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Monitoring HIV testing in diverse healthcare settings: results from a sentinel surveillance pilot study
Emily Tweed1, Antony Hale, Martin Hurrelle
1Immunisation, Hepatitis and Blood Safety Department, Health Protection Agency, Centre for Infections, London, UK. emilytweed43@gmail.com
Insights
Sentinel laboratory surveillance effectively tracks HIV testing patterns. Most tests occur in genitourinary medicine and antenatal clinics, with 60% of positive cases being newly diagnosed.
Area of Science:
- Infectious Disease Epidemiology
- Public Health Surveillance
- Clinical Laboratory Science
Background:
- Understanding human immunodeficiency virus (HIV) testing trends is crucial for public health interventions.
- Sentinel laboratory surveillance offers a potential method for monitoring HIV testing across diverse healthcare settings.
- Current HIV testing is concentrated in specific clinical areas, necessitating broader surveillance strategies.
Purpose of the Study:
- To evaluate the feasibility and utility of sentinel laboratory surveillance for monitoring HIV testing.
- To analyze patterns and trends in HIV testing across various healthcare services.
- To assess the proportion of newly diagnosed HIV cases identified through this surveillance method.
Main Methods:
- Collected and analyzed data on all anti-HIV antibody tests conducted by Leeds Teaching Hospital Trust laboratory over 12 months.
- Demographic information and the location of HIV testing were recorded.
- Positive HIV tests were matched with the national HIV diagnosis database to identify newly diagnosed individuals.
Main Results:
- Over 41,000 individuals were tested for HIV; 0.8% tested positive.
- The majority of tests (77%) were performed in genitourinary medicine (GUM) clinics or antenatal care settings.
- Of those who tested positive, 60% were newly diagnosed with HIV.
Conclusions:
- Sentinel laboratory surveillance provides valuable demographic data and identifies trends in HIV testing.
- Current HIV testing is limited outside of GUM and antenatal services.
- Integrating HIV testing surveillance into existing hepatitis surveillance systems could enable rapid expansion with minimal resources.
Objectives:
To assess the feasibility and utility of sentinel laboratory surveillance of HIV testing as a tool for understanding patterns and trends in HIV testing in a range of healthcare services.
Methods:
Data on all anti-HIV antibody tests carried out by the Leeds Teaching Hospital Trust laboratory over a 12-month period were collated and analysed by demographic information and place of test. Individuals who tested positive were matched to the national database of HIV diagnoses to identify the proportion newly diagnosed with HIV.
Results:
41,013 individuals over 1 year of age were tested at least once for HIV during the study period, of whom 0.8% (n=312) were positive. The majority of individuals (77%) were tested in a genitourinary medicine (GUM) clinic or as part of antenatal care, while routine testing of people undergoing haemodialysis, fertility treatment or occupational health screening accounted for a further 13% of those tested. Few individuals (<4%) were tested in general practice. Of the 312 people testing positive, 286 could be matched to the HIV national database and 173/286 (60%) were identified as newly diagnosed.
Conclusions:
Little HIV testing is currently performed outside GUM and antenatal settings. Monitoring of HIV testing is essential given new guidelines recommending the expansion of testing in a wide range of settings. Sentinel laboratory surveillance can provide useful demographic data on people tested for HIV and can assess trends in testing over time. Data on HIV testing could be incorporated into existing hepatitis sentinel surveillance, allowing rapid scale-up of this surveillance scheme with minimal effort.
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