1-4 April 2014, Arena and Convention Centre Liverpool

THIRD JOINT CONFERENCE

OF BHIVA AND BASHH 2014

Ms Sarah CollinsPublic Health England

Trends in HIV testing outside of

traditional services

Sarah Collins 3rd April 2014

Immunisation, Hepatitis, & Blood Safety Department, Public Health England

On behalf of the sentinel surveillances of blood borne virus testing

Background• BHIVA and BASHH guidelines1 highlight the importance of increasing HIV

testing in non-traditional services (NTS) to increase early diagnosis.

• In areas of high HIV prevalence (>2 per 1,000 population) the offer of a HIV

test should be made to

new registrants in general practice (GP)

all general medical admissions

• Although HIV testing in GUM clinics and antenatal screening programmes is

well described less is known about HIV testing in NTS.

• The Sentinel Surveillance of Blood-Borne Virus testing collects

laboratory data irrespective of test result; providing information on the

population undergoing HIV testing.

1 British HIV Association, British Association for Sexual Health and HIV, British Infection Society. UK National Guidelines

for HIV Testing. 2008.

4 Trends in HIV testing outside of traditional services

Method• Data extracted from sentinel laboratories were transformed into a unified format

and load into the ‘Denom’ database

• Demographic and testing data from 15 laboratories for people tested for HIV

between 2008 and 2012 were extracted in yearly cohorts

• Duplicate records, reference testing, under 16’s, and people tested via unknown

locations were excluded

• HIV positive individuals were excluded from analysis in subsequent years

• The service requesting the test was identified and mapped to the Local Authority

Using data from SOPHID2 HIV prevalence was classified as high (HP) if >2/1,000 and

low (LP) when ≤2/1,000

• Ethnicity was assigned using self-reported ethnicity or name analysis software

2 Data from the Survey of Prevalent HIV Infections Diagnosed (SOPHID), Public Health England, 2012.

5 Trends in HIV testing outside of traditional services

Asian or Asian British (AAB)

other or mixed ethnicity (O/M)

black or black British (BBB)

white or white British (WWB)

Trends in HIV testing

6 Trends in HIV testing outside of traditional services

GUM (n=724,525) testing was stable

Overall positivity 1.2%

Antenatal screening (n=294,149)

due to changes in commissioning

Overall positivity 0.2%

NTS (n=462,208) testing 160%

from 69,940 in 2008 to 112,033 in

2012

• LP: testing 141%

positivity from 0.9% to 0.7%

• HP: testing 178%

positivity from 1.0% to 0.6%

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

Nu

mb

er

of

ind

ivid

ua

ls t

es

ted

Year

GUM - HP Antenatal - HP NTS - HP

GUM - LP Antenatal - LP NTS - LP

Testing in NTS

The number of persons tested for HIV over time increased in every NTS

apart from Occupational Health

The increase in testing over time was more pronounced among:

• males (173%; 55,036/31,845) than females (152%; 55,174/36,204)

LP areas: testing 165% among males vs. 125% among females

HP areas: testing 179% among males vs. 181% among females

• persons of BME origin (180%; 19,893/11,048) than those of WWB origin

(152%; 79,961/52,609)

