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

Werner Leber; Jasmina Panovska-Griffiths; Peter Martin; Stephen Morris; Estela Capelas Barbosa; Claudia Estcourt; Jane Hutchinson; Maryam Shahmanesh; Farah El-Shogri; Kambiz Boomla; Valerie Delpech; Sarah Creighton; Jane Anderson; Jose Figueroa; Chris Griffiths

doi:10.1016/j.eclinm.2019.11.022

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

Werner Leber^*, Jasmina Panovska-Griffiths, Peter Martin, Stephen Morris, Estela Capelas Barbosa, Claudia Estcourt, Jane Hutchinson, Maryam Shahmanesh, Farah El-Shogri, Kambiz Boomla, Valerie Delpech, Sarah Creighton, Jane Anderson, Jose Figueroa, Chris Griffiths

^*Corresponding author for this work

HIV & Aids Reporting

Research output: Contribution to journal › Article › peer-review

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Abstract

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.

Original language	English
Article number	100229
Journal	EClinicalMedicine
Volume	19
Early online date	10 Jan 2020
DOIs	https://doi.org/10.1016/j.eclinm.2019.11.022
Publication status	Published - Feb 2020

Bibliographical note

Funding 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.

DOI: https://doi.org/10.1016/j.eclinm.2019.11.022

Keywords

HIV testing
Implementation
Interrupted time series

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

Leber, W., Panovska-Griffiths, J., Martin, P., Morris, S., Capelas Barbosa, E., Estcourt, C., Hutchinson, J., Shahmanesh, M., El-Shogri, F., Boomla, K., Delpech, V., Creighton, S., Anderson, J., Figueroa, J., & Griffiths, C. (2020). 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, Article 100229. https://doi.org/10.1016/j.eclinm.2019.11.022

@article{11e32d80f5094f90a458b7567625baee,

title = "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",

abstract = "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.",

keywords = "HIV testing, Implementation, Interrupted time series",

author = "Werner Leber and Jasmina Panovska-Griffiths and Peter Martin and Stephen Morris and {Capelas Barbosa}, Estela and Claudia Estcourt and Jane Hutchinson and Maryam Shahmanesh and Farah El-Shogri and Kambiz Boomla and Valerie Delpech and Sarah Creighton and Jane Anderson and Jose Figueroa and Chris Griffiths",

note = "Funding 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: {\textcopyright} 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. DOI: https://doi.org/10.1016/j.eclinm.2019.11.022",

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doi = "10.1016/j.eclinm.2019.11.022",

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Leber, W, Panovska-Griffiths, J, Martin, P, Morris, S, Capelas Barbosa, E, Estcourt, C, Hutchinson, J, Shahmanesh, M, El-Shogri, F, Boomla, K, Delpech, V, Creighton, S, Anderson, J, Figueroa, J & Griffiths, C 2020, '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, vol. 19, 100229. https://doi.org/10.1016/j.eclinm.2019.11.022

TY - JOUR

T1 - 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

AU - Leber, Werner

AU - Panovska-Griffiths, Jasmina

AU - Martin, Peter

AU - Morris, Stephen

AU - Capelas Barbosa, Estela

AU - Estcourt, Claudia

AU - Hutchinson, Jane

AU - Shahmanesh, Maryam

AU - El-Shogri, Farah

AU - Boomla, Kambiz

AU - Delpech, Valerie

AU - Creighton, Sarah

AU - Anderson, Jane

AU - Figueroa, Jose

AU - Griffiths, Chris

N1 - Funding 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. DOI: https://doi.org/10.1016/j.eclinm.2019.11.022

PY - 2020/2

Y1 - 2020/2

N2 - 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.

AB - 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.

KW - HIV testing

KW - Implementation

KW - Interrupted time series

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U2 - 10.1016/j.eclinm.2019.11.022

DO - 10.1016/j.eclinm.2019.11.022

M3 - Article

AN - SCOPUS:85077715697

SN - 2589-5370

VL - 19

JO - EClinicalMedicine

JF - EClinicalMedicine

M1 - 100229

ER -

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

Abstract

Bibliographical note

Keywords

UN SDGs

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