIV Public Health Team is a small team of experienced HIV public health nurses based within the Communicable Diseases Branch, Department of Health. The HIV Public Health Team:
- Follows up laboratory notification of all HIV cases diagnosed in Queensland (required under section 72 and 75 of the Public Health Act 2005) and seeks epidemiological and surveillance information.
- Provides advice to clinicians and people with HIV regarding referral pathways into HIV care and ongoing management.
- Assists clinicians with confidential HIV contact tracing where requested/required.
- Provides advice to clinicians to assist them to manage people with HIV whose behaviours may place others at risk of contracting HIV.
Laboratory notification of HIV is required under section 72 of the Public Health Act 2005. Under section 75 of the Public Health Act 2005, the Chief Executive or Executive Director of Communicable Diseases Branch as delegate, can request further information from the diagnosing clinician or the clinician providing care to the patient. For each laboratory diagnosis of HIV, clinicians are required to complete the HIV enhanced surveillance form and the HIV contact tracing form. This information is also required for individuals who have been previously diagnosed interstate or overseas.
The collection of this epidemiological and surveillance data allows Queensland Health to provide practical information on trends in HIV transmission and assists with HIV prevention planning and delivery of appropriate health services. Clinicians may ask the HIV Public Health Team for assistance with HIV contact tracing.
The HIV Public Health Team is available to provide advice to clinicians regarding the management of the very small number of people living with HIV who place others at risk of HIV transmission without disclosure and informed consent. This advice is provided in accordance with the Guideline for the management of people with HIV whose behaviours may place others at risk of HIV.
HIV enhanced surveillance notification forms
- HIV notification enhanced surveillance (PDF, 478kB)
- HIV contact tracing form (PDF, 222kB)
- Mother with perinatally exposed children to HIV (PDF, 926kB)
- Child with HIV infection or perinatal exposure to HIV (PDF, 1185kB)
- Notification of death in a person with HIV infection (PDF,1594 kB)
AIDS is no longer a notifiable condition but remains relevant. Untreated persons with HIV or late presenters may still be diagnosed with AIDS defining conditions which require management.
Pre-Exposure Prophylaxis (PrEP)
All doctors and nurse practitioners are able to prescribe pre-exposure prophylaxis (PrEP) to Medicare eligible people at medium to high risk of human immunodeficiency virus (HIV) infection through the Pharmaceutical Benefits Scheme (PBS).
A fact sheet on HIV PrEP on the PBS (PDF, 114KB) for health professionals is available for download.
The Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine has developed a number of resources to support prescribing of PrEP for HIV including:
A PrEP fact sheet for PrEP users and people interested in PrEP has been developed by the Australian Federation of AIDS Organisations (AFAO) and ASHM.
Post-Exposure Prophylaxis (PEP)
- National guidelines for post-exposure prophylaxis after non-occupational and occupational exposure to HIV
- PEP risk assessment algorithm for non-occupational exposure to HIV
- PEP fact sheet
- PEP Drug Replacement Form (PDF, 388kb)
The Queensland Department of Health accredits community-based medical practitioners who wish to become prescribers of S100 HIV and hepatitis treatment medications. As part of this process, applicants must complete the required education and prescribing courses that are conducted by the Australasian Society for HIV, Viral hepatitis and Sexual Health Medicine (ASHM).
More information on the ASHM HIV, Hepatitis B and Hepatitis C Prescriber Programs, including information on continuing professional development (CPD) requirements, copies of the National Standards for HIV and hepatitis B training and accreditation, self-adjudication of HIV and hepatitis B CPD activity forms and contact details for prescriber support are provided on the ASHM website.
View the list of accredited S100 prescribers (PDF 31KB).
HIV Testing – Informed consent (ASHM National Testing Policy 2017)
As for all pathology testing, informed consent is required for HIV testing, except for rare occasions when a legal order is made for compulsory testing or in emergency settings.
