a prioritisation tool for hiv testing in primary care in leeds
DESCRIPTION
A prioritisation tool for HIV testing in primary care in Leeds. Duncan Cooper, Owen Brigstock-Baron, Brenda Fullard and Richard Dixon - NHS Leeds Antony Hale – Leeds Teaching Hospital Trust Leena Inamdar – West Yorkshire Health Protection Unit June 2012. Late diagnosis of HIV infection. - PowerPoint PPT PresentationTRANSCRIPT
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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
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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
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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
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Epidemiology - Mixed picture
Rate of new diagnoses Probable infection route of
new diagnoses25-43yrs
35-44yrs
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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
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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
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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
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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
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HIV rate per 1,000 in Leeds (2010) [based on number of HIV+ patients accessing care]
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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
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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
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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
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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
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Learning points• Multi-agency working• Data – very dirty - previously unused for this
purpose• Multiple formats• Slow burner (worked between training
locations)