Trends in missed presentations and late HIV diagnosis in a UK teaching hospital: a retrospective comparative cohort study
Identifieur interne : 003099 ( Main/Curation ); précédent : 003098; suivant : 003100Trends in missed presentations and late HIV diagnosis in a UK teaching hospital: a retrospective comparative cohort study
Auteurs : Jared Wohlgemut [Royaume-Uni] ; Timothy Lawes [Royaume-Uni] ; Robert Bs Laing [Royaume-Uni]Source :
- BMC Infectious Diseases [ 1471-2334 ] ; 2012.
Abstract
Late diagnosis is an important cause of HIV-related morbidity, mortality and healthcare costs in the UK and undiagnosed infection limits efforts to reduce transmission. National guidelines provide recommendations to increase HIV testing in all healthcare settings. We evaluated progress towards these recommendations by comparing missed opportunities for HIV testing and late diagnosis in two six year cohorts from North East Scotland.
We reviewed diagnostic pathways of all patients newly diagnosed with HIV referred to infectious diseases and genito-urinary medicine services between 1995 and 2000 (n = 48) and 2004 to 2009 (n = 117). Missed presentations (failure to diagnose ≤ 1 month of a clinical or non-clinical indicator for testing), late diagnosis (CD4 < 350 cells/mm3), and time to diagnosis (months from first presentation to diagnosis) were compared between cohorts using
There were significant decreases in missed presentations (33% to 17%;
While early diagnosis has improved in epidemiological risk groups, clinical indications for HIV testing continue to be missed, particularly in patients who are older, of UK origin and from more deprived communities. Increasing testing in non-specialist services is a priority.
Url:
DOI: 10.1186/1471-2334-12-72
PubMed: 22455558
PubMed Central: 3337293
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Trends in missed presentations and late HIV diagnosis in a UK teaching hospital: a retrospective comparative cohort study</title><author><name sortKey="Wohlgemut, Jared" sort="Wohlgemut, Jared" uniqKey="Wohlgemut J" first="Jared" last="Wohlgemut">Jared Wohlgemut</name><affiliation wicri:level="1"><nlm:aff id="I1">School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>School of Medicine and Dentistry, University of Aberdeen, Aberdeen</wicri:regionArea><wicri:noRegion>Aberdeen</wicri:noRegion></affiliation></author><author><name sortKey="Lawes, Timothy" sort="Lawes, Timothy" uniqKey="Lawes T" first="Timothy" last="Lawes">Timothy Lawes</name><affiliation wicri:level="1"><nlm:aff id="I2">Infection Unit, Aberdeen Royal Infirmary, Aberdeen, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Infection Unit, Aberdeen Royal Infirmary, Aberdeen</wicri:regionArea><wicri:noRegion>Aberdeen</wicri:noRegion></affiliation></author><author><name sortKey="Laing, Robert Bs" sort="Laing, Robert Bs" uniqKey="Laing R" first="Robert Bs" last="Laing">Robert Bs Laing</name><affiliation wicri:level="1"><nlm:aff id="I2">Infection Unit, Aberdeen Royal Infirmary, Aberdeen, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Infection Unit, Aberdeen Royal Infirmary, Aberdeen</wicri:regionArea><wicri:noRegion>Aberdeen</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22455558</idno><idno type="pmc">3337293</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3337293</idno><idno type="RBID">PMC:3337293</idno><idno type="doi">10.1186/1471-2334-12-72</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">002164</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002164</idno><idno type="wicri:Area/Pmc/Curation">002163</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002163</idno><idno type="wicri:Area/Pmc/Checkpoint">001B78</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">001B78</idno><idno type="wicri:Area/Ncbi/Merge">001652</idno><idno type="wicri:Area/Ncbi/Curation">001652</idno><idno type="wicri:Area/Ncbi/Checkpoint">001652</idno><idno type="wicri:Area/Main/Merge">003115</idno><idno type="wicri:Area/Main/Curation">003099</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Trends