Effectiveness and cost-effectiveness of implementing HIV testing in primary care in East London: Protocol for an interrupted time series analysis

Werner Leber*, Lee Beresford, Claire Nightingale, Estela Capelas Barbosa, Stephen Morris, Farah El-Shogri, Heather McMullen, Kambiz Boomla, Valerie Delpech, Alison Brown, Jane Hutchinson, Vanessa Apea, Merle Symonds, Samantha Gilliham, Sarah Creighton, Maryam Shahmanesh, Naomi Fulop, Claudia Estcourt, Jane Anderson, Jose FigueroaChris Griffiths

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Introduction HIV remains underdiagnosed. Guidelines recommend routine HIV testing in primary care, but evidence on implementing testing is lacking. In a previous study, the Rapid HIV Assessment 2 (RHIVA2) cluster randomised controlled trial, we showed that providing training and rapid point-of-care HIV testing at general practice registration (RHIVA2 intervention) in Hackney led to cost-effective, increased and earlier diagnosis of HIV. However, interventions effective in a trial context may be less so when implemented in routine practice. We describe the protocol for an MRC phase IV implementation programme, evaluating the impact of rolling out the RHIVA2 intervention in a post-trial setting. We will use a longitudinal study to examine if the post-trial implementation in Hackney practices is effective and cost-effective, and a cross-sectional study to compare Hackney with two adjacent boroughs providing usual primary care (Newham) and an enhanced service promoting HIV testing in primary care (Tower Hamlets). Methods and analysis Service evaluation using interrupted time series and cost-effectiveness analyses. We will include all general practices in three contiguous high HIV prevalence East London boroughs. All adults aged 16 and above registered with the practices will be included. The interventions to be examined are: a post-trial RHIVA2 implementation programme (including practice-based education and training, external quality assurance, incentive payments for rapid HIV testing and incorporation of rapid HIV testing in the sexual health Local Enhanced Service) in Hackney; the general practice sexual health Network Improved Service in Tower Hamlets and usual care in Newham. Coprimary outcomes are rates of HIV testing and new HIV diagnoses. Ethics and dissemination The chair of the Camden and Islington NHS Research Ethics Committee, London, has endorsed this programme as an evaluation of routine care. Study results will be published in peer-reviewed journals and reported to commissioners.

Original languageEnglish
Article numbere018163
JournalBMJ Open
Issue number12
Publication statusPublished - 1 Dec 2017

Bibliographical note

Funding Information:
1Centre for Primary Care and Public Health, Queen Mary University of London, London, UK 2Population Health Research Institute, St George’s, University of London, London, UK 3Department of Applied Health Research, University College London, London, UK 4Department of HIV and STI, National Infection Service, Public Health England, London, UK 5Barts Sexual Health Centre, Barts Health NHS Trust, London, UK 6Centre for Sexual Health, Homerton University Hospital NHS Foundation Trust, London, UK 7School of Health and Life Sciences, Glasgow Caledonian University, London, UK 8Specialised Commissioning Team, NHS England, London, UK contributors WL, LB, CN, ECB, SM, CE, JA, JF and CG significantly contributed to designing the study and drafted the protocol. FE-S, HM, KB, VD, AB, JH, VA, MS, SG, SC, MS and NF contributed to designing the study. All authors and contributors approved the submitted version of the manuscript. Funding WL, FE-S, LB, CN, ECB were supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Barts Health NHS Trust. HM was supported by an NIHR Doctoral Fellowship from 2013 to 2016. HM was supported by a National Institute of Health Research Doctoral Fellowship from 2013 to 2016.

Funding Information:
Squibb, grants and personal fees from Gilead Sciences, personal fees from ViiV, personal fees from Merck Sharp & Dohme, grants from Janssen, and personal fees from AbbVie, outside the submitted work. CE and JH report grants from Gilead Sciences.

Publisher Copyright:
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.


  • HIV
  • HIV diagnosis
  • HIV screening
  • HIV testing
  • cost-effectiveness
  • implementation
  • interrupted time series


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