THE AIDS (CONTROL) ACT 1987
REPORTS BY NHS BOARDS – 2006/07 return
Format for Treatment and Care Returns
1. FINANCE
What was your district's HIV/AIDS treatment and care spending broken down by provider under the categories: Hospitals, Other statutory sector and Voluntary/Non-statutory sector?
Hospitals
Provider /Spend 2006/07
NHSG - Maternity Services1 / £104,736NHSG – Genitourinary Medicine2 / £1,500
Total / £106,236
1 -Antenatal Screening and Specialist staff
2 -Specialist Staff
Other statutory sector
Provider / Spend 2006/07NHSG – Community3 / £77,075
NHS Grampian – Public Health/Health Promotion4 / £224,755
Total / £301,830
3- Needles and Syringes & Hepatitis B Immunisation
4 - Condoms, Training, Specialist staff, Public Awareness, Education
Voluntary/Non-statutory sector
Drugs Action5 / £201,652Terence Higgins Trust Scotland / £87,120
Turning Point Scotland / £28,000
Total / £316,772
5 -Specialist staff, needle exchange, sex industry worker
Total Spend 2006/07 / £724,838Total Spend 2005/06 / £708,286
2. ACCESSIBILITY
a) Are there any exceptional problems with accessibility to HIV/AIDS services? If so, what? (e.g. distance to travel, restricted opening hours.)
Given the rurality and remoteness issues throughout parts of Grampian, accessibility is potentially problematic particularly for treatment and care as specialist inpatient and outpatient services are predominantly based in Aberdeen City. It is also acknowledged that needle exchange provision in rural areas is patchy although there has been an increase in the number and geographical areas covered by pharmacies providing this service. However we continue to address accessibility problems by altering opening times, relocation of services, expanding provision of services in Aberdeenshire and providing telephone contact for HIV patients.
b) What open access services are provided? Please use the table below to indicate whether open access is available in the services listed.
Service / Tick if open access is availableGUM / Ö
HIV testing / Ö
Counselling / Ö
Needle Exchange / Ö
What other services have the availability of open access?
Telephone helplines are operated from GUM, Terence HigginsTrust (THT), Drugs Action and NHS Grampian.
c) How many hospital episodes for patients with HIV disease are day-patient and how many are in-patient?
Provider / No. of in-patient episodes / No. of day-patient episodes /Aberdeen Royal Infirmary / 54 / 4
Aberdeen Maternity Hospital / 1 / 0
Woodend Hospital / 1 / 0
Dr Grays Hospital / 5 / 0
Total / 61 / 4
d) What is the average (mean) length of in-patient stay for patients with HIV disease?
Provider / Total Bed Nights / Total No. of HIV/AIDS patients / Average length of stayAberdeen Royal Infirmary / 566 / 30 / 18.9
Aberdeen Maternity Hospital / 3 / 1 / 3.0
Woodend Hospital / 14 / 1 / 14.0
Dr Grays Hospital / 29 / 2 / 14.5
Total6 / 612 / 34 / 18.0
6 median length of stay 8 days
3. DRUG THERAPY
a) What is the cost of the following drugs prescribed in the last year (by source of prescription)?
During the reporting period Antiretrovirals were prescribed by the Infection Unit, GUM and Royal Aberdeen Children’s Hospital.
Drugs / GPs / Hospitals / Other(e.g. Hospices)
Cost / No. of patients / Cost / No. of patients / Cost / No. of patients
Anti-retroviral
Combination Therapies / Dual / 0 / 0 / 1 / 0 / 0
Triple / 0 / 0 / 112 / 0 / 0
Quadruple / 0 / 0 / 11 / 0 / 0
TOTAL / 0 / 0 / £907,4587 / 124 / 0 / 0
Other Therapies
Pentamidine / 0 / 0 / 0 / 0 / 0 / 0
Foscarnet / 0 / 0 / 0 / 0 / 0 / 0
Ganciclovir / 0 / 0 / 0 / 0 / 0 / 0
Other drugs specific to HIV/AIDS
(please specify) / NA / NA / NA / NA / NA / NA
b) What percentage of patients in each of the listed disease stages receives combination therapy?
Stage of Disease / No. of Patients / No. Receiving Combination Therapy / Percentage Receiving Combination TherapyCD4 count < 200 / 23 / 20 / 87%
CD4 count 200-400 / 38 / 29 / 76%
CD4 count 400-600 / 50 / 38 / 76%
CD4 count 600 + / 56 / 37 / 66%
Total / 167 / 124 / 74%
The above information has been obtained from Health Protection Scotland CD4 request forms as all HIV patients attending specialist clinical services are offered CD4 monitoring during the course of the year.
