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 In the UK c24% of those living with HIV remain undiagnosed 40% of new cases have a late diagnosis (CD4count<350mm 3 ) – [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

New diagnoses of HIV in Leeds (2005 – 2010)

Epidemiology - Mixed picture Rate of new diagnosesProbable infection route of new diagnoses 25-43yrs 35-44yrs

Barriers to HIV testing 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 Organisational Lack of incentives to offer test No formal national targets Financial constraints Community Stigma

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

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

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

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

Data analysis 1.Take data about HIV tests from LTHT laboratory 2.Clean the data 3.Calculate HIV test rates by GP practice 4.Compare against underlying HIV prevalence using HPA data using a GIS

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

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

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