1. Manjul Medhi, Jamie Smyth, Kostas Petridis and William Gardiner
HIV Testing in Aberdeen Royal Infirmary An audit of testing in the I.D. and general medical wards
Manjul Medhi, Jamie Smyth, Kostas Petridis and William Gardiner

2. Background In 2015, over 100,000 people were living with HIV in the UK
13,500 unaware of their diagnosis and at risk of further transmission
6095 people diagnosed with HIV in 2015
Of those with CD4 data available, 1,920/4,969 were diagnosed late
Kirwan PD, Chau C, Brown AE, Gill ON, Delpech VC and contributors. HIV in the UK report. December Public Health England, London

3. Testing Guidelines
UK National Guidelines for HIV Testing 2008 – British HIV Association
Four main clauses for when HIV testing is recommended:
A - Universal HIV testing in GUM, Antenatal/TOP, drug dependency services and services for patients with TB, Hep B/C or Lymphoma
B – All persons registering with GP’s or requiring general medical admissions in high- prevalence areas
C – Patients that meet any one of a number of high risk criteria
D – Blood donors, organ donors/recipients and patients on dialysis

4. The Project Testing guidelines readily available since 2008
Late diagnosis remains a problem almost 10 years later
Are we missing the opportunity to test patients suggested by guidelines?
Is there a difference between the Infectious Diseases ward and the General Medical Wards?

5. Method
Electronic discharge letters for all admissions in targeted time frame checked for testing criteria
Current inpatients excluded
Indicator illnesses used as main indicator for testing
High risk behaviours/past medical history also examined
If criteria met for testing, microbiology results checked
Checked for previous testing and if done, results/date examined
Small pilot audit performed on ID ward and presented locally in from December ‘16 – Feb ’17
30 cases examined
Larger audit across ID ward and two General Medical wards from April – July ’17
89 cases examined

6. Results

7. Results

8. Results

9. Results

10. Summary

11. Indicator illnesses identified in this study
IV Drug Misuse (6 patients)
Weight loss of unknown cause (3 patients)
Lymphadenopathy of unkown cause (3 patients)
Salmonella, shigella or campylobacter (2 patients)
Tuberculosis (2 patients)
PUO (2 patients)
Lymphopenia (1 patient)
Mononucleosis like syndrome (1 patient)
Recurrent bacterial infections (1 patient)
Peripheral Neuropathy (1 patient)
Chronic diarrhea of unknown cause (1 patient)

12. Take home message We don’t test much for HIV on general medical wards
We test 53% of patients with indicator ilnesses on ID ward
Lack of education is unlikely to be the reason for this
53% v 9% v 13% had HIV test
41% v 19% v 7% had indicator illness
2/119 prevalence of hiv or approx 6/1000

13. Discussion points Role of situational factors in HIV testing
Are the guidelines too rigid?
Should opt out testing be considered in ‘lower prevalence’ areas

14. Thank you for your attention