A multi-district audit of the management of HIV infection in pregnant women and the prevention of mother-to-child transmission: Yorkshire HIV pregnancy audit.

A regional audit was performed to compare clinical practice against the British HIV Association guidelines for the management of HIV infection in pregnancy. Data were collected from 2000 to 2002 from eight clinics across Yorkshire using a questionnaire. There were 22 live births to 22 HIV + pregnant women. There were no cases of transmission of HIV from mother to child. The majority (20/22) of mothers received therapy as recommended in the guidelines, with only two initially receiving inappropriate dual therapy. In all, 16/22 (73%) had elective caesarean sections, 5/22 (23%) emergency sections after the onset of labour and one had a vaginal delivery. Also, 12/22 (55%) definitely received intravenous zidovudine during delivery. Added to these, 19/22 infants received appropriate antiretroviral medication for four to six weeks after birth. No mothers were known to have breast-fed.

Genitourinary medicine/HIV services for persons with insecure immigration or seeking asylum in the United Kingdom: a British Co-operative Clinical Group survey.

Over the past three years many genitourinary medicine (GUM) clinics have anecdotally reported large numbers of persons with insecure immigration or seeking asylum (PIISA) attending their facilities. We conducted a national survey to assess the prevalence and demographic background of PIISA who were attending GUM clinics in the UK during 2001 and 2002 and the effect on service provision. A questionnaire was circulated in April 2003 to 182 consultants in the UK of whom 128 (70%) responded. Amongst those centres that responded, 89 (69%) had provided GUM/HIV services for PIISA in 2002. One-third of clinics had accurate data collection systems and less than a quarter used computerized databases in order to identify the associated workload. Of the HIV-positive patients attending these clinics during 2002, 1140 (42%) were identified as PIISA. Eighty-two (95.3%) and 62 (48.8%) clinics had cared for PIISA from Africa and Europe respectively. Co-infection with HIV and tuberculosis was higher in patients from the PIISA group compared with the non-PIISA group (85% vs 15%, P = 0.001) for both 2001 and 2002. Clinics reported many problems associated with the service for PIISA. Forty-five percent of the clinics reported difficulties with funding for the increased workload associated with PIISA. The survey shows that GUM services have an important role in the management of PIISA and that the programme of dispersal is having a significant impact on the workload of clinics outside London. Services report that they are significantly overstretched and underfunded. An immediate investment in GUM services is necessary to improve the health of this client group. Any delay in diagnosis of sexually transmitted infections and HIV will have implications for public health and acute services.

Third regional audit of antiretroviral prescribing in HIV patients.

A multicentre re-audit of antiretroviral therapy (ART) prescribing in HIV-positive patients from October 2000 to March 2001, in the Yorkshire region, showed an improvement since our previous audit in 1999, with an increased proportion of patients taking three or more drugs. Overall, 53% of all patients on ART had complete HIV-1 virological suppression (<50 copies/mL). It is of concern that only 42% of ART-naïve patients who commenced their first regimen during the audit period, achieved complete virological suppression at 24 weeks of follow up. All clinics used the BHIVA guidelines and had access to HIV-1 ultrasensitive viral load and genotypic resistance testing. Future audits will be performed with an emphasis on adherence in relation to treatment response.