First visit to your HIV clinic
- a list of all the medications you take
- letters/reports from your referring doctor (if applicable)
- your GP details
Your first visit can take up to 2 hours. Please try to arrive on time as it may not be possible to see you if you are late.
You will see one of our HIV specialist doctors. He or she will take your medical history and examine you, discuss your initial bloods results, answer any questions you have, and discuss your future. We encourage you to see the same (regular) doctor for every subsequent consultation where possible. A nurse will then see you to take additional health information and explain how our service works. She or he may take (with your consent) some more blood samples and help you to arrange your next appointment(s).
Most patients attend for their routine consultation every 3–4 months. However, if you need to start HIV treatment or are not stable or tolerating your treatment, more frequent visits may be needed. It is advisable to have regular blood tests 1–2 weeks before each routine doctors appointment so that we have your latest results to give you when you see your doctor. Most routine consultations take 15–30 minutes. If additional tests are required or prescriptions need to be collected in pharmacy, your visit may be slightly longer.
The HIV clinic is specifically for the management of HIV infection, its associated infections/conditions and for starting and monitoring response to HIV treatment. It is difficult to give a simple checklist of when you should use the clinic outside of your regular appointments but if you think you have an urgent HIV-related medical problem which cannot wait until your next regular appointment (eg fever and rash develop a few days after starting HIV treatment), we have emergency clinics operating Monday to Friday:
To access the emergency clinic please call 020 3315 6509 (for Kobler walk-in clinic) or 020 3315 6699 for 10 Hammersmith Broadway. For other problems we strongly encourage you to see your GP. The emergency clinic should not be used as a replacement for your regular HIV doctor or the routine services that your GP provides. If you are not sure if your problem is HIV-related, speak to your GP first, or, failing that, call the nursing staff of your HIV clinic during opening hours who can advise you where it would be best to be seen.
Out-of-hours care—what if the HIV clinic is closed?
If you experience an urgent and HIV related problem outside of clinic opening times, contact your GP. If this is not possible, call the HIV ward on 020 3315 8540. Either will be able to advise you what to do. In an emergency you should go (or be taken) directly to the nearest A&E department.
We strongly recommend that you register with a General Practitioner (GP). Your GP plays an active role in monitoring your health in tandem with your HIV care and is usually the most qualified to deal effectively with non-HIV related complaints. Having a GP is the only way of accessing certain services such as home visits, district nurses and health visitors. They also should prescribe regular non-HIV-related medications and vaccines. If you do not have a GP, search for a GP in your area or call/visit the Information Exchange on 020 3315 5929 (based at Kobler Clinic, St Stephens Centre) for more information.
We do not provide any dental services in the directorate. For information on dental services visit/call our Information Exchange on 020 3315 5929 (based at Kobler Clinic, St Stephens Centre).
The Chelsea and Westminster HIV Directorate has partnered with Kensington & Chelsea PCT in order to provide a one-to-one smoking cessation service for our HIV+ clients. The service is run by fully trained nurses who aim to increase your chance of successfully quitting by using a combination of motivational support and nicotine replacement therapy (NRT). The course lasts for 6 weeks and currently runs on Friday afternoons at the Kobler Clinic.
We are unable to prescribe Champix (Zyban is not recommended for people with HIV) through this service and you will be referred to your GP if you would prefer this method of stopping smoking.
If you are unable to attend the Kobler Clinic but would like to stop smoking, visit the NHS Smoke Free website or call the NHS free smoking helpline on 0800 169 0 169 for information about local services.
We very much support your choice to have a baby or plan a family in the future and we have specialist services to support you in this. We are able to offer various options that will help to reduce to a minimum the possibility of passing the virus onto your baby should you conceive. If you want to get pregnant and your partner is negative then we can advise you on how best to conceive without infecting your partner. If your partner is also HIV+ the women's services Health Advisers can help you plan how to improve your chances of getting pregnant as well as refer you to a specialist gynaecologist if further fertility investigations are necessary. We also have strong ties with the Chelsea and Westminster Hospital Assisted Conception Unit (ACU) that are able to offer privately funded fertility treatment such as sperm washing and IVF/ICSI.
Whatever your situation—if you are thinking of having a baby, then discuss this with your doctor. Or you can contact our specialist women's services Health Advisers directly on 020 3315 6150.
We respect that many patients live busy professional lives and we consequently strive to minimise their number of attendances and time spent in clinic, while providing good quality HIV service. From listening to our patients we now operate late clinics, have extended opening times for bloods and provide OptionE—a telephone/email-based results service. The directorate has a large HIV+ patients forum where patients from all three HIV clinics meet regularly to give views about their experience of the HIV service and thereafter often influence decision-making, future planning and development of HIV services.
Patients are advised to have regular blood tests done 1–2 weeks before their routine doctor's appointments so that their results will be available when they see the doctor. To get bloods done, patients should come to the clinic during opening times (no appointment needed) and bring their own bloods request forms (issued by their regular doctor the previous visit). If patients don't have these forms they should speak with the nursing staff. If patients choose to have their bloods taken on the day of their appointment they can get the results:
- Kobler Clinic: Call the nurse-led results line on 020 3315 6699, option 2
- 10 Hammersmith Broadway: Results can be obtained by arrangement with your clinic doctor or day care nurse
- 56 Dean Street: Call the doctor's telephone clinic on 020 3315 9500
- Via OptionE
The doctors and nurses at the Kobler Clinic work in three consultant led teams (Teams Asboe, Nelson and Pozniak—see biographies) and your clinic doctor will belong to one of these teams. If you are unable to get an appointment with your regular doctor you can see one of the other doctors within the same team or the Team Specialist Nurse. The team specialist nurse can also see patients who are stable on or off treatment, or those having problems taking medication. At 56 Dean Street, all the doctors often see each other's patients and are happy to do so. If you are unable to get an appointment with your regular doctor, for example because s/he is away, please feel free to make an appointment with someone else.
