National Guidelines for the Management of People with HIV Who Place Others at Risk

Level Two: Counselling, education and support under advice from HIV Advisory Panel

Page last updated: April 2008

Level

Likely Pathway

Services to consider

Decision, decision maker and action

Two: Counselling, education and support under advice from HIV advisory panel or the Chief Health Officer or equivalent

Management in the community under recommendations from the Chief Health Officer or equivalent and / or HIV Advisory Panel but without a Behavioural Order.
No satisfactory change in behaviour after Level One management and individual referred by the Chief Health Officer or equivalent to the HIV Advisory Panel.

OR

Agreement between the Chief Health Officer or equivalent or Chair of HIV Advisory Panel and primary health care provider that Level Two is appropriate initial management.
Psychiatric and medical assessments may be required if not previously obtained.

Detailed recommendations on case management, including behavioural management or other services if indicated.

Additional human and financial resources to be available to allow effective public health management of client.
Decision is to admit to management at Level 2 under the Guidelines.

Made by Chief Health Officer or equivalent or Chair of HIV Advisory Panel, in consultation with primary health care provider.

Convene HIV Advisory Panel for case review.

HIV Advisory Panel considers case and provides written advice about management to the Chief Health Officer and / or the primary health care provider.

Consider need for appointment of client advocate.

Consider issuing a letter of warning to the client formally advising the client of their responsibilities and that their behaviour has come to the attention of, and is being monitored by, public health authorities.

Consider options for management under Mental Health Act, Guardianship Act, etc.

Regular review by Panel for maintenance, discharge or escalation under Guidelines at not greater than four monthly intervals.
  1. In circumstances where counselling and support measures have failed, more assertive management should be initiated. This requires that the decision be taken that an individual be managed under the Guidelines at Level 2 or above. The basis of the decision is that the client is not being effectively managed within the resources of the local clinician and other services, even with advice from the Chair of the Panel. This decision is taken by the Chief Health Officer or equivalent or Chair of the Panel.
  2. Each case needs to be considered on an individual basis. Use of a range of illicit and prescribed drugs, personality disorders, development disability, mental illness, homelessness and social isolation are some of the factors that singly, or in combination with HIV infection, can contribute to behavioural problems of the sort that might lead to management under the Guidelines at this Level or above.
  3. The local clinician, with other service providers involved in caring for the client, remains the central point of client management, but now with support from the Department / Advisory Panel. If necessary, additional resources will be provided from other agencies.
  4. In the case of longer-term interventions, it may be desirable for public health and clinical care / case management functions to be fully delineated at service provider level.
  5. The Chief Health Officer or equivalent or HIV Advisory Panel should fully review all aspects of the case in question. The Panel may be able to provide further guidance to local health care professionals regarding client management. A multi-disciplinary case conference should be convened to facilitate identification of the causes of the person’s failure to take responsibility for his or her actions as the basis for the development of a case management plan. A full medical examination, including a psychosocial assessment, may be appropriate at this stage.
  6. At the recommendation of the Panel, a letter to the client from the Chief Health Officer or equivalent may be appropriate. This letter of warning will usually indicate that the client’s behaviours have been officially brought to the attention of the Department, specify the responsibilities of the client with respect to their HIV infection, and identify expected behaviours of the client. In some cases, the letter of warning may be sufficient to prompt behaviour change.
  7. Written reports on the follow up of clients managed under the Guidelines at Level 2 or above must be considered by the Panel at each of its regular meetings (every four months, or more frequently).