'Don't forget the children' - even in a pandemic

Background: BHIVA's 'Don't Forget the Children' and Standards of Care (SoC) documents highlight the importance of routine HIV testing for children of people living with HIV (PLWH). Our HIV service audited child testing in 2008, 2009 and 2010 with 46%, 78% and 82% respectively of children requiring testing having a documented result. Having evolved a child testing pathway and MDT, with dedicated Health Advisor and Paediatric nurse support, we wanted to re-evaluate our child testing performance during the COVID-19 pandemic. Method(s): Newly diagnosed PLWH, 01/08/2020 - 31/12/2021, were identified via our HARS dataset. All 32 identified individuals case notes were reviewed and the relevant auditable outcomes from BHIVA's SoC document used. Result(s): 32/32 (100%) had documented evidence that child testing had been considered within 4 weeks of diagnosis (BHIVA target 95%). 13/32 had a total of 35 children, 29 of whom did not require testing. 20/29 had documented evidence their mother was not living with HIV post childbirth, 9/29 were >18 years and all but 1, not living in the UK, had either tested in sexual health or antenatal settings. 6/35 (17%) children required testing. 6/6 (100%) had a documented test result within 6 months of their parent's diagnosis, 1 of whom tested negative prior to parental diagnosis (BHIVA target 90%). 5/6 tested aged >18 months. 1 child <18 months, whose parent was diagnosed antenatally, awaits final 4th generation testing at 18 months. Conclusion(s): Our service has a robust mechanism in place for asking all newly diagnosed individuals, and those new to our service, about children during their first consultation. Where children without documented evidence of HIV testing are identified our child testing pathway ensures timely investigation and documentation - all child testing was completed within one month of parental diagnosis in this audit sample. Our service surpassed the BHIVA standards for child testing for all new diagnoses during the COVID-19 pandemic. Future planned work includes a re-audit of child testing for those already known to our HIV service. As neither parental status nor child location is static regular enquiry in relation to children needs embedding into routine HIV care. (Table Presented).

Single-centre review of rapid antiretroviral therapy initiation during the COVID-19 pandemic

Background: BHIVA released interim guidance on first line anti-retroviral therapy (ART) initiation during the COVID-19 pandemic, when investigations/follow-up was restricted. Our HIV service didn't restrict follow-up but suspended in-house resistance testing (RT) due to laboratory capacity. Having prescribed 'rapid ART' based on the Northern Algorithm 01/08/2020-01/01/2022 we wanted to evaluate our prescribing during the pandemic. Method(s): All new HIV diagnoses 01/08/2020-31/12/2021 were identified via our HARS dataset. Retrospective casenote review identified ART prescribed, and switches that occurred upon baseline RT availability, to more suitable and/or cost-effective regimes. Result(s): 32 new diagnoses: 11 female, 21 male, median age 41 years (17-81), 10 MSM, 22 Heterosexuals, White British 14, African 9, other 7. Median time to ART initiation 10 days (0-210). Median CD4 count 359 (2-1251), 8 had CD4<200. 7/32 had Primary HIV infection, 5 initiating ART at 1st visit. 30/32 started ART within our service, 1 relocated, 1 initiated abroad. 28/30 started algorithm compliant rapid ART. Of the 2 that delayed, 1 had significant resistance, the other patient choice. 8/30 (27%) 'rapid ART' initiations switched post RT availability. Conclusion(s): All patients initiating ART in our service during the pandemic were algorithm compliant and fulfilled BHIVA recommendations. 7/10 starting Darunavir/ r-based therapy switched to Delstrigo post RT, a more cost-effective STR. Zero patients on Biktarvy switched post RT;implying it's difficult to switch patients from small INSTI-based-STRs. Future work includes comparing our results with other centres and reviewing ART switches post HIV National Prescribing Guide implementation. (Table Presented).

Motivations and barriers to exercise among clinicians.

According to Kirk & Rhodes (2011), Nooijen et al. (2018), and Saridi et al. (2019), the motivators and barriers to exercise are influenced by one's occupation, especially among those in the healthcare field. We sought to examine the barriers and motivators to physical activity that are distinctive to clinicians. Community hospital clinicians were surveyed regarding motivators and barriers to exercise that they experience, their burnout levels as described by an adaptation of the Mini-Z single item burnout scale, and average weekly exercise habits. The top barriers and motivators were then correlated to burnout levels, levels of physical activity, and demographics. We received 64 total responses from clinicians. The overall average level of burnout was 2.37 and the median level was 2. Approximately 38% of clinicians reported adhering to American Heart Association (AHA) guidelines of 150 minutes of exercise per week, while 33% of clinicians exercise <75 minutes per week. The top general motivator was for one's own well-being and the top clinician-related motivator was reducing stress. The top two barriers to exercise were COVID-19 concerns at an indoor exercise facility and a lack of time. Higher average levels of burnout were experienced by those who marked being too stressed or too burnt out as barriers to exercise. Because of clinicians' roles in propagating healthy practices in their patients from their own habits, wellness programs should be aimed at capitalizing motivators to combat barriers that this group distinctively experiences. Efforts to improve physical and mental wellness among clinicians will translate into better provider and patient health outcomes.