Post exposure HIV prophylaxis is anti-HIV medication that is prescribed to a HIV negative person, within 72 hours of a sexual or needle-stick exposure to body fluids of a person known to be or highly likely to be infected with HIV. It needs to be taken for one month and evidence suggests it may reduce the chances of being transmitted HIV by approximately 80%. Examples of high risk exposures include unprotected vaginal sex with a HIV positive woman, unprotected anal sex with a gay man of unknown HIV status, sharing of drug injecting equipment from a HIV positive person. To access PEP call 020 3315 6699 and attend John Hunter Clinic, 56 Dean Street clinic or 10 Hammersmith Broadway directly (no appointment required). If PEP is needed outside of clinic opening times attend your nearest Accident and Emergency department
- Unprotected penetrative (usually anal or vaginal) sex with a HIV infected person
- Injection or transfusion of contaminated blood or blood products or receiving semen donation or an organ transplant from an HIV positive person.
- From an HIV infected mother to her baby—transmitted during pregnancy or the labour/birth or through breastfeeding.
- Sharing unsterilised injection equipment that has previously been used by someone who is HIV positive.
The CD4 cell count is a very crude measure as to the strength of your immune system. The CD4 helper T-lymphocyte is the predominant immune cell that the HIV virus infects and destroys. Over time the body can not replace these lost CD4 cells and the size and function of this population declines and as it does so, the ability of your immune system to fight infection will also deteriorate. The lower the CD4 count the less able your immune system is to fight infection and the more serious and extensive the range of infections you become susceptible to. A normal CD4 count is approximately 800 cells. When the CD4 count falls below 200 cells you become increasingly susceptible to AIDS defining illnesses such as Pneumocystis pneumonia (PCP).
This is a measure of how much replicating HIV is found in the circulating blood. In a HIV positive person this usually varies from a few hundred to a few million copies/ml. In patients on HIV treatment, the viral load is an accurate measure of how effective treatment is. The aim on treatment is to reach an "undetectable" level. Please note having an undetectable viral load does not mean the person is not infectious—he/she can still transmit HIV to others.
SPLASH (Safe Positive Living and Sexual Health) is a nurse led clinic, specifically for Kobler clinic patients with no genital symptoms who just need a sexual health check up, vaccination for hepatitis A or B, sexual health advice or to have a cervical smear. (SPLASH opening times) Appointments can be made over the phone 020 3315 6699 or in person at Kobler reception but some walk-in slots are available for emergencies. Please note Kobler clinic patients with genital symptoms may be asked to book an appointment in the John Hunter Clinic upstairs.
HIV+ patients who attend the Nkosi Johnson unit at the 10 Hammersmith Broadway for their HIV care and who wish to have a sexual health screen, cervical smear, Hepatitis B screening/vaccination or need contraception or advice regarding pregnancy can attend the Zodiac clinic. Appointments can be made over the phone 020 3315 6699 or in person at the Nkosi Johnson reception.
Patients attending for HIV care at 56 Dean Street may request a sexual health screen at their HIV follow-up visit or by making an appointment in the general sexual health clinic—sexual health appointments.
There is a standard process of safety checking, labelling and counselling before prescribed drugs can be released to the patient. The checks ensure the prescription dosage/amount is correct, that the patient is not allergic to the drugs, or that the patient is not taking other drugs that could potentially interact with the prescribed agents. This process takes time but is ultimately there to protect and inform the patient. During busy clinics the waiting times for pharmacy can escalate and we are aware how frustrating this is for patients. We are working hard to try and address these waiting times—eg introducing home delivery and pre-dispensing for certain clinics during the week. Because of space restrictions we have to prioritise what medications we keep in the Kobler pharmacy. This unfortunately means that patients will need to go to the main pharmacy for certain items.
Pharmacy opening times
Contrary to hospitals, any medicine dispensed in primary care (e.g. from a high street chemist) is exempt of VAT. The home delivery service is a registered primary care pharmacy which dispenses a patient's prescriptions and sends them via registered post to a nominated address in an unmarked package. The VAT savings cover the cost of the posting and also help to save the NHS money. Home delivery is not appropriate for everyone but does offer another way for patients to receive their medication. If you are stable on antiretroviral/anti-HIV treatment with an undetectable viral load this is an option for you – ask your regular doctor or HIV pharmacist.
OptionE is a convenient HIV care option developed by the former Victoria Clinic in response to the views of the people who use our service. If your health is stable, on or off treatment, and you find clinic appointments inconvenient, OptionE could help. The service operates at 10 Hammersmith Broadway and 56 Dean Street.
OptionE gives you:
- the option to have most of your HIV care after 5pm
- extra nurse appointments, making it easier to get your bloods taken in the evening
- results by email
- the choice to have your HIV medication delivered to any UK address
OptionE is an addition to our standard HIV service. You can still book an appointment with your regular doctor to discuss any concerns you may have. We will need to register you to verify your email address. You can combine this with your next routine HIV blood tests by requesting an ‘OptionE registration appointment’.
At 56 Dean Street, OptionE clinics run every day—Monday and Thursday evenings, Tuesday and Friday morning, and Wednesday afternoons. Patients may have their bloods done and get their prescriptions. Blood results are emailed on Tuesdays and Thursdays.
At the Nkosi Johnson Unit at 10 Hammersmith Broadway, OptionE clinics are open 5–7pm on alternate Wednesdays.