HIV service capacity: identifying current and future areas of clinical shortage
Kylie-Ann Mallitt A , James Jansson A , Handan Wand A , Levinia Crooks B and David P. Wilson A CA The Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia.
B The Australasian Society for HIV Medicine, Sydney, NSW 2010, Australia.
C Corresponding author. Email: dwilson@kirby.unsw.edu.au
Sexual Health 11(1) 17-23 https://doi.org/10.1071/SH13151
Submitted: 27 September 2013 Accepted: 14 October 2013 Published: 29 November 2013
Abstract
Background: The capacity of HIV services to meet the clinical needs of people living with HIV (PLHIV) has not been evaluated. Similarly, whether HIV services are positioned to respond to increases in patient demand outside metropolitan centres over the next decade is unknown. Methods: A novel statistical methodology was used to estimate HIV clinical service capacity in Australia. A survey of HIV services was conducted. Geostatistical analysis was used to identify significant regions of clinical service undersupply relative to the estimated number of PLHIV in 2010 and 2020. Results: In 2010, an estimated 2074 PLHIV (9.7% of all PLHIV) resided in regions more than 15 km from a clinical service provider; 485 PLHIV (2.3% of all PLHIV) live >50 km away. By 2020, this is estimated to rise to 3419 and 807 (11.5% and 2.7% of estimated PLHIV) for 15 km and 50 km, respectively. To meet this demand, the establishment of new HIV services are required in the areas of greatest HIV clinical undersupply. In 2010, these are northern Sydney and western New South Wales, the Queensland mid-north coast and the outer suburbs of Melbourne. At the current estimated rate of increase in PLHIV, areas that will become critically undersupplied by 2020 include south-west Sydney, the outer suburbs of Brisbane and Western Australia. Conclusions: This study provides a quantitative assessment using modern statistical techniques to identify HIV clinical service gaps that is applicable in developed and nondeveloped settings. Training of new HIV clinicians should be directed towards undersupplied areas.
Additional keywords: case management, clinical expertise, service planning, undersupply.
References
[1] World Health Organisation (WHO). Global HIV/AIDS response: epidemic update and health sector progress towards universal access. Progress report 2011. Geneva: WHO; 2011.[2] Lohse N, Hansen A, Pedersen G, Kronborg G, Gerstoft J, Sørensen H, et al Survival of persons with and without HIV Infection in Denmark, 1995–2005. Ann Intern Med 2007; 146 87–95.
| Survival of persons with and without HIV Infection in Denmark, 1995–2005.Crossref | GoogleScholarGoogle Scholar | 17227932PubMed |
[3] McLean S, Savage J. Existing services for people living with HIV in Australia. Background paper for models of access and clinical service delivery project. Sydney, NSW: Australasian Society for HIV Medicine; 2009.
[4] Gurran N, Squires C, Blakeley E. Meeting the sea change challenge: best practice models of local and regional planning for sea change communities in coastal Australia. Sydney, NSW: University of Sydney 2005.
[5] Duncombe W, Robbins M, Wolf DA. Retire to where? A discrete choice model of residential location. Int J Popul Geogr 2001; 7 281–93.
| Retire to where? A discrete choice model of residential location.Crossref | GoogleScholarGoogle Scholar |
[6] Savage J, Crooks L, McLean S. Models of access and clinical service delivery for HIV positive people in Australia. Sydney, NSW: Australasian Society for HIV Medicine ; 2009.
[7] World Health Organisation (WHO). The world health report 2006: working together for health. Geneva: WHO; 2006.
