A prioritisation tool for HIV testing in primary care in Leeds
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Transcript of A prioritisation tool for HIV testing in primary care in Leeds
A prioritisation tool for HIV testing in primary care in Leeds
Duncan Cooper, Owen Brigstock-Baron, Brenda Fullard and Richard Dixon - NHS LeedsAntony Hale – Leeds Teaching Hospital TrustLeena Inamdar – West Yorkshire Health Protection Unit
June 2012
Late diagnosis of HIV infectionIn the UK c24% of those living with HIV remain undiagnosed
40% of new cases have a late diagnosis (CD4count<350mm3) – [65% for the Black African community]
Late diagnosis leads to:poorer health and treatment outcomesincreased mortality in those with HIV infectionincreased likelihood of onward transmission
New diagnoses of HIV in Leeds (2005 – 2010)
0
40
80
120
160
2005 2006 2007 2008 2009 2010Year
Nu
mb
er
of
ne
w
dia
gn
os
is
Epidemiology - Mixed picture
Rate of new diagnoses Probable infection route of
new diagnoses25-43yrs
35-44yrs
Barriers to HIV testing
Patient: • Poor awareness of risk• Fear of + result• Fears over confidentiality• Fear of deportation/criminal
charges
Professional: • Concerns over appearing
judgemental• Fear of giving positive result • Incorrect perception of a
patient’s risk• Lack of time/resources
Organisational• Lack of incentives to offer test• No formal national targets• Financial constraints
Community• Stigma
NICE guidance 2011
Two pieces of NICE public health guidance were published in March 2011:
[1] Increasing uptake of HIV uptake among Black Africans in England[2] Increasing uptake of HIV uptake among men who have sex with men
Recommended:
- ‘Normalising’ HIV testing- Increase amount/regularity of testing within high risk groups- Increasing health care settings within which tests are offered
NICE guidance 2011
Threshold for increasing HIV testing“in areas with a HIV prevalence of above 2 per 1,000 all new primary care registrations and general medical admissions should be offered an HIV test, as well as anyone who has a blood test (regardless of the reason)”.
Leeds has a HIV prevalence of 1.4 per 1000
HIV rate per 1,000 in Leeds (2010) [based on number of HIV+ patients accessing care]
Data analysis1. Take data about HIV tests from LTHT laboratory2. Clean the data3. Calculate HIV test rates by GP practice4. Compare against underlying HIV prevalence
using HPA data using a GIS
Rank practices from low to high ‘testers’ for all high prevalence practices
Leeds GP practices in areas of high HIV prevalence - ranked by HIV test rates *
GP Code CCG Practice
Branch surgery
Number HIV tests
2008-2010
Adult population 15-65 yrs
HIV tests per 1000
pop 2008-2010
% Black African
population †
B00001 Leodis ############ Main Surgery 0 4,809 0.0 1.9
B00002 Leodis ############ Main Surgery 2 1,360 0.5 1.5
B00003 Calibre ############ Main Surgery 3 1,321 0.8 29.6
B00004 Leodis ############ Main Surgery 3 992 1.0 1.5
B00005 Leodis ############ Main Surgery 4 1,269 1.1 8.2
B00006 Leodis ############ Main Surgery 8 2,105 1.3 8.2
B00007 Calibre ############ Main Surgery 8 1,544 1.7 29.6
B00008 Leodis ############ Main Surgery 27 5,155 1.7 1.5
B00009 Calibre ############ Branch Surgery 45 8,361 1.8 8.2
B00010 H3 ############ Main Surgery 47 8,058 1.9 1.9
B00002 Leodis ############ Main Surgery 24 4,090 2.0 1.5
B00003 Leodis ############ Main Surgery 10 1,593 2.1 1.9
B00004 Calibre ############ Branch Surgery 26 4,139 2.1 16.7
B00005 - ############ - 24 3,796 2.1 -
B00006 Leodis ############ Main Surgery 7 1,068 2.2 4.6
B00007 Calibre ############ Main Surgery 45 6,720 2.2 14.7
B00008 H3 ############ Main Surgery 51 7,236 2.3 14.7
B00009 Leodis ############ Main Surgery 17 1,987 2.9 13.0
B00010 H3 ############ Main Surgery 60 5,996 3.3 1.9
B00011 Leodis ############ Main Surgery 22 2,194 3.3 2.8
B00012 Leodis ############ Main Surgery 22 2,137 3.4 13.0
B00013 Leodis ############ Main Surgery 14 1,294 3.6 1.9
B00014 Calibre ############ Main Surgery 49 4,481 3.6 29.6
B00015 Leodis ############ Main Surgery 89 8,056 3.7 1.6
B00016 Calibre ############ Main Surgery 47 4,153 3.8 0.7
B00017 Leodis ############ Main Surgery 86 7,495 3.8 4.6
B00018 Calibre ############ Main Surgery 31 2,689 3.8 29.6
B00003 Leodis ############ Main Surgery 28 2,335 4.0 16.7
B00004 Leodis ############ Main Surgery 45 3,087 4.9 3.3
B00005 Calibre ############ Main Surgery 65 4,238 5.1 29.6
