Universal-offer HIV testing in primary care: A mixed-methods evaluation of a pilot study.

BACKGROUND: Offering HIV tests to all patients undergoing blood tests in primary care has been recommended by the National Institute for Health and Care Excellence (NICE) in the UK since 2016 but has not been fully adopted. We sought to evaluate the acceptability and feasibility of such a service in primary care. METHODS: A 3-weeks pilot of offering HIV tests to all patients undergoing blood tests was conducted in a general practice in the UK and evaluated using a mixed-methods approach. Whether patients were offered and accepted tests was recorded and any differences by patient's age and gender assessed. All patients and HCPs offering testing were approached for semi-structured interviews. RESULTS: Two-hundred-and-51 patients (mean [range] 57.5 years [18 to 97], 58% female) attended blood test appointments with 117 being offered a HIV test (46.6%). 78.6% (n = 92) accepted testing with 91 negative results. The proportion of patients offered testing was associated with the HCP offering the test. No associations between the age or gender of the patient and their odds of being offered or accepting a test were observed. Patient semi-structured interviews (n = 13) revealed a range of previous HIV testing experiences, patients felt the "offer" of a test to be routine and non-judgemental and felt that receiving negative results via SMS was appropriate. Several participants reported not fully considering the implications of a positive result when they accepted the test. Interviews with HCPs (n = 3) identified no significant service-level barriers. CONCLUSIONS: Offering HIV tests to patients undergoing blood tests in primary care is feasible and acceptable. The principal barrier to uptake was HCPs not offering testing.

Beyond the binary: sexual health outcomes of transgender and non-binary service users of an online sexual health service.

Sexual health data on transgender and non-binary (TNB) people in the United Kingdom are limited. TNB individuals experience significant socioeconomic and stigma-related disadvantages. Sexual health morbidity and unmet need is likely to be significant. We compared the sexual health outcomes of TNB and cisgender users of London's online sexual health service. Of 119329 users that registered with the e-service between 30.4.19 and 31.12.19, 504 (0.42%) identified as TNB: 302 TNB users requested 463 kits. 78.4% (363/463) of kits were returned. 99.4% of dispatched kits included throat and rectal swabs for gonorrhoea and chlamydia testing. STI/HIV test positivity was: 5.5% syphilis, 4.8% chlamydia, 3.4% gonorrhoea and 0.7% HIV positive. HIV prevalence amongst TNB individuals was: 4.3%. 19.9% of TNB individuals engaged in chemsex, group sex, or fisting and were more likely to engage in sex work. 97.7% gave the service 4/5 or 5/5 star rating. We observed high positivity rates of HIV/STIs amongst TNB individuals and significant levels of high-risk sexual activity. Service users rated the service highly. Given TNB often have complex healthcare needs, some of which cannot be met entirely online, physical clinics must work collaboratively with e-services to support and protect this marginalised population.

HIV testing in patients presenting with indicator conditions in outpatient settings: offer and uptake rates, and educational and active interventions.

Approximately 13% of people living with HIV in the UK are undiagnosed which has significant implications in terms of onward transmission and late diagnosis. HIV testing guidelines recommend routine screening in anyone presenting to healthcare with an HIV indicator condition (IC); however, this does not occur routinely. This study aimed to assess the feasibility and effectiveness of using case note prompts highlighting the presence of an IC to increase HIV testing. Clinicians in three outpatient departments received case note prompts either before or after a period of clinician-led identification. Test offer and uptake rates were assessed. A parallel anonymous seroprevalence study estimated the prevalence of undiagnosed HIV. A total of 4191 patients had an appointment during the study period; 608 (14.5%) had an IC. HIV test offer was significantly higher when a prompt was inserted into notes (34.3% versus 3.2%, p < 0.001). The prevalence of diagnosed HIV in the cohort was 4.1%. No cases of undiagnosed HIV infection were identified. Despite guidelines, offer of HIV testing is low. Strategies to increase routine screening of patients presenting with an IC are needed. Individual case note prompts significantly increase HIV test offer; however, the effect is lost if the strategy is withdrawn.

South Asian patients awaiting organ transplantation in the UK.

BACKGROUND: The fate of ethnic minority patients with end-stage renal failure is often a concern due to differences in disease profile, blood groups and difficulties in organ matching. This is an issue for Asian patients in particular, and there are more Asians on the UK transplant waiting list than expected. METHODS: We reviewed the available evidence along with recent data from UK Transplant in an attempt to summarize the current situation and to suggest improvements. RESULTS: While Asians comprised 13.6% of the UK waiting list, only 0.9% of non-heart-beating donors and 1.8% of heart-beating donors were Asian. Refusal rates from relatives for deceased donation were 78.7% for Asians and 31.8% for Caucasians, but approach rates were 89.4% and 95.1%, respectively. However, 7.3% of living donors were Asian. CONCLUSIONS: Changes to the UK National Kidney Allocation Scheme in 2006 may improve access to organs for Asian patients. The interaction of biological, cultural and organizational factors affecting Asian patients needs to be considered carefully to ensure that these patients are not disadvantaged.