Data is presented as per calendar year 2006. As it is not possible nor clinically relevant to categorise patients into Asymptomatic, Symptomatic and AIDS. Information has been presented according to most recent CD4 count and most recent treatment regime for all patients.
c) What percentage of patients in each of the listed disease stages receives viral load testing?
Stage of Disease / No. of Patients / No. Receiving Viral Load Testing / Percentage Receiving Viral Load TestingCD4 count < 200 / 23 / 23 / 100%
CD4 count 200-400 / 38 / 38 / 100%
CD4 count 400-600 / 50 / 50 / 100%
CD4 count 600 + / 56 / 55 / 98%
Total / 167 / 166 / 99%
Clinicians do not report any difficulties in implementing viral load testing for all patients. Information is obtained from CD4 count returns and excludes patients not attending during the reporting year.
Total cost of Viral Load Testing / £30,78088- The total cost of viral load testing is reduced compared to the 2005-06 budget but infact the number of tests carried out has increased. This is due to the costs per test having decreased.
4. PRIMARY CARE INVOLVEMENT
a) Have there been any notable problems or successes in involving GPs in the treatment and care of people with HIV/AIDS? If so, what mechanisms are in place?
Most care for HIV patients is provided through either the Infection Unit or GUM Service. For most, their positive status is known to their GP therefore enabling the provision of appropriate support. Although the GUM service actively encourages patients to inform their GPs, at the time of reporting, approximately 17 patients had not given their consent to do so. For all patients attending the Infectious Disease service, HIV status is shared with the patient’s GP.
b) What proportion of HIV/AIDS patients are registered with or in shared care with GPs?
98% of HIV positive patients are registered with a GP; 89% are in shared care.
Provider / Total no. of patients / Total no. registered with GP / Total no. in shared care9Infection Unit / 120 / 120 / 120
GUM / 65 / 61 / 4010
Total / 185 / 181 / 160
9- In this context “shared care” is defined as GPs’ awareness of patients’ diagnoses, enabling involvement in discussions or treatment.
10- In 4 cases it is unknown whether the GP is aware or not of the patients’ HIV positive status
5. COORDINATION
Have there been any notable problems or successes in involving the non-statutory sector in planning, commissioning and service delivery? If so, what mechanisms are in place?
Non-statutory sector are invited to attend the Bloodborne Viruses (BBV) Prevention Strategy Group, responsible for coordinating Grampian’s BBV activity with a particular focus on prevention. There are a number of working subgroups involving the non-statutory sector feeding into this group e.g. Needle Exchange and Public Awareness Campaign Group. Links are also in place with the three Drugs and Alcohol Action Teams in Grampian.
6. CONSUMER INVOLVEMENT
Have there been any notable problems or successes in consulting users of HIV/AIDS services and ensuring user input is acted upon? If so, what mechanisms are in place?
The Grampian Buddy services conducted by the Befriending network has merged with Terence Higgins Trust (THT), they are now called THT Community Support Volunteers.
The THT has been involved with the GUM clinic in designing and providing a leaflet for community support for the HIV positive person. This leaflet is given out by staff at both the GUM clinic and the Infection Unit at ARI.
HIV positive patients have been actively involved in World AIDS Day events and Health Care Worker training sessions over the reporting period.
The GUM Service canvassed patients for suggestions to rename their service; it is now called the City Clinic.
7. TRAINING
Have there been any notable problems or successes in keeping staff up to date with training? If so, what mechanisms are in place?
Many specialities carry out training that incorporates information on HIV e.g. nurse, doctors, health information assistants, Terence Higgins Trust (THT). Additional training is aimed at a variety of different professional groups e.g. local authority staff, healthcare staff, voluntary agency staff, prison staff, workplace staff and students. The Health Protection Team provides the majority of targeted bloodborne virus training. There has been an increase in nurse training provided due to the appointment of a BBV and Sexual Health Trainer.
8. COMMUNITY CARE
a) Have there been any notable problems or successes in providing flexible 24 hour care for people with HIV/AIDS? If so, what mechanisms are in place?
No problems have been raised.
b) How is the continuity of care between acute and community managed?
How are the wishes of people with late stage disease to die at home accommodated?
Due to the small numbers of patients in terminal phases of the disease, long term home care/palliative care for HIV positive individuals are addressed on an individual basis. The majority of terminal care is managed in the acute sector within the Infection Unit who liase closely with the patient’s GP. There are no specific services for managing late stage HIV disease and during the reporting period there have been no requests for such a service.
