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Economic Assessment of the Community HIV Clinical Nurse Specialist role

Shaun Watson, Community HIV Clinical Nurse Specialist, Chelsea & Westminster NHS Foundation Trust

Shaun's case study was completed in May 2015 and reflects 2015 prices

The challenge posted by HIV is ever-changing, with an ageing HIV positive population, the long-term effects of antiretroviral therapy (ART) and rising rates of HIV and sexually transmitted infection. In 2014 there was an estimated 103,700 people living with HIV in the UK, with 613 deaths (PHE, 2015).

The role of the community based HIV clinical nurse specialist (Community HIV CNS) has a long and varied history. Initially, the role was commissioned to provide specialist management for those living with HIV/AIDS who wanted to live (and die) at home and be supported with the co-ordination of services, plus the requisite palliative care for those who wished to remain in their own homes.

As HIV evolved, the role developed in response, providing specialist advice and expertise around HIV care, side-effect management and adherence to (at the time) complicated ART. The current emphasis of the Community HIV CNS role is one of complex case management, which has been described as "the process of planning, coordinating and reviewing the care of an individual" and supporting HIV self-care and management. Whilst these roles vary across the UK, the overarching remit for most Community HIV CNS is the management of a cohort of patients to prevent avoidable hospital (re)admissions and speed up discharge from wards.

Chelsea & Westminster NHS Foundation Trust Clinical Nurse Specialist (HIV Community) Shaun Watson argues that CNS roles such as his are often viewed as a luxury. By undertaking an economic assessment, Shaun demonstrates that his role not only adds value but avoids considerable costs. By supporting adherence to ART therapy alone, Shaun estimates that with a caseload of 60 - 70 patients, his intervention avoids between £162,500 and £260,000 of ART waste. Consequently the avoidance of the onward transmission of HIV saves between £3,360,000 -£4,320,000 per annum. Furthermore, by presenting three case studies, Shaun illustrates how his role avoids significant costs elsewhere in the system, such as ambulance services, A&E departments, hospital beds days, GP appointments and mental health services.

You can contact Shaun by email shaun.watson@nhs.net.

Case Study
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