Auckland Regional Public Health Service
RātongaHauoraāIwioTamakiMakaurau
Working with the people of Auckland, Waitemata and Counties Manukau
Auckland Regional Public Health Service @aklpublichealth
A YEAR ON…
HEALTH ACT AMENDMENTS
David Sinclair
25August2017
Auckland Regional Public Health Service
RātongaHauoraāIwioTamakiMakaurau
Working with the people of Auckland,
Waitemata and Counties Manukau
Auckland Regional Public Health Service @aklpublichealth
Principles for managing infectious disease
• Publichealthprotectionparamount
• Respectforindividuals
• Voluntarycompliancepreferred
• Individualstobeinformed
• Proportionality
• Leastrestrictivealternative
• Measurestoapplynolongerthannecessary
• ApplicationofPrivacyandHDCCodes
Auckland Regional Public Health Service
RātongaHauoraāIwioTamakiMakaurau
Working with the people of Auckland,
Waitemata and Counties Manukau
Auckland Regional Public Health Service @aklpublichealth
HIV to be Notifiable
• HIVlistedwithAIDS,syphilis,gonorrhoea
• Notification“withoutidentifyinginformation”
(s74(3A))
– Mustnotinclude:name,address,placeofworkor
educationorcontactinformation(phone,e-mail,URL)
– IncludesAIDScode,NHI,ethnicity,sex,occupation,
[risk,modeoftransmission]
– Restrictedaccess,HIPCodeapplicable
– MOHcanobtainidentifyinginformationifsubstantial
publichealthrisk(s74(3B))
Auckland Regional Public Health Service
RātongaHauoraāIwioTamakiMakaurau
Working with the people of Auckland,
Waitemata and Counties Manukau
Auckland Regional Public Health Service @aklpublichealth
HIV to be Notifiable
• MainintenttoimprovenationalHIV/AIDS
epidemiology,identifytrendsearlier,toinform
strategiesetc.Possibilitiesforlongerterm?
• Changefromnotifyingclinical condition(AIDS) to
notifyinginfection
– OnlynewHIVinfectionnotifiable
– AEGalreadyhasHIVlaboratoryandtransmissioninfo
• Allowsfordirectlaboratorynotification(s74AA(2A))
• Notificationby“Healthpractitioner”
Auckland Regional Public Health Service
RātongaHauoraāIwioTamakiMakaurau
Working with the people of Auckland,
Waitemata and Counties Manukau
Auckland Regional Public Health Service @aklpublichealth
HIV Infection NZ
Auckland Regional Public Health Service
RātongaHauoraāIwioTamakiMakaurau
Working with the people of Auckland,
Waitemata and Counties Manukau
Auckland Regional Public Health Service @aklpublichealth
Contact tracing
• Partnernotificationcanbeundertakenbyperson
withinfection
• ContacttracingcanbebyDHB-nominated
contacttracers(e.g.SHS,CommunityHIVservice).
• HealthActspecifiesscope
– Gatherinformationtoidentifysourceandassessrisk
– Provideinformationandadvicetocontactsetc
– Infectedpersoncanberequiredtoidentifycontacts
Auckland Regional Public Health Service
RātongaHauoraāIwioTamakiMakaurau
Working with the people of Auckland,
Waitemata and Counties Manukau
Auckland Regional Public Health Service @aklpublichealth
“Directions” and “Orders”
• MOH“directions”personorcontactposing“substantial
riskofseriousharm”toothers
– Participateincounselling,educationetc
– Refrainfromspecifiedactivities,goingspecifiedplaces,
associatingwithspecifiedpeopleorgroups;
– Takespecifiedactions;isolation;havesupervisionetc
– Undergomedicalexamination,includingtesting
• MOHcancontactemployer,businessowner
• Courtordersandurgentordersinextremesituations
– Canincludedetentionandcompulsorytreatment
• Actcoversprocesseseg.duration,review,appeals
– Applicabletoallnotifiablediseases
Auckland Regional Public Health Service
RātongaHauoraāIwioTamakiMakaurau
Working with the people of Auckland,
Waitemata and Counties Manukau
Auckland Regional Public Health Service @aklpublichealth
Eligibility for Funding
• EligibilityDirection(Ministry):accessto
fundingforpublichealthmeasures(e.g.to
reducetransmission)fornotifiableinfections
• PHARMACtofundearlyARVsonPHgrounds:
CD4criteriadeleted
• Non-residentseligible
Auckland Regional Public Health Service
RātongaHauoraāIwioTamakiMakaurau
Working with the people of Auckland,
Waitemata and Counties Manukau
Auckland Regional Public Health Service @aklpublichealth
Things to think/work through
• Appearancevssubstance(needrealitycheck)
• Wordsandmessages–“surveillance”-badterm..
