Human immunodeficiency virus (HIV) is a major global health concern which has resulted in an estimated 39 million deaths world-wide. Although it is now a treatable medical condition there is still avoidable morbidity and mortality associated with HIV infection in the UK. Late diagnosis (CD4 count of \<350 cells/mm3 or AIDS-defining illness irrespective of CD4 count) is associated with increased morbidity and mortality, increased risk of transmission, impaired response to antiretroviral therapy and increased healthcare costs. In Grampian, 49% of patients were diagnosed late between 1984 and 2011. Therefore, the aim of the study is to determine the factors associated with late HIV diagnosis in Grampian between 2009 and 2014 to ascertain whether diagnoses could have been made earlier. The study constitutes a secondary data analysis. Individuals newly diagnosed with HIV between January 2009 and December 2014 were identified from a Health Protection Scotland (HPS) database. The majority of outcome data were extracted from the existing HPS database. Missing data were collected via a retrospective review of patient case-notes, laboratory reports and an electronic patient management system. Patients were classified as early or late diagnosis and comparisons were made between the groups using statistical tests. The study sought to provide a basis for recommendations for improvement of information and services to facilitate earlier HIV diagnosis in Grampian.
Study Type
OBSERVATIONAL
Enrollment
124
NHS Grampian
Aberdeen, Aberdeen City, United Kingdom
Age at diagnosis
Age in years at diagnosis; compared between early and late diagnosis groups.
Time frame: 5 years
Gender
Gender; compared between early and late diagnosis groups
Time frame: 5 years
Scottish Index of Multiple Deprivation (SIMD) Quintile
SIMD quintile (1 representing most deprived to 5 representing least deprived); compared between early and late diagnosis groups
Time frame: 5 years
Ethnicity
Ethnic group; compared between early and late diagnosis groups
Time frame: 5 years
Migrant status
Migrant status in relation to the United Kingdom; compared between early and late diagnosis groups
Time frame: 5 years
Probable mode of transmission
Probable mode of HIV transmission; compared between early and late diagnosis groups
Time frame: 5 years
Probable region of exposure
Probable region of exposure to HIV; compared between early and late diagnosis groups
Time frame: 5 years
Registration with General Practitioner
Current registration status with General Practitioner; compared between early and late diagnosis groups
Time frame: 5 years
Contact with healthcare professional
Contact with healthcare professional(s) in the year preceding HIV diagnosis (contact versus no contact); compared between early and late diagnosis groups
Time frame: 5 years
Frequency of healthcare contacts
Frequency of contact with healthcare professional(s) in the year preceding HIV diagnosis; compared between early and late diagnosis groups
Time frame: 5 years
Previous HIV testing
Previous HIV testing (no testing versus testing); compared between early and late diagnosis groups
Time frame: 5 years
Clinical indicator disease
Presence or absence of a BHIVA clinical indicator disease in the five years preceding diagnosis; compared between early and late diagnosis groups
Time frame: 5 years
Number of clinical indicator disease(s)
Number of BHIVA clinical indicator disease(s) present in the five years preceding diagnosis; compared between early and late diagnosis groups
Time frame: 5 years
Co-existing hepatitis B/C infection
Presence or absence of a co-existing hepatitis B/C infection; compared between early and late diagnosis groups
Time frame: 5 years
Frequency of missed opportunities for diagnosis
Number of missed opportunities for diagnosis as defined by the BHIVA testing guidelines; compared between early and late diagnosis groups
Time frame: 5 years
Circumstance of HIV diagnosis
Circumstance of HIV diagnosis; no BHIVA clinical indicator disease present versus testing offered following detection of a BHIVA clinical indicator disease versus no testing offered following the detection of a BHIVA clinical indicator disease. Compared between early and late diagnosis groups
Time frame: 5 years
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