Screening for HIV in patients with tuberculosis (TB) is essential, as HIV/TB co-infection has an adverse prognosis. We compared HIV testing practices in 2005 and 2008/09 in the Birmingham and Solihull region of the UK and evaluated the trends before and after the implementation of the British HIV Association (BHIVA) HIV testing guidelines (2008). A total of 371 TB patients in 2005 and 407 in 2008/09 were included. Demographics across both cohorts were similar. HIV testing increased from 14% in 2005 to 43% in 2008/09. Patients aged ≥55 years and Asian patients were less likely to be tested in 2005 and those aged ≥35 years in 2008/09. An increased rate of HIV testing was seen in all patient categories in 2008/09 compared with 2005. The odds of being tested was high in black African patients (compared with white ethnicity) in both years and increased among black Africans and African Caribbeans between both time points, albeit with wide confidence intervals (CIs). No significant difference in HIV testing was found in 2008/09 before and after the publication of the BHIVA guidelines. This study underlines the importance of continued efforts to minimize the significant gaps in HIV testing rates in TB services.
Background/introductionMissed opportunities is a leading cause for late presentation in HIV.Aim(s)/objectivesWe analysed missed opportunities, clinical outcomes and associated cost in a HIV low prevalence region in UK.MethodsA retrospective review of case notes and pathology system of new HIV diagnosis from 2010 to 2013 was undertaken. Clinical summary preceding 12 months of diagnosis collected from GPs with patient’s consent. Data analysed using Excel workbook.ResultsOut of 25 new HIV diagnosis,17 males, 21 white ethnicity, 10 heterosexual and 6 bisexual. One third > 40 years. Sixteen (64%) were late diagnosis with CD4 < 350. 13/16 had CD4 < 200 and 9/16 (56%) had an AIDS defining illness. 19/25 (76%) had atleast one missed opportunity (range 1–16). 11/19 in primary care and remaining at different levels.There was no difference in VL between early and late diagnosis. 10/16 had a blood test in the preceding 12 months. In the first 12 months post diagnosis, early group had 51 clinical consultation compared to 147 in late group. Three patients had extended inpatient stay in the late group.One died. Using Reference costs of around £385, late diagnosis costed £ 56595 compared to £19635 for early excluding inpatients cost, excess bed days, additional outpatient investigations, medications including ARVS and other specialty referral costs.Discussion/conclusionOur study shows increased missed opportunities in apparently non high-risk groups resulting in poor outcomes and significant costs. Higher HIV awareness and national testing policy tailored to HIV low prevalence region is required.
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