Improving the identification and management of HIV

Many people with HIV remain undiagnosed or are diagnosed late. Early diagnosis of HIV prevents future ill health or death, stops viral transmission to partners and children, and reduces burden to public health budgets.

General practice may provide access to HIV testing to people less likely to attend sexual health clinics, including key populations at risk of late diagnosis, such as heterosexuals and people of black African and Caribbean origin.

Using a pilot study and a cluster Randomised Controlled Trial (RHIVA2), this project demonstrated that HIV screening in Hackney general practice increased HIV diagnosis and was acceptable to staff and patients. The project included a systematic review of HIV shared and the following studies on RHIVA2:

• Health economic analysis
• Post-trial implementation, including comparison to a primary care network-enhanced service in Tower Hamlets and usual care in Newham
• Dissemination and implementation in London

Our intervention – ‘RHIVA2’ – to implement HIV screening during general practice registration in Hackney led to a fourfold increase in detection of HIV, and was cost-effective in the medium term.

City & Hackney CCG commissioned the intervention and found a sustained increase in HIV testing and new diagnoses during the following three years.

HIV screening in primary care should be considered a key strategy to reduce undiagnosed infection, particularly among high risk persons not attending sexual health services.

Our research has informed national and international guidelines:

• NICE guidelines (2015) for routine HIV testing in high prevalence areas (>2 HIV diagnoses/1000 adult population)
• British HIV Association (BHIVA) Standards of Care for People Living with HIV (2018)
• European Centre for Disease Prevention and Control recommended RHIVA as an example of good clinical practice in their HIV and hepatitis B & C testing guidelines (2018)
• INTEGRATE Joint Action: https://integrateja.eu 

We supported Newham with their new HIV testing service in primary care, and we trained Waltham Forest and Birmingham GPs on RHIVA.

We are collaborating with the University of Leicester and LSHTM on a cost-effectiveness model of multiple chronic infection screening (HIV, hepatitis B & C, and latent TB) in primary care.

Barts Health NHS Trust have introduced a failsafe procedure to ensure prompt HIV clinic entry for people newly diagnosed with HIV in general practice.

Dr Werner Leber has joined the London Hepatitis C Routemap Steering Group to eliminate the infection in the city, including plans to establish multiple chronic infection screening in general practice.

In collaboration with Positively UK and the 4M Project, we are developing a peer supporter-enhanced RHIVA model to address HIV-related stigma in primary care.

NHS Newham Clinical Commissioning Group

London Borough of Hackney

London Borough of Waltham Forest

London Borough of Tower Hamlets