Time to test for HIV
January 24, 2011 at 7:57 AM
BSMS researchers working on HIV testing studies for the Health Protection Agency have been described as successful in an interim report, Time to test for HIV: Expanded healthcare and community HIV testing in England.
Eight projects, in hospitals, primary care and community settings, were funded by the Department of Health. All except one were in high prevalence areas (where diagnosed prevalence greater than 2/1000 15-59 year olds).
BSMS is invoved in two of these studies: Dr Matthew Hankins and Professor Jackie Cassell in a hospital-based study with Martin Fisher's team at the Brighton and Sussex University Hospitals Trust; and Dr Matthew Hankins in a primary-care based study with the Brighton & Hove Primary Care Trust.
HIV testing in acute general medical admission.
The hospital-based study looked at HIV testing in acute general medical conditions as a third of HIV infections in England are thought to be undiagnosed and consequent late presentation causes avoidable morbidity, mortality and onward transmission. Among recommendations is a routine offer of HIV testing in acute general medical (AGM) admissions in areas of high HIV prevalence.
Its conclusions were that while HIV testing is acceptable to the majority of patients in AGM, the rate of offering during this pilot was low, and varied substantially between medical teams as in previous antenatal testing research. The prevalence of HIV was higher than in the general population, and well above that recommended for routine testing in AGM, surgery and orthopaedics. Although recommended as routine, clinicians appear to be targeting testing, yet failing to identify the majority of undiagnosed infections. A local Trust performance indicator (CQUIN) has now been introduced by the PCT for offering HIV testing across all acute admissions.
Universal HIV testing with newly registering patients (aged 16-59) in primary care
New HIV testing guidance recommends introducing universal HIV testing in areas where diagnosed prevalence is 2 per 1,000 or more. The acceptability, feasibility and cost effectiveness of universal HIV testing with newly registering patients (aged 16-59) was assessed in the primary care setting in Brighton and Hove, where diagnosed prevalence is more than 7 per 1,000. A total of 10 GP practices that hold locally enhanced service contracts to improve access to primary care for people living with HIV took part in the study.
Preliminary results suggest that universal HIV testing in primary care is both acceptable and feasible.The provision of genuinely universal coverage in the context of a new patient health check appointment (NPHCA) is dependent on several factors including the policies and practices of individual primary care facilities in offering NPHCAs, uptake rates by patients and follow-up mechanisms for patients who do not attend. A challenge remains in supporting clinicians to be confident in offering HIV testing to patients, particularly if this may potentially involve delivering 'bad news'.