substance users and hiv clinician’s perspective
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Substance users and HIV clinician’s perspective. Sarah Creighton Consultant GUM/HIV Homerton Hospital. Overview. Services in Hackney Case histories. 2005. Among 38 substance users there were :- 12 homeless individuals 18 sex workers 9 incarcerations - PowerPoint PPT PresentationTRANSCRIPT
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Substance users and HIVclinician’s perspective
Sarah CreightonConsultant GUM/HIVHomerton Hospital
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Overview
• Services in Hackney• Case histories
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2005Among 38 substance users there were :-
12 homeless individuals18 sex workers9 incarcerations50 sexually transmitted infection37 pregnancies40 inpatient admissions (2 ITU)12 CD4 < 20014 lost to follow up
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Service Provision• Multiple contact with health care providers• Single point of contact• Blood born virus team
-phlebotomy, adherence support, side effect management, sexual health, delivery of medication, liaison with HIV clinic, Interferon
• Outreach team• Supportive Hostels• HDM and DOT
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2005 2007
N 38 47
Lost 14 3
Needing HAART 19 22
Receiving HAART 8 20
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DeathsCD4 VL Cause of death
CW 275 98 OD
SS 895 13000 lymphoma
HH 670 135 CCF
CC 361 <40 Ca lung
CA 219 <40 cirrhosis
RT 210 430000 CRF
JD 610 4000 RTA
RA 315 410 Surgical comp
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CW• 20 yo f HIV + 2000 TB 2004• Nadir CD4 30 VL 1 million 30/12/2004• 3 pregnancies• Mother and baby unit 2007 • ARV truvada atazanavir CD4 275 VL 98• Assault, prison• Asthma treated with fluticasone• Iatrogenic Cushings, brittle diabetes• Psychiatric admission• RIP 2008 insulin overdose• Learning point – issues with multiple agencies
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RP• 41 yo F HIV + 2009 Hep C• Positive Elispot – PTB• CD4 605 3/12 TB treatment• Rehoused out of area, LTFU• 2011 DTB, CD4 11 albumen 17 weight 30 kg• 6/12 treatment. Interstitial nephritis. LTFU• TB reactivated 10/6/12 CD4 83. Still in hospital
• Learning point – ARV support impossible without substance support
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CC• 44 yo MHIV + 2005 St Elsewhere.TB, hep C, LTFU• Jan 2008 Homerton CD4 110• Ataz/r/tru• Nov 2008 – CD4 361 VL < 40• Jan 2009 GP noted to be out of area• Methadone support transferred• May 2011 metastatic Ca lung supportive care
• Learning point – need to battle for ‘special dispensation’
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DL
• 42 yo M HIV + 2005 St Elsewhere LTFU• ITU 2010 TB PCP pseudomonas Hep C PN• CD4 95 VL 167664• LTFU; Home visit; • RV 47 yo F Hep C CD4 195 VL 94954• 2013 DL VL 1 CD4 334 RV VL < 40 CD4 441
• Learning point invest in self esteem
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LB
• 24 yo F HIV + 2005 TB 2006 Butane addict• 3 x pregnancy• Nadir CD4 863 peak VL 190 000• Reckless transmission case• Started heroin, rapid deterioration• Street homeless, severe HSV CD4 528
• Learning point social structures hold things together
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AC
• 17 yo f HIV + 2010 CSA• CD4 699 VL 7094• Mother disowns her • ‘friends’ give heroin ‘for free’• Large investment in development work• 2012 in college, CD4 842 drug free
• Learning point importance of social support
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PB 32
GL 23
FA 40
DD 45
CF 39
AM 39
VA 34
NS 27
CW 30
MO 41
CM 46
JLD 41
RB 35
MF 33
LB 30
OW 32
SS 30
DML 35
BB 35
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PB 32
GL 23
FA 40
DD 45
CF 39
AM 39
VA 34
NS 27
MO 41
CW 30
CM 46
JLD 41
RB 35
MF 33
LB 30
OW 32
SS 30
DML 35
BB 35
RIP
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PB 32
GL 23
FA 40
DD 45
CF 39
AM 39
VA 34
NS 27
MO 41
CW 30
CM 46
JLD 41
RB 35
MF 33
LB 30
OW 32
SS 30
DML 35
BB 35
RIP
disability
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PB 32
GL 23
FA 40
DD 45
CF 39
AM 39
VA 34
NS 27
MO 41
CW 30
CM 46
JLD 41
RB 35
MF 33
LB 30
OW 32
SS 30
DML 35
BB 35
RIP
disability
lost
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PB 32
GL 23
FA 40
DD 45
CF 39
AM 39
VA 34
NS 27
MO 41
CW 30
CM 46
JLD 41
RB 35
MF 33
LB 30
OW 32
SS 30
DML 35
BB 35
RIP
disability
lost
V unwell
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Summary38 3 LTFU31 new registrations 2 LTFU9 RIP
2005 24 active cases 11 poor adherence2013 55 active cases 4 poor adherence
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Learning Points• Flexibility• Use of wider medical structures• Single point of contact• Social structures
– Prison– Housing– Lay structures
• Investment in self esteem