The person performing the test should use their professional judgement in securing informed consent. This should be based on their understanding of the context in which the test is being performed:
- the features which precipitate testing such as clinical presentation, risk exposure, epidemiology and prevalence and patient initiation; and
- an assessment of the person being tested with respect to their understanding of the HIV testing process and consequences of the result.
Patients should also be advised how the test result will be conveyed.
Pre-HIV test discussion
Pre-test discussion should prepare the client for HIV testing and ensure they understand the benefit, risks and implications of a positive or negative test result.
Clinicians will tailor information and language to the needs of individual patients. Not all of the issues listed below may be relevant to every patient each time they present for testing, but assumptions regarding the patient's level of knowledge should be avoided. Pre-test discussion attempts to ensure that prevention measures are in place, the patient is prepared for the test results, and the clinician's ethical and legal obligations are met.
Pre-test discussions may include:
- reason for testing and risk assessment
- timing of risk and option of post-exposure prophylaxis (PEP)
- need for other STI and blood-borne virus testing
- history of testing
- confidentiality and privacy issues around testing
- ensuring there is informed consent for the test
- natural history and transmission information (if appropriate)
- prevention of transmission and risk reduction through behaviour change
- protection of current partner/s
- potential requirement for partner disclosure and contact tracing
- implication of a positive or indeterminate test result, including availability of treatment
- implications of a negative test result
- explanation of the window period
- general psychological assessment and assessment of social supports in the event of a positive result
- logistics of the test: time taken for results to become available
- obtaining results - when and how.
Post-HIV test discussion
The way in which test results are conveyed should take account of the patient’s level of knowledge and capacity to deal with the test results.
Negative test results
The decision on how a negative HIV test result is provided (e.g. in person, by phone, etc.) should be based on clinical judgement. It is essential to check the type of HIV test used and consequently the window period before HIV can be detected (noting a default window period of three months may be used as that is the maximum window period among tests used in Australia).
Post-test discussion following an HIV-negative test result may include reinforcement of education and information messages about safe behaviours, and discussion of any difficulties or issues that the person may have in practising safe behaviours. The relief associated with receiving a negative test result may impede the processing of information and advice at that time. It should be emphasised that a negative test result following a risk event does not indicate that repeated risky behaviour is likely to be safe.
Positive test results
A positive result is ideally provided in person except in extenuating circumstances (e.g. the possibility that the patient may not return for the result and/or may engage in risk behaviour based on the incorrect assumption they are HIV negative). It is important to state the HIV test result very clearly to avoid a patient confusing a 'positive result' with a ‘good’ result.
When conveying an HIV-positive result, post-test discussion should include:
- giving the test result in person and in a manner that is sensitive and appropriate to the gender, culture, behaviour and language of the patient
- providing information about and considering support mechanisms, including immediate referral to a support agency
- discussion of ‘next steps’ including HIV management and treatment options
- how HIV is transmitted and strategies to prevent onward transmission (safe behaviours, Treatment as Prevention, post-exposure prophylaxis, pre-exposure prophylaxis)
- legal obligations, including those relating to disclosure and responsibility to prevent placing others at risk of HIV
- contact tracing and partner notification strategies.
Shock or fear associated with a positive HIV result may impact a person's capacity to absorb information immediately following diagnosis. Patients usually need time to process and react to their test result and any other information they are provided with during that appointment. Prompt follow-up appointments, written information and/or referral to support agencies is often necessary and welcomed. It may be useful to help the patient plan the next 24 to 48 hours including a follow-up appointment within that period. Some patients feel an urgent need to tell others what has happened, so it is useful to discuss the implications of disclosure and privacy to assist the patient’s consideration of the implications of those actions.
Patients who do not return for a positive test result may put others at risk if they do not know their HIV status. All efforts should be made to contact these individuals as soon as possible by phone or in writing, asking them to make contact. The HIV Public Health Team can provide advice and assistance in instances such as this.
Undetectable viral load
ASHM has developed an evidence-based guide for clinicians and other healthcare service providers of the latest scientific developments on how antiretroviral treatment for people with HIV prevents onward sexual transmission to inform clinicians and healthcare service providers.