P224 Missed Opportunities and cost implications in a HIV low prevalence region in the UK

Abstract

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.