Does general practice deliver safe primary care to people living with HIV? A case-notes review

Wellesley, Rosie; Whittle, A. M.; Figueroa, José Natal; Anderson, Jane; Castles, Richard; Boomla, Kambiz; Griffiths, Chris; Leber, Werner

doi:10.3399/bjgp15x686905

Cited by 9 publications

(12 citation statements)

References 17 publications

(30 reference statements)

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“…However, not all patients will disclose to their GP, favouring their HIV service as their primary access point for health care. This, coupled with problems associated with lack of knowledge around ART usage and co‐prescribing and suboptimal two‐way communication between HIV services and primary care , may limit the success of relying fully on primary care to take on these roles, especially as there is no consensus on shared‐care models , which are currently rare in the UK and, where present, are often ad hoc and locality‐driven rather than formally commissioned, mostly in areas of high prevalence .…”

Section: Discussionmentioning

confidence: 99%

Specialist care of older adults with HIV infection in the UK: a service evaluation

Cresswell

Levett

2017

HIV Medicine

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We identified two existing and three proposed HIV ageing services. Another 20 clinics (20%) reported an unmet need for a specialist ageing service, suggesting that complex older adults may pose a management challenge. This is the first survey of its kind to attempt to describe the current landscape and opinion around such services. HIV-infected cohorts will continue to age and current models of care may be insufficient, which should prompt services, their users and commissioners to consider what models may best fit current and future demand.

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Section: Discussionmentioning

confidence: 99%

Specialist care of older adults with HIV infection in the UK: a service evaluation

Cresswell

Levett

2017

HIV Medicine

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“…The strongest associations with HIV infection were seen for syphilis, gonorrhoea, hepatitis B/C and condyloma acuminata. The most common conditions associated with immunosuppression in individuals with HIV infection were pneumonia [17,20,31,35,37-46, 48-51,53,54,81-84], oral/oesophageal candidiasis [17,20,23,31,35,39,40,42,44,47,[49][50][51]83], Kaposi sarcoma [31,39,[42][43][44][45][46], lymphoma and non-Hodgkins lymphoma (NHL) [22,23,31,43], wasting syndrome [17,20,42] and cervical dysplasia/cervical cancer [17,20,22,23,35,45,47]. The conditions most strongly associated with immunosuppression were pneumonia, (incl, pneumocystis jiroveci pneumonia and bacterial pneumonia), oral candidiasis/candida oesophagitis, wasting syndrome and cytomegalovirus.…”

Section: Discussionmentioning

confidence: 99%

Use and Effectiveness of HIV Indicator Conditions in Guiding HIV Testing: A Review of the Evidence

Davies

Gompels

May

2017

ISRR

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Aims: To identify the most commonly reported HIV indicator conditions (HIV ICs) found in or associated with HIV infection and to review interventions incorporating HIV ICs to aid or guide offering of an HIV test and discuss their effectiveness in increasing HIV testing rates and diagnosing new cases of HIV-infection. Methodology: The following electronic databases were searched; OVID Medline, Google, Web of Science and PubMed. We included studies conducted in high income countries within the adult population (>18yrs of age) that were published in the era of combination antiretroviral therapy between 1996 and 2016. We excluded studies relating to HIV testing or screening of pregnant women. Results: We identified 42 studies investigating ICs associated with HIV infection either prior to or after diagnosis within primary, secondary and tertiary care settings. The most common ICs and symptoms associated with HIV infection were; sexually transmitted infections (syphilis, chlamydia, gonorrhoea and condyloma acuminata) and blood borne viruses (Hepatitis C and Hepatitis B),

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“…However, the number of both trial intervention (n=13) and control (n=15) practices was comparable, suggesting equal exposure to this audit across both arms. 22 Although public health teams informally collaborate across Northeast London, crossover between boroughs is unlikely given that services are developed and budgeted separately. Our analysis will adjust for any potential contamination using various vertical and horizontal controls both within Hackney, as well as between boroughs using Newham, which has been devoid of any local service HIV promotional intervention, as control.…”

Section: Discussionmentioning

confidence: 99%

“… General practice-based HIV care audit (October 2012 to March 2013) of missed diagnoses of HIV and safety of coprescribing with antiretroviral medication in Hackney general practices. 22 …”

Section: Methods and Analysismentioning

confidence: 99%

Effectiveness and cost-effectiveness of implementing HIV testing in primary care in East London: protocol for an interrupted time series analysis

et al. 2017

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IntroductionHIV remains underdiagnosed. Guidelines recommend routine HIV testing in primary care, but evidence on implementing testing is lacking. In a previous study, the Rapid HIV Assessment 2 (RHIVA2) cluster randomised controlled trial, we showed that providing training and rapid point-of-care HIV testing at general practice registration (RHIVA2 intervention) in Hackney led to cost-effective, increased and earlier diagnosis of HIV. However, interventions effective in a trial context may be less so when implemented in routine practice. We describe the protocol for an MRC phase IV implementation programme, evaluating the impact of rolling out the RHIVA2 intervention in a post-trial setting. We will use a longitudinal study to examine if the post-trial implementation in Hackney practices is effective and cost-effective, and a cross-sectional study to compare Hackney with two adjacent boroughs providing usual primary care (Newham) and an enhanced service promoting HIV testing in primary care (Tower Hamlets).Methods and analysisService evaluation using interrupted time series and cost-effectiveness analyses. We will include all general practices in three contiguous high HIV prevalence East London boroughs. All adults aged 16 and above registered with the practices will be included. The interventions to be examined are: a post-trial RHIVA2 implementation programme (including practice-based education and training, external quality assurance, incentive payments for rapid HIV testing and incorporation of rapid HIV testing in the sexual health Local Enhanced Service) in Hackney; the general practice sexual health Network Improved Service in Tower Hamlets and usual care in Newham. Coprimary outcomes are rates of HIV testing and new HIV diagnoses.Ethics and disseminationThe chair of the Camden and Islington NHS Research Ethics Committee, London, has endorsed this programme as an evaluation of routine care. Study results will be published in peer-reviewed journals and reported to commissioners.

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Does general practice deliver safe primary care to people living with HIV? A case-notes review

Abstract: Background

Cited by 9 publications

References 17 publications

Specialist care of older adults with HIV infection in the UK: a service evaluation

Specialist care of older adults with HIV infection in the UK: a service evaluation

Use and Effectiveness of HIV Indicator Conditions in Guiding HIV Testing: A Review of the Evidence

Effectiveness and cost-effectiveness of implementing HIV testing in primary care in East London: protocol for an interrupted time series analysis

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