Study Overview

Investigation Team

Dr Tristan Barber  

Dr Olubanke Davies

Dr Tristan Barber

Chelsea and Westminster NHS Foundation Trust
London
United Kingdom  

Dr Olubanke Davies

St Helier and Sutton Hospital
Surrey
United Kingdon

Proposed finish date
31 Dec 2019
 

HIV Care Continuum stages covered (4)

The goal of this study is to assess the feasibility and acceptability of opt-out testing in the emergency and acute medical settings in a suburban centre. This will reduce the amount of people with HIV undiagnosed in Sutton, London, and ensure that 90% of people living with HIV in that area are aware of their diagnosis and have access to HIV care.

This study relates to the first of the 90-90-90 targets set out by UNAIDS.

Sutton has one of the lowest rates of new diagnoses in London, but the highest proportion of people diagnosed late. Diagnosing HIV early is cost effective and better for patients, and late diagnosis affects black people more than other ethnic groups. Testing in emergency and acute medical settings is effective in picking up people who don’t test elsewhere, as pioneered by Chelsea and Westminster Hospital and supported by NICE [ 1,2 ].

References
1. Finlay S, Rayment M, Rae C, et al. 014 Routine HIV testing in the Emergency Department: a tale of two trials. Emerg Med J 2011; 28: A6-A7.
2. Rayment M, Thornton A, Mandalia S, Elam G, Atkins M, Jones R, et al. (2012) HIV Testing in Non-Traditional Settings – The HINTS Study: A Multi-Centre Observational Study of Feasibility and Acceptability. PLoS ONE 7(6): e39530. https://doi.org/10.1371/journal.pone.0039530

1 Primary objective

To assess the feasibility of delivering opt-out testing in a suburban setting (assessed by uptake rate) and the acceptability to patients of delivering testing by this method in this setting.

2 Secondary objective

To assess the acceptability of this type of testing to hospital staff. To reduce the proportion of patients diagnosed ‘late’ from 55% to below 40%. To increase the overall numbers of HIV diagnoses in Sutton initially, although this may decrease long term due to the availability of Pre-exposure Prophylaxis (PrEP). To reduce the amount of undiagnosed people with HIV in Sutton to below 10%.

This is a prospective, non-randomised, non-interventional one-year study.

During the first three-month acceptability and initiation phase, 50 patients are enrolled per week, increasing up to 140 per week in the extension and roll out phase. A potential 8,361 patients will be tested overall.

01.  

All adult admissions at St Helier Hospital Emergency Department (ED) or Medical/Admissions Unit (AMU/AAU), in Sutton, will be offered HIV testing as part of their baseline blood testing.

02.  

All ED/AMU staff will be trained as a one-off teaching session so they can raise awareness and are ready to discuss the benefits of testing with patients. This will be delivered by an existing Genito-Urinal or HIV Consultant or Senior Health Advisor.

03. 

A part-time ‘Testing Champion’ will be identified from within the local Health Advisor team. They will visit the department regularly and work with teams within the department to embed the practice and maintain levels of testing throughout the study period.

Conclusion

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Limitations

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