[8] Pell C, Donohoe S, Conway D. Health care services for men who have sex with men in different Australian states and territories since the emergence of HIV. Sex Health 2008; 5 161–8.
| Health care services for men who have sex with men in different Australian states and territories since the emergence of HIV.Crossref | GoogleScholarGoogle Scholar | 18588781PubMed |
[9] Markson LE, Houchens R, Fanning TR, Turner BJ. Repeated emergency department use by HIV-infected persons: effect of clinic accessibility and expertise in HIV care. J Acquir Immune Defic Syndr 1998; 17 35–41.
| Repeated emergency department use by HIV-infected persons: effect of clinic accessibility and expertise in HIV care.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c%2FpslamtA%3D%3D&md5=8ba5d20ba5e443bb98525e78256c40cbCAS |
[10] Carman M, Grierson J, Pitts M, Hurley M, Power J. Trends in the location of the HIV-positive population in Australia: implications for access to healthcare services and delivery. Sex Health 2010; 7 154–8.
| Trends in the location of the HIV-positive population in Australia: implications for access to healthcare services and delivery.Crossref | GoogleScholarGoogle Scholar | 20465979PubMed |
[11] Keiser O, Orrell C, Egger M, Wood R, Brinkhof MWG, Furrer H, et al Public-health and individual approaches to antiretroviral therapy: township South Africa and Switzerland compared. PLoS Med 2008; 5 e148
| Public-health and individual approaches to antiretroviral therapy: township South Africa and Switzerland compared.Crossref | GoogleScholarGoogle Scholar | 18613745PubMed |
[12] Samb B, Celletti F, Holloway J, Van Damme W, De Cock KM, Dybul M. Rapid expansion of the health workforce in response to the HIV epidemic. N Engl J Med 2007; 357 2510–4.
| Rapid expansion of the health workforce in response to the HIV epidemic.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2sXhsVemu7bI&md5=0579962316d953d447c9ae61912b105dCAS | 18077816PubMed |
[13] Walsh A, Ndubani P, Simbaya J, Dicker P, Brugha R. Task sharing in Zambia: HIV service scale-up compounds the human resource crisis. BMC Health Serv Res 2010; 10 272
| 20849626PubMed |
[14] Fulton BD, Scheffler RM, Sparkes SP, Auh EY, Vujicic M, Soucat A. Health workforce skill mix and task shifting in low income countries: a review of recent evidence. Hum Resour Health 2011; 9 1
| 21223546PubMed |
[15] Jansson J, Wilson DP. Projected demographic profile of people living with HIV in Australia: planning for an older generation. PLoS ONE 2012; 7 e38334
| Projected demographic profile of people living with HIV in Australia: planning for an older generation.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38Xht1Srs7fN&md5=d1900b5e7b34acd2fd00fb54d6630827CAS | 22912660PubMed |
[16] Altmayer L. Hot-deck imputation: a simple DATA step approach. Proceedings of the 2002 Northeast SAS User’s Group, September 2002, Buffalo, NY.
[17] Mallitt KA, Jansson J, Crooks L, McGuigan D, Wand H, Wilson DP. Demand for HIV clinical services is increasing in Australia, while supply is decreasing. Sex Health 2012; 10 43–6.
[18] Australasian Society for HIV Medicine (ASHM) Directory of HIV. Hepatitis and related services 2009–2010. Darlinghurst: ASHM; 2009.
[19] Kulldorff M. A spatial scan statistic. Comm Statist Theory Methods 1997; 26 1481–96.
| A spatial scan statistic.Crossref | GoogleScholarGoogle Scholar |
[20] Stevens A, Gillam S. Needs assessment: from theory to practice. BMJ 1998; 316 1448–52.
| Needs assessment: from theory to practice.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c3jvFKisw%3D%3D&md5=f27c1eea88d07ebd5c82f4e887464999CAS | 9572762PubMed |
[21] Newman CE, de Wit JBF, Kippax SC, Reynolds RH, Canavan PG, Kidd MR. The role of the general practitioner in the Australian approach to HIV care: interviews with ‘key informants’ from government, non-government and professional organisations. Sex Transm Infect 2012; 88 132–5.
| The role of the general practitioner in the Australian approach to HIV care: interviews with ‘key informants’ from government, non-government and professional organisations.Crossref | GoogleScholarGoogle Scholar | 22345027PubMed |