ANNEX 2: Format for Prevention and Non-treatment Returns
1. BUDGET MONITORING
a) What was your district's total HIV prevention allocation and spend?
Total Prevention Allocation / Total Prevention Spend2006/07 / £784,200 / £724,838
2005/06 / £743,600 / £708,286
Any underspend is carried forward to be used for the next year’s projects.
c) Please use the table below to break down the spend from the prevention and non-treatment budget by target group.
Target Populations / Total ExpenditureGay & Bisexual Men11 / £87,120
Women partners of men in the above groups / Nil specific
People with links to high prevalence countries (at present sub-Saharan Africa) / Nil specific
People with AIDS and HIV / Nil specific
Injecting Drug Users12 / £273,750
Other (please specify)
- Sex Workers13
- BBV Prevention Public Awareness Campaign
- Health Promotion activities including education, resources, training for professionals, condoms, direct services to young people held in formal and informal education settings.
- GUM service in Elgin & Aberdeenshire
- Pregnant Women/Babies14 / £32,977
£30,000
£138,283
£1,500
£104,736
11 THT, Community Support Volunteers
12 Needle Exchange Services, Hepatitis Immunisation
13 street outreach, drop in service for female sex workers
14 Antenatal screening
2. HIV Prevention MONITORING: 2005/06 Out-Turn
Planned Profile / Actual OutturnHalf 1
Half 2
Notes on Completion:
1) You are reminded that at least 50 percent of the total prevention budget is to be used for targeted work.
It is unclear what ‘half 1’ and ‘half 2’ refer to.
3. AGENCY MONITORING
Please indicate the amounts and percentages of expenditure from the ring-fenced prevention budget spent in the sectors indicated.
Sector / Amount / PercentageSTATUTORY HEALTH TOTAL / £408,066 / 56.3%
Substance misuse15 / £77,075
GUM / £1,500
Other statutory health (including antenatal screening, health promotion, family planning/sexual health, primary care, community care, education) / £329,491
VOLUNTARY/ NON-STATUTORY / £316,772 / 43.7%
LOCAL AUTHORITIES / 0 / 0%
PRISONS / 0 / 0%
OTHER (PLEASE SPECIFY) / 0 / 0%
TOTAL PREVENTION SPEND / £724,838 / 100%
15- where paid from HIV prevention allocation
Where ring-fenced allocations have been used to fund work in part only, please indicate separately the total costs where such information is available.
4. EFFECTIVENESS MONITORING
What steps are you taking to ensure that the commissioning of HIV prevention work is evidence-based in relation to risk groups targeted, effectiveness of interventions used and monitoring of work being undertaken?
The following steps are continuously taken to ensure this.
· Monitoring trend data on HIV, hepatitis B and hepatitis C obtained at both local level and from Health Protection Scotland
· Review evidence for new initiatives
· Monitoring needle exchange equipment distribution through local Needle Exchange Sub Group of BBV Prevention Strategy Group
· Antenatal Screening Monitoring Group reviews uptake rates for HIV and HBV screening in pregnancy.
Have there been any notable problems or successes in this area?
· Commissioning support inadequate, therefore revision of Service Level Agreements (SLAs) slow.
· The Public Health Bloodborne Virus Nurse Specialist reduced to part time working to facilitate a Bloodborne Virus training post.
A(C)A1AIDS (CONTROL) ACT 1987: STATISTICS ON REPORTED AIDS CASES AND DEATHS
NHS Board: / Grampian
Year ending 31 March 2007
Signed:
Name:
Tel. No. :
First reported from / Known to be resident
Period / People with AIDS - / this NHS board / of this NHS board
1 April 2006 / - reported to, and / 0 / 0
to 31 March 2007 / accepted by HPS
in period
numbers of cases / 0 / 0
known to have died
in period
Cumulative to / - cumulative number / 40 / 41
31 March 2007 / reported to, and accepted
by HPS in period
numbers of above / 32 / 34
known by 31 March 2007
to have died
Notes:
1. This form should be completed as part of the reports made by NHS Boards under the AIDS (Control) Act 1987.
2. The form should be completed from information supplied by Health Protection Scotland (HPS)
A(C)A2
AIDS (CONTROL) ACT 1987: STATISTICS ON NEWLY REPORTED HIV INFECTED PERSONS
NHS Board: / Grampian
1 April 2006 to 31 March 2007 (as at 31 March 2007)
Signed:
Name:
Tel. No. :
How person probably acquired the virus / Male / Female / Total
Sexual intercourse between men / 11 / 0 / 11
Sexual intercourse between men and women / * / * / 14