in missed presentations and late HIV diagnosis in a UK teaching hospital: a retrospective comparative cohort study</title><author><name sortKey="Wohlgemut, Jared" sort="Wohlgemut, Jared" uniqKey="Wohlgemut J" first="Jared" last="Wohlgemut">Jared Wohlgemut</name><affiliation wicri:level="1"><nlm:aff id="I1">School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>School of Medicine and Dentistry, University of Aberdeen, Aberdeen</wicri:regionArea><wicri:noRegion>Aberdeen</wicri:noRegion></affiliation></author><author><name sortKey="Lawes, Timothy" sort="Lawes, Timothy" uniqKey="Lawes T" first="Timothy" last="Lawes">Timothy Lawes</name><affiliation wicri:level="1"><nlm:aff id="I2">Infection Unit, Aberdeen Royal Infirmary, Aberdeen, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Infection Unit, Aberdeen Royal Infirmary, Aberdeen</wicri:regionArea><wicri:noRegion>Aberdeen</wicri:noRegion></affiliation></author><author><name sortKey="Laing, Robert Bs" sort="Laing, Robert Bs" uniqKey="Laing R" first="Robert Bs" last="Laing">Robert Bs Laing</name><affiliation wicri:level="1"><nlm:aff id="I2">Infection Unit, Aberdeen Royal Infirmary, Aberdeen, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Infection Unit, Aberdeen Royal Infirmary, Aberdeen</wicri:regionArea><wicri:noRegion>Aberdeen</wicri:noRegion></affiliation></author></analytic><series><title level="j">BMC Infectious Diseases</title><idno type="eISSN">1471-2334</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Late diagnosis is an important cause of HIV-related morbidity, mortality and healthcare costs in the UK and undiagnosed infection limits efforts to reduce transmission. National guidelines provide recommendations to increase HIV testing in all healthcare settings. We evaluated progress towards these recommendations by comparing missed opportunities for HIV testing and late diagnosis in two six year cohorts from North East Scotland.</p></sec><sec><title>Methods</title><p>We reviewed diagnostic pathways of all patients newly diagnosed with HIV referred to infectious diseases and genito-urinary medicine services between 1995 and 2000 (n = 48) and 2004 to 2009 (n = 117). Missed presentations (failure to diagnose ≤ 1 month of a clinical or non-clinical indicator for testing), late diagnosis (CD4 < 350 cells/mm<sup>3</sup>), and time to diagnosis (months from first presentation to diagnosis) were compared between cohorts using <italic>χ</italic><sup>2 </sup>and log-rank tests. Determinants of missed presentation were explored by multivariate logistic regression. Breslow-Day tests assessed change in diagnostic performance by patient subgroup.</p></sec><sec><title>Results</title><p>There were significant decreases in missed presentations (33% to 17%; <italic>P </italic>= 0.02) and time to diagnosis (mean 17 months to 4 months; <italic>P </italic>= 0.005) but not in late diagnosis (56% vs. 60%; <italic>P </italic>= 0.57) between earlier and later cohorts. In the later cohort patients were significantly more likely to have acquired HIV abroad and presented with early HIV disease, and testing was more likely to be indicated by transmission risk or contact with GUM services than by clinical presentation. Missed presentation remained significantly less likely in the later cohort (OR = 0.28, 95% CI 0.11 to 0.72; <italic>P </italic>= 0.008) after adjustment for age, transmission risks and number of clinical indicators. Reductions in missed presentation were greater in patients < 40 years, of non-UK origin, living in least deprived neighbourhoods and with early disease at presentation (<italic>P </italic>< 0.05). 27% of missed presentations occurred in primary care and 46% in general secondary care.</p></sec><sec><title>Conclusions</title><p>While early diagnosis has improved in epidemiological risk groups, clinical indications for HIV testing continue to be missed, particularly in patients who are older, of UK origin and from more deprived communities. 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