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 LeedsAntony Hale – Leeds Teaching Hospital TrustLeena Inamdar – West Yorkshire Health Protection Unit

June 2012

Late diagnosis of HIV infectionIn 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 outcomesincreased mortality in those with HIV infectionincreased likelihood of onward transmission

New diagnoses of HIV in Leeds (2005 – 2010)

0

40

80

120

160

2005 2006 2007 2008 2009 2010Year

Nu

mb

er

of

ne

w

dia

gn

os

is

Epidemiology - Mixed picture

Rate of new diagnoses Probable infection route of

new diagnoses25-43yrs

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 analysis1. Take data about HIV tests from LTHT laboratory2. Clean the data3. Calculate HIV test rates by GP practice4. Compare against underlying HIV prevalence

using HPA data using a GIS

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

Leeds GP practices in areas of high HIV prevalence - ranked by HIV test rates *

GP Code CCG Practice

Branch surgery

Number HIV tests

2008-2010

Adult population 15-65 yrs

HIV tests per 1000

pop 2008-2010

% Black African

population †

B00001 Leodis ############ Main Surgery 0 4,809 0.0 1.9


B00003 Calibre ############ Main Surgery 3 1,321 0.8 29.6

B00004 Leodis ############ Main Surgery 3 992 1.0 1.5





B00009 Calibre ############ Branch Surgery 45 8,361 1.8 8.2

B00010 H3 ############ Main Surgery 47 8,058 1.9 1.9




B00005 - ############ - 24 3,796 2.1 -



B00008 H3 ############ Main Surgery 51 7,236 2.3 14.7


B00010 H3 ############ Main Surgery 60 5,996 3.3 1.9













B00007 Leodis ############ Branch Surgery 105 6,216 5.6 1.6



B00010 H3 ############ Main Surgery 842 37,500 7.5 14.7




X00001 #N/A ############ Main Surgery 16 29.6

X00002 #N/A ############ - 12 -

X00003 #N/A ############ - 10 -

X00004 #N/A ############ - 25 -

X00005 #N/A ############ - 44 -

X00006 #N/A ############ - 36 -

X00007 #N/A ############ - 2 -

X00008 #N/A ############ - 1 -

* This table displays Leeds practices located in high prevalence geographical areas rather than practices with high prevalence practice lists.>10%

† Black African population data from UK Census 2001 (Black, Black British, Black African or Black other)

LOW

HIV

TE

ST

RA

TE

ME

DIU

M H

IV T

ES

T R

AT

EH

IGH

HIV

TE

ST

RA

TE

Leeds GP practices in areas of high HIV prevalence - ranked by HIV test rates *

GP Code CCG Practice

Branch surgery

Number HIV tests

2008-2010

Adult population 15-65 yrs

HIV tests per 1000

pop 2008-2010

% Black African

population †










B00010 H3 ############ Main Surgery 47 8,058 1.9 1.9




B00005 - ############ - 24 3,796 2.1 -



B00008 H3 ############ Main Surgery 51 7,236 2.3 14.7


B00010 H3 ############ Main Surgery 60 5,996 3.3 1.9













B00007 Leodis ############ Branch Surgery 105 6,216 5.6 1.6



B00010 H3 ############ Main Surgery 842 37,500 7.5 14.7




X00001 #N/A ############ Main Surgery 16 29.6

X00002 #N/A ############ - 12 -

X00003 #N/A ############ - 10 -

X00004 #N/A ############ - 25 -

X00005 #N/A ############ - 44 -

X00006 #N/A ############ - 36 -

X00007 #N/A ############ - 2 -

X00008 #N/A ############ - 1 -

* This table displays Leeds practices located in high prevalence geographical areas rather than practices with high prevalence practice lists.>10%

† Black African population data from UK Census 2001 (Black, Black British, Black African or Black other)

LOW

HIV

TE

ST

RA

TE

ME

DIU

M H

IV T

ES

T R

AT

EH

IGH

HIV

TE

ST

RA

TE

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)

Documents

A prioritisation tool for HIV testing in primary care in Leeds