HIV and AIDS
- HIV Public Health Team
- Post-Exposure Prophylaxis (PEP)
- S100 Prescribers
- Pre-HIV test discussion
- Post-HIV test discussion
HIV Public Health Team
The HIV Public Health Team (HPHT) is a small team of experienced HIV public health nurses based in the Department of Health who:
- Manage the notification and enhanced surveillance of HIV for all diagnosed cases in Queensland
- Provide advice to clinicians and people with HIV regarding referral pathways into HIV care and ongoing management.
- Assist clinicians with confidential HIV contact tracing.
- Provide advice to clinicians to assist them to manage people with HIV who place others at risk of 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. Clinicians may ask the HPHT for assistance with HIV contact tracing.
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.
The HPHT 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 living with HIV who 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 AIDS (PDF, 807kB)
- Notification of death in a person with HIV infection (PDF,1594 kB)
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 brochure for clients (PDF 67Kb)
- PEP Drug Replacement Form (PDF, 388kb)
The Queensland Department of Health accredits community-based medical practitioners who wish to become prescribers of HIV and hepatitis 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).
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.
While pre-test discussion may seem time consuming, practice ensures that time is used efficiently within the primary care context. Clinicians will often develop their own style for discussing HIV, tailoring 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. While the process may seem unnecessary in low-risk patients, thorough pre-test discussion ensures 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 should 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
- 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.
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 should 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 should always be 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
- probable disease progression, discussion of ‘next steps’ including staging and treatment options
- how HIV is transmitted and strategies to prevent onward transmission whether a subsequent consultation is necessary to cover all issues
- legal obligations, including those relating to disclosure
- contact tracing and partner notification strategies.
Shock or fear associated with a positive HIV result will impact most people’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. 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 people 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 contact tracing assistance in instances such as this.