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Missed opportunities for HIV diagnosis: a three-year audit in the West of Scotland
D Brawley1, A MacConnachie, R Nandwani
1NHS Greater Glasgow & Clyde, Brownlee Centre, Gartnavel General Hospital, UK. dbrawley@nhs.net
Insights
Many patients diagnosed with HIV had prior indicators for testing, suggesting missed opportunities. Improved adherence to HIV testing guidelines is crucial to prevent late diagnoses and associated health risks.
Area of Science:
- Public Health
- Infectious Diseases
- Clinical Medicine
Background:
- National guidelines exist to improve early HIV diagnosis and reduce late presentations.
- Late diagnosis of HIV infection poses significant individual and public health challenges.
Purpose of the Study:
- To audit new HIV diagnoses in Glasgow to assess adherence to national testing guidelines.
- To estimate the proportion of patients with HIV who experienced missed opportunities for earlier diagnosis.
Main Methods:
- A retrospective review of 339 patients diagnosed with HIV between September 2008 and September 2011.
- Assessed medical history for clinical indicator conditions and prior medical reviews before HIV diagnosis.
Main Results:
- 26% of patients had a documented clinical indicator for HIV testing prior to diagnosis.
- These patients had lower CD4 counts, were more likely to be severely immunocompromised, and had higher rates of AIDS-defining illnesses and HIV-related mortality.
- 80% of those with indicator conditions had prior contact with medical services, highlighting missed opportunities.
Conclusions:
- Adherence to HIV testing guidelines requires improvement in both primary and secondary care settings.
- Enhanced training and support are necessary to ensure timely HIV diagnosis.
- Preventing late presentation is essential for better patient outcomes and public health.
Background:
National specialty guidelines for HIV testing aim to increase diagnosis and reduce late presentation. An audit of new HIV diagnoses in Glasgow was performed to assess local performance against these guidelines and estimate the proportion of patients presenting who had previous missed opportunities for diagnosis.
Methods:
A retrospective case note review of 339 patients diagnosed from September 2008 to September 2011 was performed. Documented past medical history was assessed for HIV clinical indicator conditions prior to HIV diagnosis and prior review by medical services.
Results:
Ninety (26%) individuals had at least one documented clinical indicator condition prior to HIV diagnosis, of whom 80 had prior contact with at least one speciality. This group also had a lower mean nadir CD4 count (258 cells/cmm versus 393 cells/cmm, p = <0.005) and were more likely to be severely immunocompromised at diagnosis, with a CD4 count below 50 cells/cmm (31% versus 9%, p = <0.005). AIDS-defining illnesses were also more common (31% versus 8%, p ≤ 0.005) as was HIV-related mortality (p ≤ 0.005).
Conclusion:
Additional support and training are required to increase adherence to HIV-testing guidelines within primary and secondary care in order to prevent ongoing late presentation with both individual clinical and public health implications.
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