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Missed opportunities for earlier HIV diagnosis within primary and secondary healthcare settings in the UK.

By: Contributor(s): Publication details: 2008ISSN:
  • 02699370
Uniform titles:
  • AIDS
Online resources: Summary: <div class="abstr"><h3><span style="font-size: 8pt;">OBJECTIVE<span style="font-weight: normal;">:</span><span style="font-weight: normal;">To identify </span><span class="highlight" style="font-weight: normal;">opportunities</span><span style="font-weight: normal;"> for </span><span class="highlight" style="font-weight: normal;">earlier</span><span style="font-weight: normal;"> </span><span class="highlight" style="font-weight: normal;">HIV</span><span style="font-weight: normal;"> </span><span class="highlight" style="font-weight: normal;">diagnosis</span><span style="font-weight: normal;"> within </span><span class="highlight" style="font-weight: normal;">primary</span><span style="font-weight: normal;"> and </span><span class="highlight" style="font-weight: normal;">secondary</span><span style="font-weight: normal;"> care </span><span class="highlight" style="font-weight: normal;">settings</span><span style="font-weight: normal;"> in the </span><span class="highlight" style="font-weight: normal;">UK</span><span style="font-weight: normal;"> in Africans with newly diagnosed </span><span class="highlight" style="font-weight: normal;">HIV</span><span style="font-weight: normal;"> infection.</span></span></h3><div><h4><span style="font-size: 8pt;">METHODS:<span style="font-weight: normal;">A survey of newly diagnosed </span><span class="highlight" style="font-weight: normal;">HIV</span><span style="font-weight: normal;">-positive Africans attending 15 </span><span class="highlight" style="font-weight: normal;">HIV</span><span style="font-weight: normal;"> treatment centres across London was conducted between April 2004 and February 2006. The survey consisted of a confidential self-completed questionnaire linked to clinician-completed clinical records.</span></span></h4><h4><span style="font-size: 8pt;">RESULTS:<span style="font-weight: normal;">A total of 263 questionnaires were completed, representing an uptake rate of 79.5% of patients approached and 49.8% (131/263) of participants presented with advanced </span><span class="highlight" style="font-weight: normal;">HIV</span><span style="font-weight: normal;"> disease (CD4 cell count < 200 cells/mul at </span><span class="highlight" style="font-weight: normal;">diagnosis</span><span style="font-weight: normal;">). In the year prior to </span><span class="highlight" style="font-weight: normal;">HIV</span><span style="font-weight: normal;"> </span><span class="highlight" style="font-weight: normal;">diagnosis</span><span style="font-weight: normal;"> 76.4% (181/237) had seen their GP, 38.3% (98/256) had attended outpatient services, and 15.2% (39/257) inpatient services, representing </span><span class="highlight" style="font-weight: normal;">missed</span><span style="font-weight: normal;"> </span><span class="highlight" style="font-weight: normal;">opportunities</span><span style="font-weight: normal;"> for </span><span class="highlight" style="font-weight: normal;">earlier</span><span style="font-weight: normal;"> </span><span class="highlight" style="font-weight: normal;">HIV</span><span style="font-weight: normal;"> </span><span class="highlight" style="font-weight: normal;">diagnosis</span><span style="font-weight: normal;">. Of those attending GP services the issue of </span><span class="highlight" style="font-weight: normal;">HIV</span><span style="font-weight: normal;"> and/or </span><span class="highlight" style="font-weight: normal;">HIV</span><span style="font-weight: normal;"> testing was raised for 17.6% (31/176) and 37.1% (78/210) had a previous negative </span><span class="highlight" style="font-weight: normal;">HIV</span><span style="font-weight: normal;"> test, 32.5% of these within the </span><span class="highlight" style="font-weight: normal;">UK</span><span style="font-weight: normal;">. Medical attention was sought for wide ranging reasons, often not obviously connected to underlying </span><span class="highlight" style="font-weight: normal;">HIV</span><span style="font-weight: normal;"> status. Despite the population predominantly coming from countries of high </span><span class="highlight" style="font-weight: normal;">HIV</span><span style="font-weight: normal;"> prevalence personal appreciation of risk was comparatively low and knowledge of benefits of testing lacking.</span></span></h4><h4><span style="font-size: 8pt;">CONCLUSION:<span style="font-weight: normal;">Africans are accessing health services but clinicians are failing to use these </span><span class="highlight" style="font-weight: normal;">opportunities</span><span style="font-weight: normal;"> effectively for preventive and diagnostic purposes with regards to </span><span class="highlight" style="font-weight: normal;">HIV</span><span style="font-weight: normal;"> infection. Comparatively low appreciation of personal risk and lack of perceived ill health within this community means clinicians need to be more proactive in addressing </span><span class="highlight" style="font-weight: normal;">HIV</span><span style="font-weight: normal;">.</span></span></h4></div></div>
