Answers in Untested Mystery

posted: 12/04/2011

HIV experts in England are puzzled why some people using STI clinics refuse HIV tests. We know for sure that some of those refusing HIV tests do have HIV (from using blood from samples given for syphilis tests and after the syphilis test is done and the blood sample is made completely anonymous, it can be tested for HIV).

The 2009 results from doing this show that 2.4% of gay and bisexual men and 0.25% of heterosexuals tested for syphilis came to the sexual health clinic with undiagnosed HIV.

But only 63% of these people agreed to a HIV test at the STI clinic - much lower than the average rate of HIV testing for people using STI clinics.

Why are so many people who have ‘undiagnosed’ HIV, refusing HIV tests?

One quarter must already know they have HIV - they are taking HIV treatment !

Some useful answers to the testing mystery have now emerged. Now we know that around a quarter of people with ‘undiagnosed’ must know they have HIV, because blood tests prove they are taking HIV treatment. These and other results, given at the British HIV Association conference in Bournemouth last week, are the first clear evidence of some answers to the ‘undiagnosed’ mystery.
 

Slightly more heterosexual women and men (32% for both men and women) than gay men (24%) are using a different clinic for STI checks than for their HIV treatment. Experts thought gay men with HIV were more likely to go elsewhere for HIV checks than heterosexuals. Experts don’t always guess right. Some people with HIV have told community organisations and patient advocates that one reason they go elsewhere for testing is to avoid unwanted, intrusive or judgemental discussion of their sexual behaviour by their own HIV clinic.
 

The results means

• 9 in 100 of the gay and bisexual men who said yes to a syphilis test but no to a HIV test have HIV. At least 2 of those 9 are on treatment but didn’t tell the STI clinic they have HIV
• 8 in 1000 of the heterosexual women and men similarly are HIV positive. At least 2 of those 8 are on treatment but did not tell the STI clinic they have HIV.
   

These findings will make little difference to national estimates of how much undiagnosed HIV there is in the country.
 

Why do gay men who don’t yet know they have HIV refuse HIV tests?
Another small study given to last weeks conference looked at why some gay men refuse HIV tests. Researchers gave an anonymous questionnaire to 19 men who didn’t want to be tested, even though they had had anal sex without condoms and have, either never been tested, or had taken anal sex risks since their last HIV test.

The men could tick more than one reason.
 

15 of the 19 men said they believed they were at low risk of HIV infection [2 of the 19 men knew their partner has HIV]

• 14 said they were emotionally unprepared for a positive result
• 4 said they don’t like giving a blood [but nonetheless gave this to have the syphilis test]
• 4 also mentioned prosecutions for HIV transmission
• 4 said they were planning to test 'next month'
• 3 mentioned worries about the confidentiality of the HIV test result.

Testing Advantages well known

Most of the men know the advantages of HIV testing

• 16 said testing could give peace of mind
• 16 said testing allows treatment to start at the best time.

Testing worries rule

But all the gay men listed the disadvantages to them of HIV testing.

• 17 said testing was stressful
• 8 were worried about having to tell a boyfriend if they were positive
• 7 were concerned about the insurance and mortgage implications.

Unready for positive result, testing stress, in denial about risks

So most of these gay men didn’t feel emotionally ready to deal with a positive result, and find HIV testing stressful.

• Most thought their HIV risk was low, despite having taken enough risks to have got HIV and needing to visit an STI clinic.

The study authors suggest investigating ways of overcoming gay men’s resistance to testing at STI clinics.
 

Source 
Reference – the free conference abstracts - read O13 & P152

HIV Healthcare Training Online

posted: 03/03/2011

HIV and STI doctors and other healthcare staff have an engaging and extensive online learning programme called eHIV-STI. This e-training has been put together by the British Association for Sexual Health and HIV and the Federation of the Royal Colleges of Physicians. Keeping HIV clinic staff well trained is an important part of good HIV care.
 

This eHIV-STI training provides the knowledge healthcare professionals need for treating and supporting people with sexually transmitted infections, including HIV, and related conditions. It’s designed to be used alongside clinic training.
 

3 knowledge levels

They provide training to three levels of knowledge, from introductory, to more advanced and finally specialist knowledge, so people can learn in stages.
 

The 60 sessions of e-learning with video clips and case studies cover most of what HIV and STI clinic staff need to know. The training is open for doctors and NHS healthcare staff in England who register with the site.
 

HIV & STI e-Learning for Healthcare

Better Primary Care for HIV

posted: 11/02/2011

How should HIV clinics and GPs work together caring for people living with HIV, when HIV clinics look after the HIV, and the GP is responsible for general healthcare? Lots of people with HIV, GPs and HIV doctors find this split rather clumsy. Two central London NHS Trusts asked Positively UK to investigate what people want and how we can make things work better.

