Factors Associated With Late HIV Diagnosis in Grampian: an Epidemiological Study

Human immunodeficiency virus (HIV) is a major global health concern which has resulted in an estimated 39 million deaths world-wide. Although it is now a treatable medical condition there is still avoidable morbidity and mortality associated with HIV infection in the UK. Late diagnosis (CD4 count of <350 cells/mm3 or AIDS-defining illness irrespective of CD4 count) is associated with increased morbidity and mortality, increased risk of transmission, impaired response to antiretroviral therapy and increased healthcare costs. In Grampian, 49% of patients were diagnosed late between 1984 and 2011. Therefore, the aim of the study is to determine the factors associated with late HIV diagnosis in Grampian between 2009 and 2014 to ascertain whether diagnoses could have been made earlier.

The study constitutes a secondary data analysis. Individuals newly diagnosed with HIV between January 2009 and December 2014 were identified from a Health Protection Scotland (HPS) database. The majority of outcome data were extracted from the existing HPS database. Missing data were collected via a retrospective review of patient case-notes, laboratory reports and an electronic patient management system. Patients were classified as early or late diagnosis and comparisons were made between the groups using statistical tests. The study sought to provide a basis for recommendations for improvement of information and services to facilitate earlier HIV diagnosis in Grampian.

Study Overview

• Status: Completed
• Conditions: Human Immunodeficiency Virus
• Intervention / Treatment: Other: No intervention

• Study Type: Observational
• Enrollment (Actual): 124

Contacts and Locations

Study Locations

• United Kingdom
  • Aberdeen City
    • Aberdeen, Aberdeen City, United Kingdom, AB25 2ZN
      • NHS Grampian

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Individuals newly diagnosed with HIV in Grampian between January 2009 and December 2014

Description

Inclusion Criteria:

• Individuals diagnosed with HIV between January 2009 and December 2014
• Individuals diagnosed in NHS Grampian

Exclusion Criteria:

• Individuals aged < 16 years of age

Study Plan

How is the study designed?

Design Details

• Time Perspectives: Retrospective

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Newly diagnosed individuals with HIV; Individuals newly diagnosed with HIV in Grampian between January 2009 and December 2014	Other: No intervention

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Age at diagnosis	Age in years at diagnosis; compared between early and late diagnosis groups.	5 years
Gender	Gender; compared between early and late diagnosis groups	5 years
Scottish Index of Multiple Deprivation (SIMD) Quintile	SIMD quintile (1 representing most deprived to 5 representing least deprived); compared between early and late diagnosis groups	5 years
Ethnicity	Ethnic group; compared between early and late diagnosis groups	5 years
Migrant status	Migrant status in relation to the United Kingdom; compared between early and late diagnosis groups	5 years
Probable mode of transmission	Probable mode of HIV transmission; compared between early and late diagnosis groups	5 years
Probable region of exposure	Probable region of exposure to HIV; compared between early and late diagnosis groups	5 years
Registration with General Practitioner	Current registration status with General Practitioner; compared between early and late diagnosis groups	5 years
Contact with healthcare professional	Contact with healthcare professional(s) in the year preceding HIV diagnosis (contact versus no contact); compared between early and late diagnosis groups	5 years
Frequency of healthcare contacts	Frequency of contact with healthcare professional(s) in the year preceding HIV diagnosis; compared between early and late diagnosis groups	5 years
Previous HIV testing	Previous HIV testing (no testing versus testing); compared between early and late diagnosis groups	5 years
Clinical indicator disease	Presence or absence of a BHIVA clinical indicator disease in the five years preceding diagnosis; compared between early and late diagnosis groups	5 years
Number of clinical indicator disease(s)	Number of BHIVA clinical indicator disease(s) present in the five years preceding diagnosis; compared between early and late diagnosis groups	5 years
Co-existing hepatitis B/C infection	Presence or absence of a co-existing hepatitis B/C infection; compared between early and late diagnosis groups	5 years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Frequency of missed opportunities for diagnosis	Number of missed opportunities for diagnosis as defined by the BHIVA testing guidelines; compared between early and late diagnosis groups	5 years
Circumstance of HIV diagnosis	Circumstance of HIV diagnosis; no BHIVA clinical indicator disease present versus testing offered following detection of a BHIVA clinical indicator disease versus no testing offered following the detection of a BHIVA clinical indicator disease. Compared between early and late diagnosis groups	5 years

Collaborators and Investigators

• Sponsor: University of Aberdeen
• Collaborators: NHS Grampian
• Investigators: Principal Investigator: Emmanuel Okpo, MBBS FFPH, NHS Grampian and University of Aberdeen

Publications and helpful links

General Publications

• Wohlgemut J, Lawes T, Laing RB. Trends in missed presentations and late HIV diagnosis in a UK teaching hospital: a retrospective comparative cohort study. BMC Infect Dis. 2012 Mar 28;12:72. doi: 10.1186/1471-2334-12-72.
• Sullivan AK, Curtis H, Sabin CA, Johnson MA. Newly diagnosed HIV infections: review in UK and Ireland. BMJ. 2005 Jun 4;330(7503):1301-2. doi: 10.1136/bmj.38398.590602.E0. Epub 2005 May 13. No abstract available.
• Ellis S, Curtis H, Ong EL; British HIV Association (BHIVA); BHIVA Clinical Audit and Standards sub-committee. HIV diagnoses and missed opportunities. Results of the British HIV Association (BHIVA) National Audit 2010. Clin Med (Lond). 2012 Oct;12(5):430-4. doi: 10.7861/clinmedicine.12-5-430.
• Lucas SB, Curtis H, Johnson MA. National review of deaths among HIV-infected adults. Clin Med (Lond). 2008 Jun;8(3):250-2. doi: 10.7861/clinmedicine.8-3-250.

Helpful Links

• British HIV Association. UK National Guidelines for HIV testing 2008

Study record dates

Study Major Dates

• Study Start: June 1, 2015
• Primary Completion (Actual): August 1, 2015
• Study Completion (Actual): August 1, 2015

Study Registration Dates

• First Submitted: June 29, 2015
• First Submitted That Met QC Criteria: June 14, 2016
• First Posted (Estimate): June 17, 2016

Study Record Updates

• Last Update Posted (Estimate): June 17, 2016
• Last Update Submitted That Met QC Criteria: June 14, 2016
• Last Verified: June 1, 2016

More Information

Terms related to this study

• Keywords: HIV; Human immunodeficiency virus; Late diagnosis
• Additional Relevant MeSH Terms: RNA Virus Infections; Virus Diseases; Infections; Blood-Borne Infections; Communicable Diseases; Sexually Transmitted Diseases, Viral; Sexually Transmitted Diseases; Lentivirus Infections; Retroviridae Infections; Immune System Diseases; Slow Virus Diseases; HIV Infections; Acquired Immunodeficiency Syndrome; Immunologic Deficiency Syndromes
• Other Study ID Numbers: 2-030-15

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No