Introduction 24% of deaths among HIV-positive adults in the UK are due to late diagnosis of HIV. Many ‘late presenters’ have previously been seen by healthcare professionals and the diagnosis missed. The study city also has a significantly higher late diagnoses rate (61%) compared to the national rate (45%).

Aim To identify: newly- diagnosed HIV positive patients between 2010- 2012; rates of ‘late’ diagnosis; missed opportunities for testing.

Methods Reviewing the case-notes of all newly diagnosed HIV positive residents in the study city, with a CD4 count <350 cells/μl.

National Testing guidelines were used to define the indicators for testing. The primary outcome was ‘late’ diagnosis (CD4 count <350 cells/μl). The secondary outcome was ‘missed opportunity’(failure to diagnose HIV within one month) in the presence of an indicator for testing.

Results From 180 new HIV-positive cases reviewed 85 met the case definition of ‘late’ diagnosis, 38 of which had been diagnosed prior to 2010. Meaning the true number of late diagnosis cases during the audit period was 47 (26%). 14.8% of cases had pre-existing HIV indicators, and 46% of cases had missed opportunities for early diagnosis.

Conclusions This audit demonstrates that the actual late-diagnosis rate is lower than that reported previously. There is a high rate of missed opportunities, which warrants increasing the awareness of clinicians and the general population for early detection of HIV, the responsibility for which rests with both clinicians and commissioners.