Monitoring of older HIV-1-positive adults by HIV clinics in the United Kingdom: a national quality improvement initiative

N. Ekong, H. Curtis, E. Ong, C. A. Sabin, D. Chadwick, D. Asboe, V. Balasubramaniam, F. Burns, D. Chadwick, M. Chaponda, D. Churchill, Valerie Delpech, N. Ekong, A. Freedman, E. Kaide, R. Kulasegaram, N. Larbalestier, K. Lowndes, R. Mbewe, O. OlarindeE. Ong, S. Pires, C. Sabin, A. Sullivan, J. Vera

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1 Citation (Scopus)

Abstract

Objectives: The aim of the study was to describe a UK-wide process to assess adherence to guidelines for the routine investigation and monitoring of HIV-positive adults aged ≥ 50 years and provide clinical services with individual feedback to support improvement in quality of care. Methods: The British HIV Association (BHIVA) invited HIV clinical care sites to provide retrospective data from case notes of up to 40 adults aged ≥ 50 years with HIV-1 infection attending the clinic for care during 2017 and/or 2018, using a structured dynamic online questionnaire. Results: A total of 4959 questionnaires from 141 clinical services were returned. Regarding the key targets specified in the BHIVA monitoring guidelines, 97% of patients on antiretroviral therapy (ART) had had their viral load measured in the last 9 months, or 15 months if on a protease inhibitor, and 94% had had all medications recorded in the last 15 months. Only 67% of patients on ART without cardiovascular disease (CVD) had had a 10-year CVD risk calculated in the last 3 years. It was reported that 80% and 92% had had their smoking status documented in the last 2 years and blood pressure checked in the last 15 months, respectively. HIV services had communicated with the general practitioners of 90% of consenting individuals, but consulted electronic primary care records for only 10%. Conclusions: Nationally, targets were met for viral load and blood pressure monitoring but not for CVD risk assessment, smoking status documentation and recording of comedication. There was variable performance in relation to other outcomes; adherence and laboratory measurements were carried out more regularly than lifestyle and wellbeing assessments.

Original languageEnglish
Pages (from-to)409-417
Number of pages9
JournalHIV Medicine
Volume21
Issue number7
DOIs
Publication statusPublished - 1 Aug 2020

Bibliographical note

Funding Information:
Financial disclosure : This national quality improvement project was funded by the British HIV Association (BHIVA).

