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The Royal District Nursing Service HIV Program in a Changing Epidemic

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The Royal District Nursing Service HIV Program in a Changing Epidemic ‘They make me feel worthy’ ‘RDNS was there for me when no family was’ Project Team: Liz Crock, Nalla Burk, Judy Frecker, Oscar Morata, John Hall ‘I can talk about The Royal District things Nursing Service I cannot talk with family or HIV Program in a friends’ changing epidemic: an action evaluation ‘When I finish tablets, Final report they come. If I am sick, they come’ Elizabeth Crock 17th September 2013 ‘ "invaluable" emotional support, especially for those who live alone, living longer’. ‘They helped me when I was homeless’ Disclaimer The work in this project was undertaken in partial fulfilment of the requirements of The University of Melbourne for the degree of Master of Public Health. The views expressed are those of the author and may not reflect the views of The University of Melbourne, School of Population Health or of the Royal District Nursing Service Limited. Acknowledgements I would like to acknowledge gratefully the contribution of all below to the completion of this project: Ms Rosemary McKenzie provided exceptional guidance, supervision and encouragement throughout. Dr. Dianne Currier from the School of Population Health gave me advice on survey design that vastly improved the questionnaires. Martin Wischer, HIV Program Manager at RDNS granted me leave to pursue the project. My HIV Team colleagues at the Royal District Nursing Service, HIV Clinical Nurse Consultants: Nalla Burk, Judy Frecker, Oscar Morata and HIV Resource Nurses: Andrew Becker, Annie Boulton, Denise Larocque, Annette Campbell–Sinni, and Julie Martin assisted with questionnaire design, recruitment and the project overall. Their commitment to the clients and to the project’s success was exemplary, especially in recruiting people from diverse backgrounds. Erika Van Der Spuy kindly provided HIV Program data. I would also like to thank: Dr. Catherine Crock, Sophie Blackmore, Mary Natoli and James May for reviews of the draft questionnaires; Staff of the RDNS Institute of Community Health – Charne Miller, Dr. Susan Koch, Dr. John Barlow and Catherine Standing for support and assistance. Clinical Support Manager Janeen Cato; Client Service Manager Kerry Oates and the staff of Heidelberg RDNS, and all other RDNS staff who promoted and supported this project. Staff of the Victorian AIDS Council/Gay Men’s Health Centre, especially John Hall, Campbell Smith, Marcus Younger, Sue Robinson and Liz Craig; Brent Allen – Living Positive Victoria; Tania Phillips and Michelle Wesley – Positive Women; Jeffrey Robertson – Straight Arrows; Karen Blyth and Dr. Olga Vujovic – State–wide HIV Consultancy, Tom Carter – Victorian Department of Health, Dr. Alan Street and Joanne Paterson – Victorian Infectious Diseases Service; Tom Carter, Department of Health; Stefanie Christian, Straight Arrows. Kia Egan, University of Melbourne. Alex Nikolovski from the Positive Living Centre and Jane Howard, University of Melbourne assisted with Excel© spreadsheets; My partner Giancarlo Di Stefano has supported me through the years leading up to this project and throughout the writing process with much patience. Finally, thanks are due to the clients of the Royal District Nursing Service HIV Program who gave generously of their time, expertise, experiences and knowledge to help develop the HIV Program for the benefit of future clients. The RDNS HIV Program is funded by the Sexual Health and Viral Hepatitis Section, Health Development Unit, Prevention and Population Health Branch, Victorian Department of Health. i Acronyms & abbreviations Acquired Immune Deficiency Syndrome AIDS Antiretroviral therapy ART Clinical Nurse Consultant CNC Gay, Lesbian, Bisexual, Transgender, GLBTIQ or LGBTI Intersex, Queer Human Immunodeficiency Virus HIV Men who have Sex with Men MSM RDNS Homeless Person’s Program HPP Royal District Nursing Service RDNS Royal District Nursing Service HIV HIV Team/HIV Program Team/Program Victorian AIDS Council/Gay Men’s Health VAC Centre ii Contents DISCLAIMER ................................................................................................................................................ I ACKNOWLEDGEMENTS ........................................................................................................................... I ACRONYMS & ABBREVIATIONS .......................................................................................................... II EXECUTIVE SUMMARY ........................................................................................................................... 1 BACKGROUND ............................................................................................................................................................ 1 AIM .............................................................................................................................................................................. 1 METHODOLOGY ......................................................................................................................................................... 1 KEY FINDINGS ........................................................................................................................................... 2 CLIENT PROFILE AND NEEDS – HIV PROGRAM DATA ........................................................................................ 2 Client demographics ............................................................................................................................................... 2 Human resource use ................................................................................................................................................ 2 CLIENT SURVEY ......................................................................................................................................................... 2 Service description ................................................................................................................................................... 2 Client satisfaction ..................................................................................................................................................... 3 Quality of care ............................................................................................................................................................ 3 FUTURE NEEDS .......................................................................................................................................................... 6 Clients’ views on their needs in the next 5 to 10 years ............................................................................ 6 Key informants' views ............................................................................................................................................ 6 Strengths ...................................................................................................................................................................... 7 Service gaps ................................................................................................................................................................ 7 Mainstreaming .......................................................................................................................................................... 7 STAFF SURVEY – WORKFORCE DEVELOPMENT NEEDS ....................................................................................... 7 Knowledge and skills .............................................................................................................................................. 7 Attitudes ....................................................................................................................................................................... 8 Practice ......................................................................................................................................................................... 9 Stigma and discrimination .................................................................................................................................. 9 PROGRAM DEVELOPMENT, SERVICE IMPROVEMENT........................................................................................ 10 SUSTAINABILITY .................................................................................................................................................... 10 Leadership and management .......................................................................................................................... 11 CONCLUSIONS AND RECOMMENDATIONS .................................................................................... 12 HIV PROGRAM EVALUATION RECOMMENDATIONS ........................................................................................ 13 CHAPTER 1: INTRODUCTION ............................................................................................................. 16 BACKGROUND ......................................................................................................................................................... 16 Community context............................................................................................................................................... 16 RDNS HIV model of care ..................................................................................................................................... 17 Policy context .........................................................................................................................................................
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