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A prioritisation tool for HIV testing in primary care in Leeds

A prioritisation tool for HIV testing in primary care in Leeds. Duncan Cooper, Owen Brigstock-Baron, Brenda Fullard and Richard Dixon - NHS Leeds Antony Hale – Leeds Teaching Hospital Trust Leena Inamdar – West Yorkshire Health Protection Unit June 2012. Late diagnosis of HIV infection.

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A prioritisation tool for HIV testing in primary care in Leeds

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  1. A prioritisation tool for HIV testing in primary care in Leeds Duncan Cooper, Owen Brigstock-Baron, Brenda Fullard and Richard Dixon - NHS Leeds Antony Hale – Leeds Teaching Hospital Trust Leena Inamdar– West Yorkshire Health Protection Unit June 2012

  2. Late diagnosis of HIV infection In the UK c24% of those living with HIV remain undiagnosed 40% of new cases have a late diagnosis (CD4count<350mm3) – [65% for the Black African community] Late diagnosis leads to: poorer health and treatment outcomes increased mortality in those with HIV infection increased likelihood of onward transmission

  3. New diagnoses of HIV in Leeds (2005 – 2010)

  4. Epidemiology - Mixed picture Rate of new diagnoses Probable infection route of new diagnoses 25-43yrs 35-44yrs

  5. Barriers to HIV testing Organisational Lack of incentives to offer test No formal national targets Financial constraints Community Stigma Patient: • Poor awareness of risk • Fear of + result • Fears over confidentiality • Fear of deportation/criminal charges Professional: • Concerns over appearing judgemental • Fear of giving positive result • Incorrect perception of a patient’s risk • Lack of time/resources

  6. NICE guidance 2011 Two pieces of NICE public health guidance were published in March 2011: [1] Increasing uptake of HIV uptake among Black Africans in England [2] Increasing uptake of HIV uptake among men who have sex with men

  7. NICE guidance 2011 Recommended: - ‘Normalising’ HIV testing - Increase amount/regularity of testing within high risk groups - Increasing health care settings within which tests are offered

  8. Threshold for increasing HIV testing “in areas with a HIV prevalence of above 2 per 1,000 all new primary care registrations and general medical admissions should be offered an HIV test, as well as anyone who has a blood test (regardless of the reason)”. Leeds has a HIV prevalence of 1.4 per 1000

  9. HIV rate per 1,000 in Leeds (2010) [based on number of HIV+ patients accessing care]

  10. Data analysis • Take data about HIV tests from LTHT laboratory • Clean the data • Calculate HIV test rates by GP practice • Compare against underlying HIV prevalence using HPA data using a GIS

  11. Rank practices from low to high ‘testers’ for all high prevalence practices

  12. Application • Prioritisation and surveillance tool for primary care HIV testing, used to inform: • Training for GPs (STIF training) • Circulated to CCGS / evidence for commissioning • GP attitude survey • Input to cost-benefit analysis • Inform on-going HIV surveillance in Leeds

  13. Learning points • Multi-agency working • Data – very dirty - previously unused for this purpose • Multiple formats • Slow burner (worked between training locations)

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