B00006 Calibre ############ Main Surgery 22 1,431 5.1 29.6
B00007 Leodis ############ Branch Surgery 105 6,216 5.6 1.6
B00008 Leodis ############ Main Surgery 49 2,663 6.1 0.5
B00009 Calibre ############ Main Surgery 97 5,107 6.3 14.7
B00010 H3 ############ Main Surgery 842 37,500 7.5 14.7
B00011 Calibre ############ Main Surgery 94 4,142 7.6 29.6
B00012 Calibre ############ Main Surgery 283 7,729 12.2 1.5
B00013 Leodis ############ Main Surgery 85 521 54.4 1.5
X00001 #N/A ############ Main Surgery 16 29.6
X00002 #N/A ############ - 12 -
X00003 #N/A ############ - 10 -
X00004 #N/A ############ - 25 -
X00005 #N/A ############ - 44 -
X00006 #N/A ############ - 36 -
X00007 #N/A ############ - 2 -
X00008 #N/A ############ - 1 -
* This table displays Leeds practices located in high prevalence geographical areas rather than practices with high prevalence practice lists.>10%
† Black African population data from UK Census 2001 (Black, Black British, Black African or Black other)
LOW
HIV
TE
ST
RA
TE
ME
DIU
M H
IV T
ES
T R
AT
EH
IGH
HIV
TE
ST
RA
TE
Leeds GP practices in areas of high HIV prevalence - ranked by HIV test rates *
GP Code CCG Practice
Branch surgery
Number HIV tests
2008-2010
Adult population 15-65 yrs
HIV tests per 1000
pop 2008-2010
% Black African
population †
B00001 Leodis ############ Main Surgery 0 4,809 0.0 1.9
B00002 Leodis ############ Main Surgery 2 1,360 0.5 1.5
B00003 Calibre ############ Main Surgery 3 1,321 0.8 29.6
B00004 Leodis ############ Main Surgery 3 992 1.0 1.5
B00005 Leodis ############ Main Surgery 4 1,269 1.1 8.2
B00006 Leodis ############ Main Surgery 8 2,105 1.3 8.2
B00007 Calibre ############ Main Surgery 8 1,544 1.7 29.6
B00008 Leodis ############ Main Surgery 27 5,155 1.7 1.5
B00009 Calibre ############ Branch Surgery 45 8,361 1.8 8.2
B00010 H3 ############ Main Surgery 47 8,058 1.9 1.9
B00002 Leodis ############ Main Surgery 24 4,090 2.0 1.5
B00003 Leodis ############ Main Surgery 10 1,593 2.1 1.9
B00004 Calibre ############ Branch Surgery 26 4,139 2.1 16.7
B00005 - ############ - 24 3,796 2.1 -
B00006 Leodis ############ Main Surgery 7 1,068 2.2 4.6
B00007 Calibre ############ Main Surgery 45 6,720 2.2 14.7
B00008 H3 ############ Main Surgery 51 7,236 2.3 14.7
B00009 Leodis ############ Main Surgery 17 1,987 2.9 13.0
B00010 H3 ############ Main Surgery 60 5,996 3.3 1.9
B00011 Leodis ############ Main Surgery 22 2,194 3.3 2.8
B00012 Leodis ############ Main Surgery 22 2,137 3.4 13.0
B00013 Leodis ############ Main Surgery 14 1,294 3.6 1.9
B00014 Calibre ############ Main Surgery 49 4,481 3.6 29.6
B00015 Leodis ############ Main Surgery 89 8,056 3.7 1.6
B00016 Calibre ############ Main Surgery 47 4,153 3.8 0.7
B00017 Leodis ############ Main Surgery 86 7,495 3.8 4.6
B00018 Calibre ############ Main Surgery 31 2,689 3.8 29.6
B00003 Leodis ############ Main Surgery 28 2,335 4.0 16.7
B00004 Leodis ############ Main Surgery 45 3,087 4.9 3.3
B00005 Calibre ############ Main Surgery 65 4,238 5.1 29.6
B00006 Calibre ############ Main Surgery 22 1,431 5.1 29.6
B00007 Leodis ############ Branch Surgery 105 6,216 5.6 1.6
B00008 Leodis ############ Main Surgery 49 2,663 6.1 0.5
B00009 Calibre ############ Main Surgery 97 5,107 6.3 14.7
B00010 H3 ############ Main Surgery 842 37,500 7.5 14.7
B00011 Calibre ############ Main Surgery 94 4,142 7.6 29.6
B00012 Calibre ############ Main Surgery 283 7,729 12.2 1.5
B00013 Leodis ############ Main Surgery 85 521 54.4 1.5
X00001 #N/A ############ Main Surgery 16 29.6
X00002 #N/A ############ - 12 -
X00003 #N/A ############ - 10 -
X00004 #N/A ############ - 25 -
X00005 #N/A ############ - 44 -
X00006 #N/A ############ - 36 -
X00007 #N/A ############ - 2 -
X00008 #N/A ############ - 1 -
* This table displays Leeds practices located in high prevalence geographical areas rather than practices with high prevalence practice lists.>10%
† Black African population data from UK Census 2001 (Black, Black British, Black African or Black other)
LOW
HIV
TE
ST
RA
TE
ME
DIU
M H
IV T
ES
T R
AT
EH
IGH
HIV
TE
ST
RA
TE
Application• Prioritisation and surveillance tool for primary
care HIV testing, used to inform:– Training for GPs (STIF training)– Circulated to CCGS / evidence for commissioning– GP attitude survey– Input to cost-benefit analysis– Inform on-going HIV surveillance in Leeds
Learning points• Multi-agency working• Data – very dirty - previously unused for this
purpose• Multiple formats• Slow burner (worked between training
locations)