BackgroundUK National Guidelines (UKNG) advise HIV testing in clinically indicated neurological presentations. We audited the impact of our practical strategies to increase uptake of HIV testing at a regional acute neurology admissions unit.MethodsWe audited HIV testing in 4 periods over 2 years: before we designed a UKNG-based “HIV testing in Neurology” protocol (“pre-protocol”); after dissemination of the protocol alone (“post-protocol”); post-protocol dissemination combined with both a tailored departmental admissions clerking proforma to prompt for HIV testing & consenting, and regular focussed tutorials to doctors on HIV testing in neurological patients (“post-proforma”); and finally one year after the post-proforma period (“+1 year”). We also looked at the total number of HIV tests sent from the unit during the two-year period. We assessed significance using Fisher’s exact test.Results47.8% of all acute neurology non-stroke admissions were eligible for HIV testing during all the audit periods. Testing rates were as follows: pre-protocol 21.9%; post-protocol 36.6%; post-proforma 83.3%; and at +1 year 65.4% (p<0.05 for both post-protocol and +1 year when compared to pre-protocol). Documentation of consent for HIV testing improved from 25% to 67.6% with the HIV-tailored clerking proforma. The total number of HIV tests requested from the unit doubled in the post-proforma period compared to pre-protocol (p<0.05).ConclusionIn conclusion: the combination of an HIV testing protocol, a tailored departmental clerking proforma and regular focussed teaching to doctors on indications for HIV testing led to a sustained increase in HIV testing uptake in our regional acute neurology admissions unit.

IntroductionNew diagnosis of HIV can be psychologically challenging, and presents an important opportunity to improve health literacy and engagement in care. Peer-led interventions are an effective means of providing support to people living with HIV (PLWH). We present an evaluation of a newly-diagnosed course (NDC) in London.MethodThe NDC, established in its current form in 2011, is accessible to ‘those recently diagnosed or struggling with diagnosis’. Providing a structured, peer-led, group-based, participatory programme delivered by experienced facilitators. NDC comprises 6 sessions (21 contact hours). All participants were invited to complete pre-and post-course questionnaires (using a 4-or 5-point scale), most did at the first and last sessions. This analysis presents data from 2011-2016. Data were analysed in STATA using Wilcoxon signed rank test.ResultsAcross 30 NDCs, 314 participants completed both questionnaires (response rate 87%). The majority were men who have sex with men (91.3%), 72% of whom were of white ethnicity. Approximately 15% were female, the majority Black-African ethnicity (56%) and heterosexual (88%). Heterosexual men and transgender individuals represented 6.5% and 0.3% respectively. The table summarises participant’s responses for selected questions (P Values <0.001 for all comparisons):Pre- and Post-Course Questions:•Pre-course n/N (%)•Post-course n/N (%)*Current emotional state144/136 (43)287/339 (85)*Confidence in dealing with HIV status130/335 (39)307/339 (91)*Confidence around sex and relationships46/336 (14)172/279 (62)*Confidence in the future130/338 (39)290/332 (90)How confident do you feel about disclosing your HIV status?26/338 (8)136/340 (40)How satisfied are you with your ability to get more information about HIV medications?97/336 (29)130/314 (41)How much knowledge do you have about how HIV is transmitted?183/337 (54)324/340 (95)How much do you know about how to access Post Exposure Prophylaxis (PEP)?169/337 (28)274/340 (81)How much knowledge do you have about CD4 count and HIV viral load?82/337 (24)300/340 (88)Personal satisfaction with NDC overall n/N (%) rating ‘mostly’ or ‘fully’ useful324/328 (99)*Questions headed: ‘Thinking about your HIV how would you rate the following’ Respondents rating highest using 4- or 5-point scaleDiscussionThis innovated peer-led NDC engaged over 300 PLWH since 2011, resulting in short-term self-reported improvements. 6-and 12-month questionnaires would assess durability of changes, and we’re exploring the association with attendance at NDC and clinical outcomes (e.g. viral suppression and retention in care). In conclusion, the NDC is a sustainable and acceptable model, providing holistic support and promoting self-management in PLWH.

Results 92 feedback forms were returned (20 [22%] from the hub and 72 [78%] from four spokes). 4 (5%) males: 86 (96%) females, median age 30 years (range 16-64). Knowledge of services offered improved from median 4/10 (range 1-10/10) to median 10/10 (range 1-10/10) after reading the leaflet. 33/66 (50%) patients not originally attending for an STI screen would consider or agree to screening after reading the leaflet (36/82 [44%] for HIV testing respectively). The leaflet received an overall rating of median 10/10 (range 5-10/10). Discussion/conclusion Overall the leaflet was well received and improved patient's knowledge of services offered, and uptake of STI/HIV testing. Females provided the majority of feedback most likely due to spokes previously providing primarily contraceptive services. More work needs to be done to encourage males to attend the spoke clinics.

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