Missed opportunities for HIV testing--a costly oversight

Area of Science:

• Medical Research
• Public Health
• Virology

Background:

• One-third of individuals with human immunodeficiency virus (HIV) in the UK are undiagnosed, with a similar proportion diagnosed at a late stage.
• National guidelines recommend HIV testing across all medical specialties to address this public health issue.

Purpose of the Study:

• To investigate HIV testing patterns in an inner London area with high HIV prevalence.
• To identify missed opportunities for HIV testing and their consequences within the healthcare system.

Main Methods:

• A review of all human immunodeficiency virus (HIV) tests conducted in 2008 at Guys and St Thomas' NHS Trust.
• Stratification of tests by location of request and case-note review for hospital diagnoses outside genitourinary medicine (GUM) or screening settings.

Main Results:

• Out of 40,883 HIV tests, 354 (1%) were positive. In non-GUM/screening settings, 2.8% of inpatients, 0.3% of outpatients, and 1.12% of primary care patients tested positive.
• Of 46 evaluable hospital diagnoses, 19 patients presented within the previous year with an HIV indicator condition but were not tested.
• The mean inpatient admission cost for diagnosed HIV was £36,625, with a total cost of £439,500 for 12 patients tested late despite prior healthcare contact.

Conclusions:

• Despite high HIV test volumes in GUM and antenatal settings, testing is infrequent in other specialties, incurring significant costs.
• Missed opportunities to test individuals with HIV in various healthcare settings are a major concern.
• Urgent engagement of primary, secondary, and tertiary healthcare systems is needed to increase HIV testing and prevent late-stage diagnoses.