BackgroundUK guidelines recommend routine HIV testing in healthcare settings if the local diagnosed HIV prevalence >2/1000 persons. This prospective study assessed the feasibility and acceptability, to patients and staff, of routinely offering HIV tests in four settings: Emergency Department, Acute Care Unit, Dermatology Outpatients and Primary Care. Modelling suggested the estimated prevalence of undiagnosed HIV infection in attendees would exceed 1/1000 persons. The prevalence identified prospectively was not a primary outcome.MethodsPermanent staff completed questionnaires assessing attitudes towards routine HIV testing in their workplace before testing began. Subsequently, over a three-month period, patients aged 16–65 were offered an HIV test by study staff. Demographics, uptake, results, and departmental activity were collected. Subsets of patients completed questionnaires. Analyses were conducted to identify factors associated with test uptake.FindingsQuestionnaires were received from 144 staff. 96% supported the expansion of HIV testing, but only 54% stated that they would feel comfortable delivering testing themselves, with 72% identifying a need for training. Of 6194 patients offered a test, 4105 (66·8%) accepted (61·8–75·4% across sites). Eight individuals were diagnosed with HIV (0–10/1000 across sites) and all transferred to care. Younger people, and males, were more likely to accept an HIV test. No significant associations were found between uptake and ethnicity, or clinical site. Questionnaires were returned from 1003 patients. The offer of an HIV test was acceptable to 92%. Of respondents, individuals who had never tested for HIV before were more likely to accept a test, but no association was found between test uptake and sexual orientation.ConclusionsHIV testing in these settings is acceptable, and operationally feasible. The strategy successfully identified, and transferred to care, HIV-positive individuals. However, if HIV testing is to be included as a routine part of patients’ care, additional staff training and infrastructural resources will be required.

The routine offer of HIV testing in general medical services is feasible, but implementation requires training and support for staff, which may be best provided by the local sexual health service.

ObjectivesRoutine HIV testing in nonspecialist settings has been shown to be acceptable to patients and staff in pilot studies. The question of how to embed routine HIV testing, and make it sustainable, remains to be answered. MethodsWe established a service of routine HIV testing in an emergency department (ED) in London, delivered by ED staff as part of routine clinical care. All patients aged 16 to 65 years were offered an HIV test (latterly the upper age limit was removed). Meetings were held weekly and two outcome measures examined: test offer rate (coverage) and test uptake. Sustainability methodology (process mapping; plan-do-study-act (PDSA) cycles) was applied to maximize these outcome measures. ResultsOver 30 months, 44 582 eligible patients attended the ED. The mean proportion offered an HIV test was 14%, varying from 6% to 54% per month over the testing period. The mean proportion accepting a test was 63% (range 33-100%). A total of 4327 HIV tests have been performed. Thirteen patients have been diagnosed with HIV infection (0.30%). PDSA cycles having the most positive and sustained effects on the outcome measures include the expansion to offer blood-based HIV tests in addition to the original oral fluid tests, and the engagement of ED nursing staff in the programme. ConclusionsHIV testing can be delivered in the ED, but constant innovation and attention have been required to maintain it over 30 months. Patient uptake remains high, suggesting acceptability, but time will be required before true embedding in routine clinical practice is achieved.Keywords: HIV testing, Emergency Department, non-specialist settings, sustainability methodology, feasibility, acceptability Accepted 12 June 2013 IntroductionThe UK HIV epidemic is characterized by a high proportion of late-stage diagnoses, and of a persistently high proportion of undiagnosed infections [1]. Guidance from the National Institute for Health and Clinical Excellence follows that from the British Association for Sexual Health and HIV, and the British HIV Association, in calling for more widespread testing, including routine HIV testing in general medical settings in areas where HIV prevalence exceeds 0.2% [2][3][4][5].The HIV Testing in Non-traditional Settings (HINTS) study was one of several Department of Health-funded studies commissioned to evaluate the acceptability, feasibility and effectiveness of implementing these guidelines. Routine HIV testing services were established in four contexts, all in high-prevalence areas in London, UK: an emergency department (ED), an acute assessment unit, an out-patient department, and a primary care centre. Over SHORT COMMUNICATION 6 4 months, 6194 patients were offered HIV tests (51% of all age-eligible patients). The uptake was 67%, with 4105 tests performed. Eight individuals (0.19%) were newly diagnosed with HIV infection and all were transferred to care. Of 1003 questionnaire respondents, the offer of an HIV test was acceptable to 92%. In all settings, additional specialist staff and/or infrastructura...

An opt out BBV testing program in the ED is feasible and effective at finding new cases. However, the testing rate was low at 24%. Although QI interventions led to some improvement in testing rates, further studies are required to identify ways to achieve sustained increases in testing in this setting.

IntroductionBy providing a structured forum to exchange information and ideas, multidisciplinary team meetings improve working relationships, expedite investigations, promote evidence-based treatment, and ultimately improve clinical outcomes.MethodsThis discursive paper reports the introduction of a multidisciplinary team approach to manage hepatobiliary diseases in Jamaica, focusing on the challenges encountered and the methods used to overcome these obstacles.ConclusionDespite multiple challenges in resource-limited environments, a multidisciplinary team approach can be incorporated into clinical practice in developing nations. Policy makers should make it a priority to support clinical, operational, and governance aspects of the multidisciplinary teams.

Nurse led community based GUM services, such as the one provided at the Merseyside Brook Centre, appeal to young people and our success should encourage others to consider similar ventures.

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ObjectiveTo determine the intermediate and long-term survival of patients diagnosed with colorectal cancer (CRC) and to determine factors that affect survival.MethodPatients were identified from a prospectively maintained colonoscopy database. All patients who underwent colonoscopy during the period January 2008 to December 2012 and had histologically confirmed invasive carcinoma were included. These patients were contacted at the end of 2013 to determine their survival status. In addition to demographics, variables analyzed included presenting complaint and tumor site and stage at presentation.ResultsOf 1757 patients being subjected to colonoscopy, 118 had endoscopic and histologic documentation of invasive CRC. Of these the survival status of 102 was determined as of December 2013 and they formed the basis of our study. The mean age of the group was 62 years with approximately 20% of the group being age 50 years or younger. Females (54%) slightly outnumbered males. Anemia or overt rectal bleeding was a dominant indication (44%) and 65% of the tumours were left sided. There were 58 (57%) deaths and the median overall survival time was two years post diagnosis. Log rank tests for equality of survivorship looking at age, gender, tumor site and presentation revealed that only presenting complaint was a predictor of survivorship (p < 0.001). Patients presenting with bleeding or anemia have the best survival.ConclusionsLong-term survival from colorectal cancer remains poor with only about 33% of patients being alive five years after their diagnosis.