THE FIRST ‘90’: FEASIBILITY AND ACCEPTABILITY OF IMPLEMENTING TRAINING AND DEVELOPMENT TO SUPPORT SUCCESSFUL ADOPTION OF OPT OUT HIV TESTING IN THE EMERGENCY AND ACUTE MEDICAL SETTINGS IN A SUBURBAN CENTRE
Background
A significant risk of excess mortality in people living with HIV is late diagnosis. Testing in emergency departments (ED) and acute medical settings has been shown to be effective in picking up those who do not test elsewhere, including in sexual health clinics. This practice, pioneered by Chelsea and Westminster Hospitals NHS Trust and supported by National Institute of health and Care Excellence (NICE), has now been adopted in many metropolitan centres in the UK. Feasibility, acceptability, and cost effectiveness, however, have not been demonstrated in suburban sites.
Using an implementation science methodology, this study at St Helier Hospital in the UK explores introducing HIV testing in the ED. The aim is to also develop guidance to successfully advise others in similar clinic or hospital setting on approaches to increase opt out HIV testing, improve diagnosis rates, reduce ‘late’ diagnosis, and ensure linkage to care.
Design
This project follows a prospective, pre-post study evaluation adopting a mix of qualitative and quantitative outcome measures. The primary implementation strategy of this project is a comprehensive training package (theory and practical role play) and ongoing supportive infrastructure such as dedicated personnel, advertising resources, and patient information. The staff training provided in the comprehensive training package is for all A&E and AMU testing staff (nurses, phlebotomists, healthcare assistants, doctors). The study is expected to report in October 2022.
Primary objectives
- Determine acceptability to staff and patients of implementing opt out testing.
- Determine feasibility and uptake of testing, barriers, facilitators and utility of training, reduction in the proportion of patients diagnosed ‘late’ (CD4 <350), number of new HIV diagnoses, and reduction of local undiagnosed fraction to below 10% (meeting first ‘90’)
Collaborators
Dr. Olubanke Davies
Setting
St Helier University Hospitals
NHS Trust
Location
Carshalton, Surrey, United Kingdom
Duration
Sep 2018 – Oct 2022
Category
Retention in Care and Adherence
RELATED STUDIES
JAMAICA
This study is the first attempt to implement the distribution of HIV Home-based Self-Testing (HIVST) within an emergency medicine setting to increase the coverage of HIV screening and the subsequent linkage to care of PLHIV in Jamaica.
USA
In an effort to increase retention in care, this study aims to evaluate the effectiveness of phone calls from primary caregiver to retain HIV positive patients in care and within the same health care system.
ITALY
The RELAPP study is focused upon developing an algorithm for general practitioners in Italy to identify earlier those at risk of HIV.
Study focus areas
Our implementation research projects have a global reach and focus on improving the HIV prevention and care continuum.
NP-GBL-HVX-WCNT-220049 October 2023
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