LP areas: testing 153% among BME vs. 136% among WWB

HP areas: testing 200% among BME vs. 169% among WWB

7 Trends in HIV testing outside of traditional services

Testing in GP

8 Trends in HIV testing outside of traditional services

170,304 persons tested

161% from 25,731 in 2008 to

41,310 in 2012

HP: testing 207%

positivity varied from 0.5% to 0.7%

LP: testing 120%

positivity varied from 0.5% to 0.6%

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

22,000

24,000

26,000

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1.0

2008 2009 2010 2011 2012

Nu

mb

er

of

ind

ivid

ua

ls t

es

ted

Pro

po

rtio

n H

IV p

os

itiv

e

Year

HP % positive LP % positiveHP tested LP tested

Comparison with HCV – testing in GP

9 Trends in HIV testing outside of traditional services

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

22,000

24,000

26,000

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1.0

2008 2009 2010 2011 2012

Nu

mb

er

of

ind

ivid

ua

ls t

es

ted

Pro

po

rtio

n H

IV p

osit

ive

Year

HP % positive

LP % positive

HP tested

LP tested

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

22,000

24,000

26,000

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

2008 2009 2010 2011 2012

Nu

mb

er

of

ind

ivid

ua

ls t

es

ted

fo

r a

nti

-HC

V

Pro

po

rtio

n H

CV

po

sit

ive

Year

HP % positive

LP % positive

HP tested

LP tested

Testing in general medical surgical

10 Trends in HIV testing outside of traditional services

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

2008 2009 2010 2011 2012

Nu

mb

er

of

ind

ivid

ua

ls t

es

ted

Pro

po

rtio

n H

IV p

os

itiv

e

Year

HP % positive LP % positiveHP tested LP tested

26,566 persons tested

244% from 2,939 in 2008 to

7,176 in 2012

HP: testing 275%

positivity from 2.8% to 1.4%

LP: testing 206%

positivity from 3.2% to 1.2%

HIV positivity in NTSThe odds of testing HIV positive were

significantly higher among

• males (aOR=1.76; 95% CI=1.63-1.90)

• those of black ethnic origin (aOR=5.40;

95% CI=4.85-6.02)

• those attending A&E services (aOR=4.28;

95% CI=3.60-5.08)

• those attending specialist liver services

(aOR=5.21; 95% CI=4.65-5.83)

Positivity decreased over time (aOR=0.84;

95% CI=0.82-0.87)

LP/HP was not significant p=0.14

11 Trends in HIV testing outside of traditional services

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

Male / LP Male /HP

Female /LP

Female /HP

Pro

po

rtio

n p

os

itiv

e

Gender / prevalence

AAB BBB O/M WWB

Conclusions

During 2008-12, 50% of persons were tested for HIV by GUM clinics, 20% by

antenatal screening services, and 30% by NTS

BUT the greatest increase in testing during this period was in NTS

• 141% in LP areas

• 178% in HP areas

In GP increased testing has not resulted in proportional reduction in positivity

the pool of persons with undiagnosed HIV infections who engage with GP

has not been exhausted

12 Trends in HIV testing outside of traditional services

AcknowledgementsImmunisation, Hepatitis, and Blood Safety department PHEDr Sam Lattimore Dr Sema Mandal Dr Mary Ramsay

Celia Penman Tracey Leach

Participating Sentinel Laboratories: HIV trend dataAshford Hamid Jalal, Melanie Matthews, Rachael Smith. Addenbrookes Hospital, Cambridge

John Croall. Chester Microbiology Laboratory, Countess of Chester Hospital, Chester

Tony Vicca. Diana Princess of Wales Hospital, Grimsby

Valerie Delpech, Jennifer Tosswill Public Health England, London

Janet Mowbray, Erasmus Smit. West Midlands laboratory, Birmingham

David Lewis, Antony Hale. Leeds Teaching Hospitals NHS Trust, Leeds

David Johnson, Mark Zuckerman. Kings College Hospital, London

Alan Blackley, Paul Klapper, Ken Mutton. Manchester Royal Infirmary, Manchester

Matthew Longbone, Mohammed Osman Hassan Ibrahim, Royal Sussex County Hospital, Brighton

Will Irving, Lisa Prichett, Yursi Taha. Queens Medical Centre, Nottingham

Josephine Silles. Middlesex University Hospital, London

Louise Hesketh. Royal Preston Hospital, Preston

Lynne Ashton, Ian Hart. Royal Liverpool Hospital, Liverpool

Mike Kidd, Peter Luton. University College Hospital, London

Mark Baker, James Nash. William Harvey Hospital, Ashford, Kent

13 Trends in HIV testing outside of traditional services