Funding Information:
Members of BHIVA Audit and Standards Sub-Committee: D. Asboe, V. Balasubramaniam, F. Burns, D. Chadwick (chair), M. Chaponda, D. Churchill, V. Delpech, N. Ekong, A. Freedman, E. Kaide, R. Kulasegaram, N. Larbalestier, K. Lowndes, R. Mbewe, O. Olarinde, E. Ong, S. Pires, C. Sabin, A. Sullivan (vice-chair) and J. Vera. We would like to thank all the HIV clinical services that provided data, as follows: Woolmanhill Hospital, Aberdeen; Monklands Hospital, Airdrie; Ashton Primary Care Centre, Ashton-under-Lyne; Ysbyty Gwynedd Hospital, Bangor; Barking Community Hospital, Barking; Barnsley Hospital NHS Foundation Trust, Barnsley; North Devon District Hospital, Barnstaple; Solent NHS Trust, Basingstoke; Royal United Hospital, Bath; iCASH Bedfordshire, Bedford; Royal Hospitals Trust, Belfast; Queen Elizabeth Hospital, Birmingham; Birmingham Heartlands Hospital, Birmingham; Bishop Auckland General Hospital, Bishop Auckland; Blackburn Royal Infirmary, Blackburn; Royal Bolton Hospital, Bolton; Royal Bournemouth Hospital, Bournemouth; Bradford Hospitals NHS Trust, Bradford; Royal Sussex County Hospital, Brighton; Southmead Hospital, Bristol; Queen's Hospital, Burton-upon-Trent; Virgin Care, Bury; West Suffolk Hospital, Bury St Edmunds; Addenbrooke's Hospital NHS Trust, Cambridge; Kent and Canterbury Hospital, Canterbury; Cardiff Royal Infirmary, Cardiff; St Helier Hospital, Carshalton; Medway Sexual Health, Chatham; Fountains Building, Chester; Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield; Essex County Hospital, Colchester; Castle Hill Hospital, Cottingham; City of Coventry Health Centre, Coventry; Northumbria Specialist Emergency Care Hospital, Cramlington; Crawley Hospital, Crawley; Leighton Hospital, Crewe; Croydon University Hospital, Croydon; Derbyshire Royal Infirmary NHS Trust, Derby; Doncaster Royal Infirmary, Doncaster; Downe Hospital, Downpatrick; Avenue House Sexual Health Clinic, Eastbourne; Lothian University Hospitals, Edinburgh; Western General Hospital, Edinburgh; Exeter NHS Walk-in Centre, Exeter; Borders Sexual Health, Galashiels; Gartnaval General Hospital, Glasgow; Gloucestershire Royal Hospital, Gloucester; Gravesham Community Hospital, Gravesend; Northgate Hospital, Great Yarmouth; Buryfields Clinic, Guildford; Sexual Health Centre, Halifax; Northwick Park Hospital, Harrow; Station Plaza Health Centre, Hastings; Wye Valley NHS Trust, Hereford; Wycombe General Hospital, High Wycombe; Conifer within The Wilberforce Centre, Hull; The Oak Tree Centre, Huntingdon; Orwell Clinic, Ipswich; Noble's Isle of Man Hospital, Isle of Man; Worcestershire Acute Hospitals NHS Trust, Kidderminster; iCASH Norfolk, King's Lynn; Kingston Hospital, Kingston upon Thames; Whytemans Brae Hospital, Kirkcaldy; Leeds Teaching Hospitals NHS Trust, Leeds; Lincolnshire Community Health Services NHS Trust, Lincoln; Royal Liverpool University Hospital, Liverpool; Royal Glamorgan Hospital, Llantrisant; Chelsea and Westminster Hospital, London; Newham University Hospital, London; St Thomas' Hospital, London; Royal Free London NHS Foundation Trust, London; University Hospital Lewisham, London; Queen Elizabeth Hospital, London; Homerton University Hospital NHS Foundation Trust, London; Central Middlesex Hospital, London; King's College Hospital, London; Imperial College Healthcare NHS Trust, London; The Royal London Hospital, London; 10 Hammersmith Broadway, London; Chelsea and Westminster Hospital, London; Sir Ludwig Guttman Health and Wellbeing Centre, London; St George's Hospital, London; Mortimer Market Centre, London; North Middlesex Hospital, London; Altnagelvin Area Hospital, Londonderry; Luton & Dunstable Hospital NHS Trust, Luton; Macclesfield District Hospital, Macclesfield; Maidstone Hospital, Maidstone; Manchester Royal Infirmary, Manchester; North Manchester General Hospital, Manchester; Withington Hospital, Manchester; James Cook University Hospital, Middlesbrough; Milton Keynes General Hospital, Milton Keynes; New Croft Sexual Health Centre, Newcastle upon Tyne; Royal Victoria Infirmary, Newcastle upon Tyne; St Mary's Hospital, Newport; Royal Gwent Hospital, Newport; Norfolk & Norwich University Hospital, Norwich; Nottingham City Hospital, Nottingham; George Eliot Hospital NHS Trust, Nuneaton; Oxford Radcliffe NHS Trust, Oxford; Oxford Radcliffe NHS Trust, Oxford; Peterborough and Stamford NHS Foundation Trust, Peterborough; Derriford Hospital, Plymouth; St Mary's Hospital, Portsmouth; Royal Preston Hospital, Preston; Royal Berkshire Hospital, Reading; Glan Clwyd District General Hospital NHS Trust, Rhyl; Rochdale Borough Sexual Health and Contraception Service, Rochdale; Rotherham NHS Foundation Trust, Rotherham; Hospital of St Cross, Rugby; Lance Burn Sexual Health Centre, Salford; Salisbury District Hospital, Salisbury; Royal Hallamshire Hospital, Sheffield; One to One Centre, Shiremoor; Royal Shrewsbury Hospital, Shrewsbury; Upton Hospital, Slough; Ealing Hospital, Southall; Royal South Hants Hospital, Southampton; Southport & Ormskirk NHS Trust, Southport; St Helen's and Knowsley Hospital, St Helens; Jersey General Hospital, St Helier; Southgate Health Centre, Stevenage; Manchester Foundation NHS Trust, Stockport; Midland Partnership Foundation Trust, Stoke-on-Trent; Stratford Hospital, Stratford-upon-Avon; Sunderland Royal Hospital, Sunderland; Sherwood Forest Hospitals NHS Foundation Trust, Sutton-in-Ashfield; Great Western Hospitals NHS Foundation Trust, Swindon; Musgrove Park Hospital, Taunton; Princess Royal Hospital NHS Trust, Telford; Torbay Hospital, Torquay; Royal Cornwall Hospital, Truro; Manor Hospital, Walsall; Southend Hospital, Westcliffe on Sea; Weymouth Community Hospital, Weymouth; Arrowe Park Hospital, Wirral; New Cross Hospital, Wolverhampton; TriHealth Bassetlaw Integrated Sexual Health Service, Worksop; Wrexham Maelor Hospital, Wrexham; York Hospitals NHS Trust, York. Conflicts of interest: HC has no competing interest to declare. NE received travel bursaries from Gilead Sciences and a WebEx meeting fee from Merck Sharp & Dohme. ELCO has received research funding from Pfizer and Gilead Sciences. CS has received funding for membership of data safety and monitoring boards and advisory boards and for preparation of educational materials from Gilead Sciences and ViiV Healthcare. DRC has received research funding from ViiV Healthcare and lecture fees from Pfizer and Gilead. Financial disclosure: This national quality improvement project was funded by the?British HIV Association?(BHIVA).

Funding Information:
Conflicts of interest: HC has no competing interest to declare. NE received travel bursaries from Gilead Sciences and a WebEx meeting fee from Merck Sharp & Dohme. ELCO has received research funding from Pfizer and Gilead Sciences. CS has received funding for membership of data safety and monitoring boards and advisory boards and for preparation of educational materials from Gilead Sciences and ViiV Healthcare. DRC has received research funding from ViiV Healthcare and lecture fees from Pfizer and Gilead.

Publisher Copyright:
© 2020 British HIV Association

Keywords

  • HIV
  • care quality
  • comorbidities
  • older patients
  • polypharmacy

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