Trends in HIV testing and recording of HIV status in the UK primary care setting: a retrospective cohort study 1995–2005
- H E R Evans1,
- C H Mercer1,
- G Rait2,
- M Hamill3,
- V Delpech4,
- G Hughes4,
- M G Brook5,
- T Williams6,
- A M Johnson7,
- S Singh2,
- I Petersen2,
- T Chadborn4,
- J A Cassell1,8
- 1Centre for Sexual Health and HIV Research, Research Department of Infection & Population Health, University College London, London, UK
- 2Research Department of Primary Care & Population Health, Royal Free Campus, University College London, London, UK
- 3Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, UK
- 4Centre for Infections, Health Protection Agency, London, UK
- 5Patrick Clements Clinic, North West London Hospitals NHS Trust, London, UK
- 6GPRD, Medicines and Healthcare products Regulatory Agency, London, UK
- 7Research Department of Infection & Population Health, Royal Free Campus, University College London, London, UK
- 8Brighton and Sussex Medical School, Mayfield House, University of Brighton, Brighton, UK
- Correspondence to J A Cassell, Brighton and Sussex Medical School, Mayfield House, University of Brighton, Falmer, Brighton BN1 9PH, UK; j.cassell{at}bsms.ac.uk
- Accepted 9 June 2009
- Published Online First 29 June 2009
Abstract
Objectives: To provide nationally representative data on trends in HIV testing in primary care and to estimate the proportion of diagnosed HIV positive individuals known to general practitioners (GPs).
Methods: We undertook a retrospective cohort study between 1995 and 2005 of all general practices contributing data to the UK General Practice Research Database (GPRD), and data on persons accessing HIV care (Survey of Prevalent HIV Infections Diagnosed). We identified all practice-registered patients where an HIV test or HIV positive status is recorded in their general practice records. HIV testing in primary care and prevalence of recorded HIV positive status in primary care were estimated.
Results: Despite 11-fold increases in male testing and 19-fold increases in non-pregnant female testing between 1995 and 2005, HIV testing rates remained low in 2005 at 71.3 and 61.2 tests per 100 000 person years for males and females, respectively, peaking at 162.5 and 173.8 per 100 000 person years at 25–34 years of age. Inclusion of antenatal tests yielded a 129-fold increase in women over the 10-year period. In 2005, 50.7% of HIV positive individuals had their diagnosis recorded with a lower proportion in London (41.8%) than outside the capital (60.1%).
Conclusion: HIV testing rates in primary care remain low. Normalisation of HIV testing and recording in primary care in antenatal testing has not been accompanied by a step change in wider HIV testing practice. Recording of HIV positive status by GPs remains low and GPs may be unaware of HIV-related morbidity or potential drug interactions.
Footnotes
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‣ Additional materials are published online only at http://sti.bmj.com/content/vol85/issue7
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Funding This work was funded by the Medical Research Council, with funding allocated from the Health Departments, under the aegis of the MRC/UK Health Departments Sexual Health and HIV Research Strategy Committee.
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Competing interests None.
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Ethics approval No study specific ethics approval was required. The protocol was submitted to the Independent Scientific Advisory Committee for the GPRD who approved it under delegated authority.
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The Medical Research Council has had no role in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper publication. The views expressed are those of the authors and not necessarily those of the MRC or the Health Departments.
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Contributors: JC had the original idea for the study and developed a detailed proposal for funding alongside CM, GR, MGB, VD, AMJ, SS, GH, TW and IP. Code lists were developed and refined by all members of the team, particularly MH, MGB, GH and JC. HE undertook all analyses under the supervision of CM and JC, with input from all other members of the team. VD and TC led the provision, use, analysis and interpretation of SOPHID data. HE wrote the first draft and all authors contributed to and commented on subsequent versions. JC acted as guarantor.
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Provenance and Peer review Not commissioned; externally peer reviewed.
