Background: UK and European guidelines recommend HIV testing in general practice. We report on the implementation of the Rapid HIV Assessment trial (RHIVA2) promoting HIV screening in general practice into routine care.
Methods: Interrupted time-series, difference-in-difference analysis and Pearson-correlation on three cohorts comprising 42 general practices in City & Hackney (London, UK); covering three periods: pre-trial (2009–2010), trial (2010–2012) and implementation (2012–2014). Cohorts comprised practices receiving: “trial intervention” only (n = 19), “implementation intervention” only (n = 13); and neither (“comparator”) (n = 10). Primary outcomes were HIV testing and diagnosis rates per 1000 people and CD4 at diagnosis.
Findings: Overall, 55,443 people were tested (including 38,326 among these cohorts), and 101 people were newly diagnosed HIV positive (including 65 among these cohorts) including 74 (73%) heterosexuals and 69 (68%) people of black African/Caribbean background; with mean CD4 count at diagnosis 357 (SD=237). Among implementation intervention practices, testing rate increased by 85% (from 1·798 (95%CI=(1·657,1·938) at baseline to 3·081 (95%CI=(2·865,3·306); p = 0·0000), diagnosis rate increased by 34% (from 0·0026 (95%CI=(0·0004,0·0037)) to 0·0035 (95%CI=(0·0007,0·0062); p = 0·736), and mean CD4 count at diagnosis increased by 55% (from 273 (SD=372) to 425 (SD=274) cells per μL; p = 0·433). Implementation intervention and trial intervention practices achieved similar testing rates (3·764 vs. 3·081; 6% difference; 95% CI=(-5%,18%); p = 0·358), diagnosis rates (0·0035 vs. 0·0081; -13% difference; 95%CI=(-77%,244%; p = 0·837), and mean CD4 count (425 (SD=274) vs. 351 (SD=257); 69% increase; 95% CI=(-61%,249%); p = 0·359). HIV testing was positively correlated with diagnosis (r = 0·114 (95% CI=[0·074,0·163])), and diagnosis with CD4 count at diagnosis (r = 0·011 (95% CI=[-0·177,0·218])).
Interpretation: Implementation of the RHIVA programme promoting nurse-led HIV screening into routine practice in inner-city practices with high HIV prevalence increased HIV testing, and may be associated with increased and earlier diagnosis. 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.
Funding: National Institute for Health Research ARC North Thames, and Barts and The London School of Medicine and Dentistry.
Bibliographical noteFunding Information: Dr. Anderson reports unremunerated support from Gilead Sciences and from Merck Sharp & Dohme Corp outside the submitted work; and she co-chairs the HIV Outcomes Initiative unremunerated. Dr. Shahmanesh reports grants from the US National Institute for Health, the UK National Research Institute for Health, the Medical Research Council, the Bill and Melinda Gates Foundation, Unitaid, 3ie, ViiV Health Care, the Engineering Physical Science Research Council, and grants from the Wellcome Trust, outside the submitted work. WL, JPG, PM, SM, ECB, CE, JH, FES, KB, VD, SC, JA, JF and CG have nothing to disclose.
This report is independent research funded by the National Institute for Health Research ARC North Thames. The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care. HM was supported by an NIHR Doctoral Fellowship from 2013 to 2016. The funders had no role in the study design, data collection and analysis, interpretation and writing of the report.
Open Access: This is an open access article under the CC BY-NC-ND license. (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Publisher Copyright: © 2019 Published by Elsevier Ltd.
Citation: Leber, Werner, et al. "Evaluating the impact of post-trial implementation of RHIVA nurse-led HIV screening on HIV testing, diagnosis and earlier diagnosis in general practice in London, UK." EClinicalMedicine 19 (2020): 100229.
- HIV testing
- Interrupted time series