Lekshmi Suresh Babu
Mid Cheshire Hospitals NHS Trust, UK
Title: Prevalence of HIV testing in line with British HIV association guidelines: A clinical audit
Biography
Biography: Lekshmi Suresh Babu
Abstract
The elimination of HIV transmission in the UK is now an achievable goal, according to Public Health England. The two key components that make this aim achievable are prompt HIV testing and efficient and timely Anti-Retroviral Therapy. We conducted an audit on HIV testing in an NHS Hospital in the UK. The standards used were British HIV association standards for HIV testing, which states that every patient presenting with a Clinical indicator condition should receive an HIV test.
However, various factor such as lack of awareness among non- HIV clinicians about when to test for HIV, stigma, fear of outcome and barriers of communication are major hurdles when ordering for an HIV test. The audit was carried out using data collected from patients admitted over a 3-year period (2018-2020) at our hospital. The clinical indicator condition that we audited for was Community Acquired Pneumonia. According to BHIVA, every patient admitted with the diagnosis should receive an HIV test. However, only 16.6% of patients admitted to critical care with severe pneumonia received an HIV test. While in patients receiving ward-based care, only 7.4% were tested for HIV. This is a very low figure. The audit also uncovers some interesting biases, that we as clinicians may have while clinical decision making. In Critical Care, more than 75% of patients who ended up receiving an HIV test were under the age of 65 and more than 80% of patients who received the tests were those who identified themselves as belonging to the male gender. The BHIVA guidelines do not use the criteria of age or gender, but rather warranties an HIV test to anyone presenting with a community acquired pneumonia. Also, more than 50% of the patients received a test on the day of their admission to hospital and the probability of receiving a test significantly dropped thereafter, even if they did not show any improvement in their condition. This was quiet contrary to what would have otherwise been expected.
Looking at the data published by Public Health England, 50% of patients diagnosed with HIV in the Midlands are late diagnoses, thereby significantly impacting the lives of those affected, by reducing life expectancy and quality of life. To allow for early diagnosis, BHIVA published a list of Clinical Indicator Conditions in this guideline. However, the awareness regarding these indicator conditions is low among healthcare workers and many cases of HIV are late diagnoses or remain undiagnosed.
Increasing awareness, by disseminating such findings and educating clinical decision makers is the way forward to improve HIV testing in clinical practice.