HIV treatment and care for people not eligible for Medicare

Directive number: QH-HSD-055
Effective date: 14 August 2025
Review date: 14 August 2028
Supersedes: 1.0

Purpose

The purpose of this health service directive is to ensure Queensland Health meets the obligations of the Federation Funding Agreement – Health (FFA) for Access to HIV treatment for people who are not eligible for Medicare. The State of Queensland signed this Agreement on 21 June 2023 and the Program commenced on 1 July 2023. This directive fulfils criteria four and five in section 47 (1) of the Hospital and Health Boards Act 2011, ensuring consistent approaches to the delivery of health services and supporting agreements entered into by the State.

Scope

This directive applies to all Hospital and Health Services.

Principles

• Queensland Health is committed to the equitable provision of HIV treatment and medical care for people ineligible for Medicare, consistent with the Federation Funding Agreement – Health (FFA) for Access to HIV treatment for people who are not eligible for Medicare.
• This Agreement supports Queensland Health in meeting international and national goals for the virtual elimination of HIV transmission in Australia.
• The Program is a joint initiative of the Commonwealth, States and Territories to be delivered through jurisdictional public health infrastructure and excludes care or treatment through private health services. The Federation Funding Agreement – Health (FFA) for Access to HIV treatment for people who are not eligible for Medicare specifies eligibility for the program, roles and responsibilities of the Commonwealth, States and Territories and reporting requirements.

Outcomes

All Hospital and Health Services shall achieve the following outcomes:

• Provision of free outpatient HIV-related medical care to Medicare-ineligible people currently residing in Queensland beyond a short-term stay through public health facilities, such as sexual health clinics or a public hospital. A short-term stay is defined as three months or less. Medicare-ineligible patients who are visiting from interstate or who have recently moved interstate are eligible to receive HIV antiretroviral medications under the Program in Queensland if they meet the criteria for entry into the Program as detailed in the protocol QH-HSDPTL-055-1.
• Provision of free HIV antiretroviral therapy (ART) listed on the Pharmaceutical Benefits Scheme (PBS) and available through the Queensland Health (QH) List of Approved Medicines (LAM) to Medicare-ineligible people resident in Queensland via public hospital pharmacies.
• Medicare-ineligible people presenting as an inpatient for care related to HIV are not covered under this Program and hospitals should continue to treat these patients according to existing local policies and protocols.
• The cost of care or treatment related to diagnosing HIV, comorbidities, or any other health condition arising from taking HIV ART is not covered under this Program.

Mandatory requirements

All Health and Hospital Services shall:

• Determine if an individual meets the criteria for entry into the Program as detailed in the protocol QH-HSDPTL-055-1.
• Provide free HIV-related public outpatient consultations to Medicare ineligible persons in the Program by medical professionals appropriately trained and credentialed to provide HIV-related care.
• Provide free HIV-related pathology services such as viral load testing and CD4 count to Medicare ineligible persons in the Program.
• Provide free HIV ART listed on the PBS and available through the QH LAM to Medicare-ineligible people resident in Queensland via public hospital pharmacies.
• Forgo any HIV medication co-payment revenue.
• Record all dispensing under this Program in i.Pharmacy as detailed in the protocol QH-HSDPTL-055-1.
• Submit their annual activity report to BBVCDU@health.qld.gov.au in early July each year as specified in protocol QH-HSDPTL-055-1.
• Meet all other requirements as detailed in protocol QH-HSDPTL-055-1.

Compliance

Compliance with this directive will be determined via:

• Submission of an annual activity report to BBVCDU@health.qld.gov.au in early July each year as specified in protocol QH-HSDPTL-055-1.

Human rights

This Program is a public health program intended to support the national and international objective of the virtual elimination of HIV in Australia. It will enable people living with HIV who are not eligible for Medicare, to meaningfully reduce their viral load and risk of ongoing HIV transmission for the duration of their stay in Australia or until they transition to another program such as Medicare.

Aboriginal and Torres Strait Islander considerations

This Health Service Directive will not negatively impact Aboriginal and Torres Strait Islander stakeholders.

Related or governing legislation, policy and agreements

• Federation Funding Agreement – Health (FFA) for Access to HIV treatment for people who are not eligible for Medicare.
• Hospital and Health Boards Act 2011 (Qld).

Supporting documents

• Federation Funding Schedule: Communicable diseases of public health concern – Access to HIV treatment for people who are not eligible for Medicare.
• HIV treatment and care for people who are not eligible for Medicare - Health Service Directive Protocol QH-HSDPTL-055-1.
• Co-payment waiver for HIV medication- Health Service Directive QH-HSD-056.
• Note: HIV treatment and care for people who are not eligible for Medicare - Statewide guideline QH-GDL-972 has been rescinded.

Business area contact

Susan Greenbank, Assistant Director, Blood Borne Viruses and Sexually Transmissible Infections Unit on 07 2100 9259 or Susan.Greenbank@health.qld.gov.au

Approval and implementation

Directive Custodian

Executive Director, Communicable Diseases Branch, Population Health Division.

Approval by Chief Executive

Definitions of terms used in this directive

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