HIV testing in A&E diagnoses 78

Thursday 15 September 2016


A UK-first initiative to routinely test A&E patients for HIV has led to 78 new diagnoses in its 12 months.

Since July 2015, all patients over the age of 16 having a blood test in the Emergency Department (A&E) at St Thomas’ Hospital have been tested for HIV, unless they chose to opt out.

During the first year, more than 29,000 people were tested. In total 78 people tested positive who were unaware of their HIV status and another 12 had not sought follow-up treatment since their diagnosis.

The prevalence of HIV in the area of south London served by Guy’s and St Thomas’ is the highest in the UK. In Lambeth, 15 per 1,000 people have HIV, and in Southwark this figure is 13 per 1,000. Nationally, only 1.9 people per 1,000 have the virus (Source: Public Health England).

Dr Nick Larbalestier, consultant physician and clinical lead for HIV at Guy’s and St Thomas’, says: “People with HIV can live long and healthy lives, but this depends on them being diagnosed promptly and receiving the specialist treatment they need. This is why it’s so important to normalise the testing process and increase detection rates.

“In 2014 there were 613 HIV/AIDS deaths in the UK (according to Public Health England) – half were associated with late diagnosis. We introduced routine testing in our Emergency Department to provide early diagnosis, so we can start to treat people sooner.

“Since introducing this new approach to testing, we have also seen a 15% decrease in the number of people with HIV being admitted to our hospital because people are getting the treatment they need before they become acutely unwell.”

Joel Paparello, HIV specialist nurse at Guy’s and St Thomas’, says: “Our HIV screening programme is helping to identify people who might not otherwise get timely diagnoses. A quarter of the people we diagnosed had recently acquired the infection and early treatment intervention will have great personal and public health benefits.”

Prince Harry heard about the results of this new approach to HIV testing in A&E when he visited Burrell Street Sexual Health Centre in July. During the visit he said: “To de-stigmatise HIV testing it is important that everyone gets tested. Why wouldn’t you?”

Dr Michael Brady, Medical Director at Terrence Higgins Trust, says: "This proactive approach to HIV testing by Guy's and St Thomas' has been a fantastic success in terms of diagnosing people living with HIV who may not otherwise have known their status.

“We know that 1 in 6 people living with HIV remain undiagnosed. Testing puts people in control. When someone with HIV is on effective treatment they can expect long and healthy lives and won’t pass the virus on to others. This opt-out approach to testing will prevent people getting seriously ill, enable them to live longer and ultimately reduce further HIV transmissions. I hope other A&E departments, especially those in areas where rates of HIV and late diagnosis are higher, will be able to implement similar testing programmes.”

An estimated 107,800 people are living with HIV in the UK and 24% of these are undiagnosed (Source: Terrence Higgins Trust). If people do not realise they have the infection they can unknowingly transmit it to others.

HIV is a treatable medical condition and, by increasing the detection of undiagnosed cases, Guy’s and St Thomas’ can ensure that patients receive care and treatment from the Trust’s dedicated team of specialists.

Late diagnosis reduces the patient’s life expectancy and increases the risk of ongoing transmission. The cost of including HIV in the routine blood tests is less than £5 per patient but the cost of a late diagnosis is often considerable, in terms of both the patient’s health and unknowing onward transmission. The lifetime cost of treating an individual living with HIV is around £300,000.

Last updated: September 2016

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