Reducing late HIV diagnoses in London

Reducing late HIV diagnoses in London Dr Alison Brown 26th November 2010

New report!

Number of new HIV diagnoses1 by prevention group, UK: 2000-2009 1 Data are adjusted for missing route of infection 2 Includes Mother to child transmission and blood product recipient HIV and AIDS New Diagnoses and Deaths

Diagnosed HIV-infected individuals seen for care by age group, UK: 2000-2009 • Excludes individuals with age not reported, 5 in 2000 and 0 in 2009. Annual survey of HIV-infected persons accessing care

Estimated number of adults (15-59 years) living with HIV (both diagnosed and undiagnosed) in the UK: 2009 T credible interval −

Late and very late HIV diagnoses

Why the focus on late HIV diagnoses? • Prompt diagnosis: • Reduces risk of AIDS and death • PREVENTION: reduces onwards transmission • Behaviour • Treatment • Undiagnosed HIV infection • reduce lengthy inpatient stays In 2009, 516 HIV-infected people died, of these, 73% had been diagnosed late.

HIV prevention indicator • Each PCT to reduce late diagnosis of HIV to 15% by 2010-11 • Definition: CD4<200 within 91 days of diagnosis • Baseline: average of late diagnoses for 2004-05 to increase numbers • Baseline of 34% means a halving of late diagnoses across London • Data collected and analysed by the HPA for NHS London • No differential targets by ethnic group/risk group

London: very late HIV diagnoses

Prevalence of diagnosed HIV infection, London: 2009 BHIVA testing guidelines: PCT where diagnosed HIV prevalence >0.2% should extend HIV testing beyond GUM settings

Pilot projects • Evaluation: feasibility; acceptability; cost effectiveness; efficacy. • 8 projects funded: • Primary care • Hospital settings • Community settings • Key findings: • The offer and recommendations of HIV tests is feasible and acceptable • Total of 50 HIV-infected persons newly diagnosed

Clinical outcomes Four outcomes have been developed to monitor key aspects of treatment and care: Outcome 1 - time between HIV diagnosis & the patient being integrated in to HIV care Outcome 2 - effectiveness of HIV therapy after one year treatment Outcome 3 - disease stage of patients after one year in HIV related care Outcome 4 - survival of patients recently diagnosed, adjusted by disease stage at diagnosis

Outcome 1: length of time from HIV diagnosis date to first CD4 count

London results: 2008 Outcome two: 85% of patients starting ART in 2007 had an undetectable viral load in 2008 Outcome three: 94% of patients receiving care for at least one year had a CD4 count ≥200 cells in 2008 Outcome four: Between 2005-8, 4.3% of patients diagnosed with a CD4 count<200 cells died within one year of diagnosis

Summary • Late and very late HIV diagnoses continue to be major challenge in the UK • Groups at highest risk of late diagnoses are black African heterosexuals, particularly men • Testing in non-traditional settings is feasible and acceptable • Import to ensure pathways into care.

Thank you

Reducing late HIV diagnoses in London