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Substance users and HIV clinician’s perspective Sarah Creighton Consultant GUM/HIV Homerton Hospital.

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Presentation on theme: "Substance users and HIV clinician’s perspective Sarah Creighton Consultant GUM/HIV Homerton Hospital."— Presentation transcript:

1 Substance users and HIV clinician’s perspective Sarah Creighton Consultant GUM/HIV Homerton Hospital

2 Overview Services in Hackney Case histories

3 2005 Among 38 substance users there were :- 12 homeless individuals 18 sex workers 9 incarcerations 50 sexually transmitted infection 37 pregnancies 40 inpatient admissions (2 ITU) 12 CD4 < 200 14 lost to follow up

4 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

5 20052007 N3847 Lost143 Needing HAART1922 Receiving HAART820

6 Deaths CD4VLCause of death CW27598OD SS89513000lymphoma HH670135CCF CC361<40Ca lung CA219<40cirrhosis RT210430000CRF JD6104000RTA RA315410Surgical comp

7 CW 20 yo fHIV + 2000TB 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

8 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

9 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’

10 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

11 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

12 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

13 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

14 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

15 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

16 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

17 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

18 Summary 383 LTFU 31 new registrations2 LTFU 9 RIP 2005 24 active cases11 poor adherence 2013 55 active cases 4 poor adherence

19 Learning Points Flexibility Use of wider medical structures Single point of contact Social structures –Prison –Housing –Lay structures Investment in self esteem


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