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Boardman E, Boffito M, Chadwick DR, Cheserem E, Kabagambe S, Kasadha B, Elliott C. Tackling late HIV diagnosis: Lessons from the UK in the COVID-19 era. Int J STD AIDS 2024; 35:244-253. [PMID: 38016099 PMCID: PMC10908195 DOI: 10.1177/09564624231202287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Late diagnosis of HIV is associated with increased morbidity and mortality, and an increased risk of non-infectious comorbidities. On a societal level, late diagnosis leads to higher treatment and healthcare costs and is a major driver of HIV transmission. Despite improvements in other areas of the HIV care pathway, late diagnosis remains an individual and public health concern globally. OBJECTIVE To examine the barriers to HIV testing and highlight successful strategies to improve prompt diagnosis. This review describes the prevalence of late diagnosis in the UK and discusses key factors that contribute to late diagnosis, including the effect of the COVID-19 pandemic. Late HIV diagnosis is lower in the UK than in most other European countries. In this review, pilot projects and ongoing initiatives that have reduced late diagnosis in the UK are highlighted; moreover, further strategies for improving prompt diagnosis are suggested. CONCLUSIONS Insufficient testing is the fundamental reason for late HIV diagnosis, with societal, systemic, and individual factors all contributing to inadequate testing. Improving access to testing, removing barriers to health-seeking behaviour, and ensuring all people with HIV indicator conditions are promptly tested are key to reducing the rates of late diagnosis globally.
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Affiliation(s)
- Emily Boardman
- The Northern Contraception, Sexual Health and HIV Service, Manchester Royal Infirmary, Manchester, UK
| | - Marta Boffito
- Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
| | | | | | | | - Bakita Kasadha
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Bakewell N, Kanitkar T, Dissanayake O, Symonds M, Rimmer S, Adlakha A, Lipman MC, Bhagani S, Agarwal B, Miller RF, Sabin CA. Estimating the risk of mortality attributable to recent late HIV diagnosis following admission to the intensive care unit: A single-centre observational cohort study. HIV Med 2022; 23:1163-1172. [PMID: 36404292 PMCID: PMC10099479 DOI: 10.1111/hiv.13436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/18/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Despite improvements in survival of people with HIV admitted to the intensive care unit (ICU), late diagnosis continues to contribute to in-ICU mortality. We quantify the population attributable fraction (PAF) of in-ICU mortality for recent late diagnosis among people with HIV admitted to a London ICU. METHODS Index ICU admissions among people with HIV were considered from 2000 to 2019. Recent late diagnosis was a CD4 T-cell count < 350 cells/μL and/or AIDS-defining illness at/within 6 months prior to ICU admission. Univariate comparisons were conducted using Wilcoxon rank-sum/Cochran-Armitage/χ2 /Fisher's exact tests. We used Poisson regression (robust standard errors) to estimate unadjusted/adjusted (age, sex, calendar year of ICU admission) risk ratios (RRs) and regression standardization to estimate the PAF. RESULTS In all, 207 index admissions were included [median (interquartile range) age: 46 (38-53) years; 72% male]; 58 (28%) had a recent late diagnosis, all of whom had a CD4 count < 350 cells/μL, and 95% had advanced HIV (CD4 count < 200 cells/μL and/or AIDS at admission) as compared with 57% of those who did not have a recent late diagnosis (p < 0.001). In-ICU mortality was 27% (55/207); 38% versus 22% in those who did and did not have a recent late diagnosis, respectively (p = 0.02). Recent late diagnosis was independently associated with increased in-ICU mortality risk (adjusted RR = 1.75) (95% confidence interval: 1.05-2.91), with 17.08% (16.04-18.12%) of deaths being attributable to this. CONCLUSIONS There is a need for improved public health efforts focused on HIV testing and reporting of late diagnosis to better understand potentially missed opportunities for earlier HIV diagnosis in healthcare services.
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Affiliation(s)
- Nicholas Bakewell
- Institute for Global Health, University College London, London, UK.,National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections, University College London, London, UK
| | - Tanmay Kanitkar
- Intensive Care Unit, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK.,HIV services, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Oshani Dissanayake
- HIV services, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Maggie Symonds
- HIV services, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Stephanie Rimmer
- Intensive Care Unit, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Amit Adlakha
- Intensive Care Unit, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Marc C Lipman
- HIV services, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK.,UCL Respiratory, Division of Medicine, University College London, London, UK.,Respiratory Medicine, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Sanjay Bhagani
- HIV services, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Banwari Agarwal
- Intensive Care Unit, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Robert F Miller
- HIV services, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK.,Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK
| | - Caroline A Sabin
- Institute for Global Health, University College London, London, UK.,National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections, University College London, London, UK
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