Barriers to targeted HIV testing on an acute admissions unit: evaluation of the UK guideline

Peck, Leah; Ferenczi, Emily; Burns, Fiona; Cosgrove, Catherine; Brown, Mike

doi:10.1093/qjmed/hcp185

Cited by 13 publications

(16 citation statements)

References 7 publications

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“…Investigation of missed presentations in this setting is an important priority [22]. Without concurrent control it is not possible to attribute trends in missed presentation to national strategies to improve HIV diagnosis [39]. Indeed our study suggests most improvements relate to changes in patient demographics and service provision.…”

Section: Discussionmentioning

confidence: 92%

Trends in missed presentations and late HIV diagnosis in a UK teaching hospital: a retrospective comparative cohort study

2012

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BackgroundLate diagnosis is an important cause of HIV-related morbidity, mortality and healthcare costs in the UK and undiagnosed infection limits efforts to reduce transmission. National guidelines provide recommendations to increase HIV testing in all healthcare settings. We evaluated progress towards these recommendations by comparing missed opportunities for HIV testing and late diagnosis in two six year cohorts from North East Scotland.MethodsWe reviewed diagnostic pathways of all patients newly diagnosed with HIV referred to infectious diseases and genito-urinary medicine services between 1995 and 2000 (n = 48) and 2004 to 2009 (n = 117). Missed presentations (failure to diagnose ≤ 1 month of a clinical or non-clinical indicator for testing), late diagnosis (CD4 < 350 cells/mm3), and time to diagnosis (months from first presentation to diagnosis) were compared between cohorts using χ2 and log-rank tests. Determinants of missed presentation were explored by multivariate logistic regression. Breslow-Day tests assessed change in diagnostic performance by patient subgroup.ResultsThere were significant decreases in missed presentations (33% to 17%; P = 0.02) and time to diagnosis (mean 17 months to 4 months; P = 0.005) but not in late diagnosis (56% vs. 60%; P = 0.57) between earlier and later cohorts. In the later cohort patients were significantly more likely to have acquired HIV abroad and presented with early HIV disease, and testing was more likely to be indicated by transmission risk or contact with GUM services than by clinical presentation. Missed presentation remained significantly less likely in the later cohort (OR = 0.28, 95% CI 0.11 to 0.72; P = 0.008) after adjustment for age, transmission risks and number of clinical indicators. Reductions in missed presentation were greater in patients < 40 years, of non-UK origin, living in least deprived neighbourhoods and with early disease at presentation (P < 0.05). 27% of missed presentations occurred in primary care and 46% in general secondary care.ConclusionsWhile early diagnosis has improved in epidemiological risk groups, clinical indications for HIV testing continue to be missed, particularly in patients who are older, of UK origin and from more deprived communities. Increasing testing in non-specialist services is a priority.

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Section: Discussionmentioning

confidence: 92%

Trends in missed presentations and late HIV diagnosis in a UK teaching hospital: a retrospective comparative cohort study

2012

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“…Availability of counselling or a pathway to refer discharged patients for outside counselling and testing should be routinely provided in all emergency departments in order to detect HIV infection early . If available, an acute admissions unit could provide timely in‐house testing without the use of extra resources , but a recent UK audit showed inadequate testing even after introduction of simplified guidelines, particularly in patients with shorter hospital stays and in patients not seen by an infectious disease specialist .…”

Section: Discussionmentioning

confidence: 99%

The late‐presenting HIV‐infected patient 30 years after the introduction of HIV testing: spectrum of opportunistic diseases and missed opportunities for early diagnosis

et al. 2016

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“…A further criticism could be that two of the three cases identified were likely to have been detected through the already locally established practice of targeted testing of high risk individuals as defined by indicator disease or risk group [16], and that expanding practice to universal testing is unnecessary. The authors would certainly like to believe that the two cases with indicator diseases would have been identified without the RAPID pilot in place, unfortunately published data suggests that this may not necessarily have occurred [16], [17].…”

Section: Discussionmentioning

confidence: 99%

“…The authors would certainly like to believe that the two cases with indicator diseases would have been identified without the RAPID pilot in place, unfortunately published data suggests that this may not necessarily have occurred [16], [17]. Earlier diagnosis is increasingly acknowledged as fundamental in prevention of HIV related morbidity and mortality, and in the prevention of onward transmission of infection.…”

Section: Discussionmentioning

confidence: 99%

Acceptability and Feasibility of Universal Offer of Rapid Point of Care Testing for HIV in an Acute Admissions Unit: Results of the RAPID Project

et al. 2012

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BackgroundUK guidance recommend all acute medical admissions be offered an HIV test. Our aim was to determine whether a dedicated staff member using a multimedia tool, a model found to be effective in the USA, is an acceptable, feasible, and cost-effective model when translated to a UK setting.DesignBetween 14th Jan to 12th May 2010, a Health advisor (HA) approached 19–65 year olds at a central London acute medical admissions unit (AAU) and offered a rapid HIV point of care test (POCT) with the aid of an educational video. Patients with negative results had the option to watch a post-test video providing risk-reduction information. For reactive results the HA arranged a confirmatory test, and ensured linkage into HIV specialist care. Feasibility and acceptability were assessed through surveys and uptake rates. Costs per case of HIV identified were established.ResultsOf the 606 eligible people admitted during the pilot period, 324 (53.5%) could not be approached or testing was deemed inappropriate. In total 23.0% of eligible admissions had an HIV POCT. Of the patients who watched the video and had not recently tested for HIV, 93.6% (131/140) agreed to an HIV test; four further patients had an HIV test but did not watch the video. Three tests (2.2%, 3/135) were reactive and all were confirmed HIV positive on laboratory testing. 97.5% felt HIV testing in this setting was appropriate, and 90.1% liked receiving the information via video. The cost per patient of the intervention was £21.DiscussionUniversal POCT HIV testing in an acute medical setting, facilitated by an educational video and dedicated staff appears to be acceptable, feasible, effective, and low cost. These findings support the recommendation of HIV testing all admissions to AAU in high prevalence settings, although with the model used a significant proportion remained untested.

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Barriers to targeted HIV testing on an acute admissions unit: evaluation of the UK guideline

Cited by 13 publications

References 7 publications

Trends in missed presentations and late HIV diagnosis in a UK teaching hospital: a retrospective comparative cohort study

Trends in missed presentations and late HIV diagnosis in a UK teaching hospital: a retrospective comparative cohort study

The late‐presenting HIV‐infected patient 30 years after the introduction of HIV testing: spectrum of opportunistic diseases and missed opportunities for early diagnosis

Acceptability and Feasibility of Universal Offer of Rapid Point of Care Testing for HIV in an Acute Admissions Unit: Results of the RAPID Project

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