Their report gives Manchester as one example of how to offer better primary care for people with HIV.
 

Manchester Primary Care Trust did this by introducing compulsory HIV awareness training for GPs and offering guidelines about disclosure and confidentiality. It made this a compulsory part of every GPs contract.

Another way of improving GP care for people with HIV is being used in Brighton. There they didn’t try compulsion, but invited GPs there to sign up to offer a Local Enhanced Service (the doctors are paid extra for this) where there is HIV training, see a minimum number of HIV+ patients, and carry out some extra health tests and checks.

This Positively UK study surveyed people with HIV, primary care staff and HIV clinics about what would help patients make the change from using the HIV clinic for everything, to using a GP for day to day, non-HIV healthcare. The report includes these 15 recommendations.

15 suggestions for action and improvement

• Increase people with HIV’s use of primary care by providing services in new ways 
• Provide short training sessions for all general practices to raise awareness of HIV, patients’ concerns and to boost practice confidence
• Introduce enhanced GP services for HIV using a 2-day training course and annual update training
• All staff (including receptionists) of practices that offer an enhanced service for HIV must attend HIV awareness training
• Develop quality standards on the basic information GPs should gather on patients’ HIV health and medications; increase standard length of appointments for patients living with HIV; agree protocols for protecting patient confidentiality
• Incorporate these quality standards into the existing GP Quality Outcomes Framework, to help implementation and monitoring of progress
• Provide enhanced HIV services to patients outside the practice catchment area where people with HIV have no local practice offering an enhanced HIV service
• Encourage practices already offering an enhanced local STI service or HIV testing to extend this by offering an enhanced HIV service
• PCTs consider providing primary healthcare for people with HIV in any ‘one-stop shops’ that are developed
• Base a GP at HIV clinics to offer short-term primary care as a step to using a local GP for primary care
• Consider how to manage the transfer to primary care of people using clinics in another PCT district
• Provide a ‘hotline’ at HIV clinics for GPs with concerns about HIV patient care
• Use the CQUN standards as a basis for routine sharing of information between HIV clinics and General Practice
• Following past recommendations appoint a nurse specialist and community lead as ‘champions’ to promote good practice and care shared between General Practice and HIV Clinics
• Provide information for people with HIV about finding a GP, patient rights and telling the doctor.

Primary Care Access: GPs responding better to the needs of people living with HIV – executive summary and recommendations
 

Primary Care Access full report and recommendations 
 

free to download HIV in Primary Care book from MedFash

£1bn UK HIV Care Costs

posted: 24/01/2011

The cost of providing HIV treatment in the UK could reach £758 million by 2013. Adding HIV social care costs to this total means the total state spending on HIV care could be over £1 billion a year in 2013.
 

The UK has the fastest growing HIV epidemic in Europe, with rising numbers using NHS HIV services. People are continuing to get HIV, and because modern HIV treatments work so well, few are dying early. Both of these trends increase the total cost of HIV care, every year.
 

Annual costs from 1997

The study looked at how much it cost the NHS to provide treatment and care to people with HIV between 1997 and 2006. They also calculated the costs for future years, to 2013.
 

Using information from 14 clinics, they divided people up, depending on the stage of their HIV illness (no symptoms; with illness symptoms; an AIDS diagnosis), and their HIV treatment. They used routinely collected NHS HIV service use data to work out typical care for the different stages of HIV illness.
 

Triple the people, quadruple the bill
The total using NHS HIV services tripled from near 17,000 in 1997 to just over 52,000 in 2006. At the same time, the cost of treatment and care more than quadrupled from £104 million in 1997 to £483 million in 2006.
 

Social Care
Adding in social and community care costs increases the total health and social care costs from £104 to £164 million in 1997, and from £483 to £683 million in 2006.
 

The proportion of the money spent on treatment rose between 1997 and 2006, but spending on social care fell.

Treatment cost between £18,000 to £41,000 a year
In 2006, medical care and HIV treatments costs just over £18,000 for each person without symptoms, £21,500 for people with HIV symptoms, and over £41,000 for people with AIDS.
 

Estimating future costs
By 2013 the researchers estimate there will be 78,370 people using NHS HIV clinics, with their treatment and care costing between £720 million and £758 million.

Adding in social and community care costs raises the total state spending on HIV treatment and care in the UK to as much as £1,065 million.
 

“The direct cost for treatment and care for PLWHIV [people living with HIV] has risen 4.6 fold between 1997 and 2006,” say the investigators, with costs projected to increase “1.5 fold” between 2007 and 2013.
 

