The research led by Pamoja’s Gavin Stedman-Bryce found that routine HIV testing was feasible and acceptable in the primary care setting and has led to increased HIV testing in some GP practices.

Background

The case for early diagnosis of HIV is compelling. Early treatment of HIV (when CD4+ cells are still >200/μl) has several benefits, both for the individual and for public health—it reduces associated morbidity and mortality and greatly reduces the potential for onward HIV transmission. Self-awareness of HIV seropositivity can be a powerful prevention tool at an individual and community level. Evidence suggests that some people with HIV behave in a less risky manner shortly after they learn they are HIV positive. Early diagnosis and treatment is also cost effective, with direct care costs for late presenters (CD4+ cells <200/μl) estimated to be 200% higher than for early presenters.

Despite medical advances in diagnosing and treating HIV, many people still present late with HIV infection. The UK has an estimated 86,500 people living with HIV, of whom 26 per cent (22,490) are thought to be unaware of their HIV status. Data from 2009 shows that of those diagnosed with HIV over half (52%, 3,450) were diagnosed late. Amongst heterosexual men and women, 66 per cent of all male cases and 59 per cent of all female cases were considered to be late diagnoses, compared with 39 per cent of all diagnoses amongst men who have sex with men. Adults over 50 years old are more likely to present late and are 2.4 times more likely to die within a year of diagnosis when compared with younger adults.

Recent policy discourse has centred on reframing the way we think about HIV testing. A good approach to prevention unites medical, behavioural, and structural strategies for optimum effectiveness. Because encouraging people to test for HIV has limited success and primary HIV infection is often overlooked in primary care, provider initiated routine HIV testing provides a promising solution.

Guidance published in the UK by the British HIV Association, the British Association of Sexual Health and HIV, and the British Infection Society advocates a move towards routine HIV testing in a variety of new settings, including termination of pregnancy services and substance misuse services. The guidance recommends that, in areas where the prevalence of HIV is more than two in 1000, HIV testing should be offered routinely to all men and women (15-59 years old) who register in primary care and are admitted to hospital.

Achieving great things together!

Pamoja’s Gavin Stedman-Bryce acted as Principal Investigator for a research initiative that aimed to assess aspects of new HIV testing guidance in the primary care setting in Brighton and Hove. Brighton and Hove is a city in the South East of England with a total population of approximately 256,000.  The population has a large Lesbian, Gay, Bisexual and Transgender (LGBT) community and has a diagnosed HIV prevalence of 7.6 per1000 people aged 16-59 years – the highest diagnosed HIV prevalence outside of London.  In 2009 there were 1381 people registered as accessing NHS-funded care for the treatment of HIV in the city of whom 91 per cent were male, 87 per cent were white and 84 per cent had acquired the infection through sex between men.

The purpose of the research project was to assess whether universal HIV testing in the primary care setting was feasible, acceptable and cost effective. The research project ran from April to November 2010. During the research project- involving a small sample of GP practices – all newly registering patients (aged 16-59) attending for a new patient health check appointment were offered a point of care bioLytical INSTi® HIV test. Patient acceptability was assessed through uptake of the test and through a self-completed questionnaire using Likert scales. Feasibility factors were assessed with clinicians through reflective diaries, regular working group meetings and a focus group.

The results of the research suggest that universal HIV testing in primary care is both acceptable and feasible. Extending the provision of genuinely universal coverage depends on several factors including adapting to practices’ different approaches to new patient registrations and the provision of training and support for clinicians to be confident in offering HIV testing.

The findings from this research, together with findings from similar projects have been reported on by the Health Protection Agency in collaboration with the Department of Health. You can view these reports in the resource section in the right-hand section of this page.

 ”the study has shown me that we can all hold beliefs that are out-dated and unfounded.”

“having a reactive patient, although difficult, made me feel better about being in the study, I immediately saw the benefit of universal testing.”

- Primary health care professionals, Brighton and Hove