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&lt;div class="abstr"&gt;&lt;h3&gt;&lt;span style="font-size: 8pt;"&gt;OBJECTIVE&lt;span style="font-weight: normal;"&gt;:&lt;/span&gt;&lt;span style="font-weight: normal;"&gt;To identify &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;opportunities&lt;/span&gt;&lt;span style="font-weight: normal;"&gt; for &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;earlier&lt;/span&gt;&lt;span style="font-weight: normal;"&gt; &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;HIV&lt;/span&gt;&lt;span style="font-weight: normal;"&gt; &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;diagnosis&lt;/span&gt;&lt;span style="font-weight: normal;"&gt; within &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;primary&lt;/span&gt;&lt;span style="font-weight: normal;"&gt; and &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;secondary&lt;/span&gt;&lt;span style="font-weight: normal;"&gt; care &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;settings&lt;/span&gt;&lt;span style="font-weight: normal;"&gt; in the &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;UK&lt;/span&gt;&lt;span style="font-weight: normal;"&gt; in Africans with newly diagnosed &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;HIV&lt;/span&gt;&lt;span style="font-weight: normal;"&gt; infection.&lt;/span&gt;&lt;/span&gt;&lt;/h3&gt;&lt;div&gt;&lt;h4&gt;&lt;span style="font-size: 8pt;"&gt;METHODS:&lt;span style="font-weight: normal;"&gt;A survey of newly diagnosed &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;HIV&lt;/span&gt;&lt;span style="font-weight: normal;"&gt;-positive Africans attending 15 &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;HIV&lt;/span&gt;&lt;span style="font-weight: normal;"&gt; treatment centres across London was conducted between April 2004 and February 2006. The survey consisted of a confidential self-completed questionnaire linked to clinician-completed clinical records.&lt;/span&gt;&lt;/span&gt;&lt;/h4&gt;&lt;h4&gt;&lt;span style="font-size: 8pt;"&gt;RESULTS:&lt;span style="font-weight: normal;"&gt;A total of 263 questionnaires were completed, representing an uptake rate of 79.5% of patients approached and 49.8% (131/263) of participants presented with advanced &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;HIV&lt;/span&gt;&lt;span style="font-weight: normal;"&gt; disease (CD4 cell count &amp;lt; 200 cells/mul at &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;diagnosis&lt;/span&gt;&lt;span style="font-weight: normal;"&gt;). In the year prior to &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;HIV&lt;/span&gt;&lt;span style="font-weight: normal;"&gt; &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;diagnosis&lt;/span&gt;&lt;span style="font-weight: normal;"&gt; 76.4% (181/237) had seen their GP, 38.3% (98/256) had attended outpatient services, and 15.2% (39/257) inpatient services, representing &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;missed&lt;/span&gt;&lt;span style="font-weight: normal;"&gt; &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;opportunities&lt;/span&gt;&lt;span style="font-weight: normal;"&gt; for &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;earlier&lt;/span&gt;&lt;span style="font-weight: normal;"&gt; &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;HIV&lt;/span&gt;&lt;span style="font-weight: normal;"&gt; &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;diagnosis&lt;/span&gt;&lt;span style="font-weight: normal;"&gt;. Of those attending GP services the issue of &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;HIV&lt;/span&gt;&lt;span style="font-weight: normal;"&gt; and/or &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;HIV&lt;/span&gt;&lt;span style="font-weight: normal;"&gt; testing was raised for 17.6% (31/176) and 37.1% (78/210) had a previous negative &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;HIV&lt;/span&gt;&lt;span style="font-weight: normal;"&gt; test, 32.5% of these within the &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;UK&lt;/span&gt;&lt;span style="font-weight: normal;"&gt;. Medical attention was sought for wide ranging reasons, often not obviously connected to underlying &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;HIV&lt;/span&gt;&lt;span style="font-weight: normal;"&gt; status. Despite the population predominantly coming from countries of high &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;HIV&lt;/span&gt;&lt;span style="font-weight: normal;"&gt; prevalence personal appreciation of risk was comparatively low and knowledge of benefits of testing lacking.&lt;/span&gt;&lt;/span&gt;&lt;/h4&gt;&lt;h4&gt;&lt;span style="font-size: 8pt;"&gt;CONCLUSION:&lt;span style="font-weight: normal;"&gt;Africans are accessing health services but clinicians are failing to use these &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;opportunities&lt;/span&gt;&lt;span style="font-weight: normal;"&gt; effectively for preventive and diagnostic purposes with regards to &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;HIV&lt;/span&gt;&lt;span style="font-weight: normal;"&gt; infection. Comparatively low appreciation of personal risk and lack of perceived ill health within this community means clinicians need to be more proactive in addressing &lt;/span&gt;&lt;span class="highlight" style="font-weight: normal;"&gt;HIV&lt;/span&gt;&lt;span style="font-weight: normal;"&gt;.&lt;/span&gt;&lt;/span&gt;&lt;/h4&gt;&lt;/div&gt;&lt;/div&gt;

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