Missed opportunities for HIV testing in a Scottish Health Board

Background Early diagnosis of HIV allows commencement of combination antiretroviral therapy, reducing morbidity and mortality, as well as transmission. In 2010, 64.3% of new patients diagnosed with HIV in Lanarkshire had missed opportunities for earlier diagnosis, leading to various educational initiatives. Their success in reducing missed opportunities is examined here. Methods People who were newly diagnosed with HIV in 2017 were identified. For each person, NHS Lanarkshire hospital records, dating back ten years, were analysed to identify missed opportunities for testing. These were defined as episodes of care with potential HIV indicator conditions (shown in the British HIV Association testing guideline), that did not lead to an HIV test. Comparisons were made to 2010 data. Results 16 patients who were newly diagnosed with HIV in 2017 were identified. 43.8% (7/16) had missed opportunities for earlier diagnosis compared to 64.3% (9/14) in 2010. One presented with an AIDS-defining illness, compared with 3 in 2010. Blood dyscrasia was the most common clinical indicator that failed to prompt testing, although other commonly missed indicators were pneumonia and mononucleosis-like syndrome. Conclusion Educational initiatives are effective in improving appropriate HIV testing, however are not enough in isolation. Quality improvement strategies to increase testing, that are applicable to any Health Board/Trust, are currently being used. These include engagement with haematologists to provide testing prompts in reports, and opt-out testing in presumed high-prevalence clinical areas.