What’s pushing up costs?
People should start HIV treatment by the time their CD4 count has fallen to around 350. But late diagnosis is a major problem in the UK and this means many people start treatment late, which is always much more expensive. There’s now a national target to reduce late diagnosis, and this will increase the number of people on HIV treatment and therefore the total bill. But the researchers believe that this is well worth it.

“Starting PLWHIV on cost-effective regimens earlier, will maintain them in better health, resulting in fewer health or social services and thereby generating fewer treatment and care costs, while enabling them to remain socially and economically active members of society.”
 

Cut the bill – spend to prevent HIV
The continuing rise in HIV treatment and care costs really matters when the NHS and council social care budgets are being cut. The authors say trimming the amount it costs for each person would probably worsen HIV patient care, and save little.
 

Instead they say invest more in prevention, to reduce the number of new people needing HIV treatment every year. “Only comprehensive prevention strategies, responding directly to the epidemic dynamics operating in each country, will be able to reduce HIV incidence,” they argue.
“Policy makers and other relevant stakeholders need to use evidence-informed HIV prevention, treatment and care strategies…which will prolong life, reduce morbidity and ultimately deliver the best for both the individual and public health agendas.”
 

Source, with reference 

Free, complete article online

Reasons for Travelling to Clinics

posted: 09/12/2010

Most people with HIV in England live within 5km (3 miles) of a specialist HIV clinic, according to a new study. The average distance people travel to their clinic was 2.5km (just over 1.5 miles). However, fewer than 1 in 10 people with HIV use the clinic that is nearest to their home. Why do people travel to a clinic further away?

Researchers wanted to see how far people live from a HIV clinic, and understand why some people travel further than they have to for HIV care.
 

Choice and advice on chosing clinics

People have the right to choose which HIV clinic to use and the British HIV Association recommends people who require routine, uncomplicated care to use their local clinic, and that people with more complex needs should use a more specialised clinic.

Not much has been studied about travelling to HIV clinics in the UK, nor about the social, demographic or clinical characteristics associated with people's choices about travelling to a HIV clinic.

Over 46,000 people studied
To get a clearer understanding of clinic travel, researchers looked at data on 46,550 HIV-positive adults who received HIV care in England in 2007. They pinpointed the closest HIV clinic for each person. All clinics within 5km of a someone’s home are considered ‘local’.

They looked at the wealth in each person’s borough of residence, and the person’s ethnicity, HIV risk category, length of HIV diagnosis, and HIV treatment status.

What they found – urban and often poor

Most (66%) of the people were men and 50% were white. The great majority (95%) live in an urban area, and 42% live in an economically deprived area. Almost three-quarters (73%) were on HIV treatments.

The median distance travelled to their clinic was 2.5km; but this ranged from less than 1km to 80km (50 miles). People in London travelled less than everyone else (2km vs. 3.7km).

Clinic access is good: 81% live within 5km of a specialist HIV clinic, and 93% live within 10km.
In London people had an average choice of three clinics within 5km, but those living outside the capital average just one local clinic.

The average distance travelled by patients to their clinic was a little under 5km. Overall, 73% use a local clinic. However, only 9% used the clinic closest to where they lived.

Reasons for travelling further
Haemophilia - People who were infected with HIV by blood products (mainly haemophiliacs infected during an old UK blood scandal) were most likely to travel further (51%). “These patients may need to attend specialist services that are not provided locally,” comment the authors.

Urban – People living in urban areas were significantly more likely to attend a non-local clinic than those who live in rural areas (44% vs. 22%) – people in major towns and cities are more likely to have a local choice. People living in rural areas and smaller towns have less or no choice nearby. Travelling to the next clinic is also less practical.

Ethnicity - Black African and black Caribbean people were statistically rather less likely to travel beyond their local service than white people.

Length of diagnosis - How long people have been diagnosed also affected travelling distance. People who had been diagnosed for at least a year were 50% more likely to use a clinic over 5km away service than those diagnosed within the last year (27% vs. 20). The investigators suggest “this may be because patients may not become aware of the choices available to them until they have adjusted to their HIV diagnosis.”

Poverty - Wealth also significantly affects the choice of clinic. People who lived in the better areas were twice as likely as those living in the poorest districts to travel further for treatment (42% vs. 21%). The investigators suggest that “financial difficulty” may prevent some people from travelling to clinics further away. Another recent study showed that almost a third of people with HIV in the UK did not have enough money to meet their needs and that 10% had difficulty meeting travel costs.

Help with paying to travel

If you have a low income or are on benefits, you may have a right to help with the costs of travelling to your clinic. Here's information on help with hospital travel costs.

“Barriers to service choice are likely to related to poverty and unfamiliarity with the options for HIV care,” conclude the authors, “consequently, provision of local services remains vital.”

Source including reference details