Evaluating a pilot process for reviewing late HIV diagnoses in England and Wales

Abstract

Late HIV diagnosis is associated with signifi cant mortality in people living with HIV (PLWH) and high numbers of missed opportunities (MO) for earlier testing have been identifi ed. A pilot of a national late diagnosis review process (LDRP) was undertaken in 15 HIV services evaluating the feasibility of LDRP implementation, as a patient safety initiative. All newly diagnosed PLWH with CD4 counts <200 cells/mm 3 were included, and healthcare episodes within 5 years of presentation reviewed. Of 127 patients identifi ed, 40 (31.5%) had MO and were more often white, UK-born and suffered more serious harm around diagnosis. Of these, four were designated serious incidents (undergoing root cause analysis) and eight were serious learning events. Engagement with services where MO occurred was challenging, however 75% of services found the LDRP sustainable. Widespread implementation of the LDRP should enable progress with training and policy changes within external services, enabling earlier HIV diagnosis and preventing deaths.

Estimating the risk of mortality attributable to recent late HIV diagnosis following admission to the intensive care unit: A single‐centre observational cohort study

“…We aimed to quantify the risk of in-ICU mortality among people with HIV associated with and attributable to late The persistent problem of late diagnosis and its association with an increased risk of mortality among people with HIV in general is well documented [8,21,22,[34][35][36][37]. A 10-year study using data collected between 1999 and 2008 from a national cohort of people with HIV in England and Wales estimated that 60% of all-cause mortality was attributable to late diagnosis [38].…”

Late diagnosis of HIV in 2022: Why so little change?

“…It is also important to include the experience of medical professionals and their views of things that might help. Two main suggestions from a large BHIVA audit in 2016 were to (i) expand coverage of HIV in medical training and inductions and in grand round discussions and (ii) to expand HIV testing more broadly when commissioning services [16, 17].…”

Tackling late HIV diagnosis: Lessons from the UK in the COVID-19 era

“…Analyses of very late diagnoses in England and Wales found that approximately 60% of missed opportunities for testing occurred in primary care and approximately 30% in secondary care. 57 , 58 In the hospital setting, high staff turnover, competing clinical priorities, and confusion around consenting procedures may contribute to missed opportunities for diagnosis. 55 Peers encouraging best practice and the provision of up-to-date information to physicians via trusted sources (e.g.…”

“… 61 Treating missed opportunities for HIV diagnosis as a patient safety issue in cases of patient death may also facilitate individual and institutional learning. 57 …”

“… 53 However, in a national audit in 2016, 55% of HIV services had not reviewed cases of late diagnosis, owing to there being no clearly defined process, poor access to health record data, concerns about stigma, patient embarrassment or confidentiality, and concerns about apportioning blame. 57 More recently, the BHIVA Late Diagnosis Review Protocol was published ( Figure 3 ). 62 This supports units in assessing whether there were missed opportunities for testing and if the patients were harmed as a result, and whether serious incident review should be performed.…”