Research Study Gavin Bryce Health Promotion Specialist NHS Brighton and Hove Provider-initiated HIV testing in primary care

2 Background Tremendous advances in treatment and health outcomes for individuals Expanded access to HIV testing with rapid testing available in some settings Early diagnosis and treatment is cost-effective Consciousness of HIV status can be a powerful prevention tool Despite this significant numbers present late with HIV infection

3 Building the Case Around c25% of people don’t know they are HIV positive –50% thought to be men who have sex with men –25% thought to be among black Africans One-third of all newly diagnosed cases were ‘late’ –42% heterosexual men –36% heterosexual women –19% men who have sex with men

4 New guidance Urge all healthcare workers to consider HIV testing in a wide range of situations and settings –GUM & sexual health clinics; antenatal services; termination of pregnancy services; drug dependency programme; Tuberculosis, hepatitis B & C & lymphoma services; and dialysis, blood donation and organ transplant services Aims to address the challenges of late and undiagnosed HIV For high HIV prevalent areas, testing is recommended for all adults (15-59) in all healthcare settings during primary care registration or at in-patient points of contact

5 Local Epidemiology Diagnosed HIV prevalence 1,311 –90% male, 10% female –Highest rates in year olds –80% acquired through sex between men 260 new infections in 2007 –16% increase on previous year Highest diagnosed prevalence outside of London –7 th highest PCT nationally –Prevalence 4 times above guidance threshold

6 Research Study Design Locally Enhanced Contract for HIV within Primary Care (Across 26 GP Practices) –15 GP Practices have expressed interest to take part Assess- Acceptability, Feasibility & Cost effectiveness 3 phase design –Phase I: Protocol refinement; patient and healthcare professional questionnaires tested (1 month) –Phase II: research protocol piloted (6 months) –Phase III: self-administered healthcare professional questionnaire

7 Newly registering patient offered an appointment for a health check HIV test offered to patient Patient declines health check appointment Patient accepts offer of a health check appointment Patient accepts offer to take part in research study Patient “opts out” of HIV test LOST TO STUDY Patient completes questionnaire LOST TO STUDY Patient accepts HIV test Blood taken with method for receiving results agreed with patient Appointment made for blood to be taken Blood test is HIV negative Blood test is HIV positive EXIT STUDY Patient referred into specialist HIV services Patient given opportunity to take part in research study Patient declines to take part in research study OPT-OUT ROUTE OPT-IN ROUTE

8 Other Local Initiatives Termination of Pregnancy Substance Misuse Service ‘opt-out’ pilot in acute medical admissions at Royal Sussex County Hospital Joint Advisory Group

9 Other National Initiatives Leicester –acute medical admissions Sheffield Centre for HIV and Sexual Health –HIV home sampling London –3 non-GU hospital settings –THT- African community case finding –African community and MSM testing pilot Lewisham –General practice

10 For further information Gavin Bryce NHS Brighton and Hove