– Intentiontoimprovecounting,notmonitoring
• Whohasaccesstosensitiveinformation?
– Mostlydoesn’tchange–clinics,GPs,hospitals...
– PHUcan’troutinelyaccessidentifyinginformation
– Mustbewithindataaccessrules,HIPC
• Ensuringrules/policyaroundactions,escalation
• Implicationsfortesting?
• ImplicationsforpeoplelivingwithHIV?
Auckland Regional Public Health Service
RātongaHauoraāIwioTamakiMakaurau
Working with the people of Auckland,
Waitemata and Counties Manukau
Auckland Regional Public Health Service @aklpublichealth
Scenario
• Alexhasbeenverysexuallyactivesincediscovering
datingappssuchasGrindrandhornet.Hehasalong-
termpartner,isbisexualanddoesnotalwaysusea
condom.Laboratoryresultshaveconfirmedhisdoctor’s
diagnosisofHIV,anddespitethisAlexisreluctanttotell
hispartnerandothershehashadsexwiththattheymay
havebeeninfected.
• ThelocalpublichealthunitfindsAlex’sinfectionrisk
whenAlexisnamedbyapersonreceivingapositive
diagnosticHIVresult.
Auckland Regional Public Health Service
RātongaHauoraāIwioTamakiMakaurau
Working with the people of Auckland,
Waitemata and Counties Manukau
Auckland Regional Public Health Service @aklpublichealth
Scenario
• Marvin,agymtrainerwhohasnotbeeninNewZealandlongand
doesnotspeakEnglishwell,hasbeenconfirmedashavingHIV,with
adetectableviralloadandsignificantinfectionrisk.Heisnot
currentlyonAntiretroviraltherapyandissporadicallylinkedto
medicalcare.HetravelsbetweenAucklandandWellingtonforwork.
• Aconcernedex-partnerwhoisawareofMarvinsHIVstatushas
madeseveralphonecallstohealthauthoritiestoinformthemthat
Marvinhasbeenengaginginunprotectedsexwithmultiple,casual
partnerswhileinWellington.Marvinandhisex-partneraredealing
withacrystalmethaddictionandhadengagedinsexpartiesduring
theirrelationship.Theex-partnerbrokeupwithMarvinasthe
partieswereaffectingtheirworkandlifebutMarvindidn’twantto
stopashedidn’tthinkitwasaproblem.Theex-Partnerisengaged
inaddictionsupporttodealwithhisMethaddictionandhas
recentlytestedHIVnegative.
Auckland Regional Public Health Service
RātongaHauoraāIwioTamakiMakaurau
Working with the people of Auckland,
Waitemata and Counties Manukau
Auckland Regional Public Health Service @aklpublichealth
Scenario
• SomeoneIknowrecentlyhadsexwithaguyhestartedseeing.
Aftertheyhadsex,theguydisclosedhisHIV-positivestatusand
thatheisundetectable.Theyhadn'tusedcondoms.Theyarestill
seeingeachotherandhisresponsetothedisclosurewaschill.But
asaprecautionthepersonwenttogettested,hehadn'tbeen
testedinalongtimeanyhowanddidn'tknowhisstatus,but
assumedhewasnegative,sowasagoodexcuseforacheckup.
• Theguywenttohislocalclinic.Attheclinichetoldthedoctorwhy
hewasthereandthattheguydisclosedaftersexbutthattheguy
wasundetectable.Thedoctorconfirmedthatitwasvirtually
impossiblethatHIVtransmissionhadoccurred,butinformedthe
guythathecouldandshouldcriminallypresschargesagainstthe
positiveguybecausewhathedidwasagainstthelaw.Thetest
resultcamebackpositive.