Suite managers should keep a procedure room to endoscopist ratio between 1:1 and 2:1 while considering the utilization of related key resources as a decision factor as well. The sensitivity of the system to processes such as turnaround time should be evaluated before improvement efforts are made.

1Objectives: Tenofovir disoproxil fumarate (TDF) is widely used in the treatment or prevention of HIV 2 and hepatitis B infection. TDF may cause renal tubulopathy in a small proportion of recipients. We 3 aimed to study the risk factors for developing severe renal tubulopathy. 4 Methods:We conducted an observational cohort study with retrospective identification of cases of 5 treatment-limiting tubulopathy during TDF exposure. We used multivariate Poisson regression 6 analysis to identify risk factors for tubulopathy, and mixed effects models to analyse adjusted 7 estimated glomerular filtration rate (eGFR) slopes. 8

Results of a community HIV testing pilot (fasTest) targeting men who have sex with men (MSM) in Brighton are reported and service users are compared with those testing in genitourinary medicine (GUM) clinics. FasTest offers rapid HIV testing in a weekly evening drop-in session staffed by GUM professionals in a community organisation. It was prospectively evaluated from November 2004 to March 2006 using a self-completed paper questionnaire assessing demographics, previous use of GUM, HIV testing history and sexual behaviour. Follow-up through GUM/HIV services was monitored. A simplified questionnaire was completed by MSM accessing the GUM clinic over the same time period. Men were included in the analysis if they identified as gay or bisexual or had recent sex with a man, tested for HIV and received a result. In both the fastest and GUM groups, men reported high rates of unprotected anal sex in the last 3 months. fasTest clients were significantly younger and less likely to test positive for HIV. This difference was independent of age and HIV testing history. There was no difference in rates of recent infection between the two. We conclude that community HIV testing is feasible and reaches the target group of high risk MSM.

Following changes in national antiretroviral therapy (ART) guidelines removing the CD4 threshold for initiation of ART, we evaluated the time to ART initiation and reasons for delayed or non-initiation. A retrospective notes review of 292 newly diagnosed HIV-positive individuals attending two London clinics between August 2015 and December 2016 was performed. Two hundred and fifty-four of 292 (87%) individuals started ART. Median time to ART initiation was 29 days (range: 0–514). Thirty of 292 (13%) did not start ART. Rates of virological suppression at six months were similar regardless of time to ART initiation. People who inject drugs (16.7% vs. 3.6%) (p = 0.009), having a higher median baseline CD4 cell count (500 vs. 388 cells/mm3, p = 0.001), and having gastrointestinal/liver co-morbidities (23% vs. 9%, p = 0.001) were associated with delayed ART initiation. The cohort not on ART had a higher median baseline CD4 cell count (500 vs. 388 cells/mm3, p < 0.001). Documented reasons for delayed or ART non-initiation included patient’s choice, prolonged adjustment periods, and difficulty leaving work. We conclude that delayed or non-initiation of ART was associated with injecting drug use and prolonged adjustment to a new HIV diagnosis. Clinician factors may include lack of urgency with higher baseline CD4 cell counts. Improved linkage to care and drug services pathways may encourage timely ART initiation.