Trends in HIV testing in the UK primary care setting: a 15-year retrospective cohort study from 2000 to 2015

ObjectivesTo estimate trends in HIV testing, positivity and prevalence in UK primary care for 2000–2015 as part of a wider investigation into reasons for late diagnosis of HIV.DesignRetrospective cohort study using the Clinical Practice Research Datalink (CPRD) which is derived from computerised cli...

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Vydáno v:BMJ open Ročník 9; číslo 11; s. e027744
Hlavní autoři: Gompels, Mark, Michael, Skevi, Davies, Charlotte, Jones, Tim, Macleod, John, May, Margaret
Médium: Journal Article
Jazyk:angličtina
Vydáno: England British Medical Journal Publishing Group 24.11.2019
BMJ Publishing Group LTD
BMJ Publishing Group
Témata:
Acquired immune deficiency syndrome
AIDS
Clinical medicine
Cohort analysis
CPRD
Drug therapy
General practice / Family practice
Health care
Health surveillance
HIV
HIV & AIDS
HIV testing
Hospitals
Human immunodeficiency virus
Infections
Life expectancy
Medical tests
Patients
Primary care
Public health
Trends
United Kingdom > UK
England
CPRD
HIV testing
primary care
HIV & AIDS
ISSN:2044-6055, 2044-6055
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Abstract ObjectivesTo estimate trends in HIV testing, positivity and prevalence in UK primary care for 2000–2015 as part of a wider investigation into reasons for late diagnosis of HIV.DesignRetrospective cohort study using the Clinical Practice Research Datalink (CPRD) which is derived from computerised clinical records produced during consultations in primary care.Setting404 general practices in England.Participants5 979 598 adults aged ≥16 years registered between 2000 and 2015 with 45 093 761 person years of observation.OutcomesAnnual HIV testing rates, proportion of positive tests and prevalence of HIV-infected people recorded in primary care 2000–2015.ResultsHIV testing in primary care increased from 2000 to 2010, but then declined. Testing was higher in females than in males and in those aged 16–44 years compared with older adults. Rates per 100 000 in women aged 16–44 years were 177 (95% CI 167 to 188); 1309 (95% CI 1282 to 1336); 1789 (95% CI 1757 to 1821) and 839 (95% CI 817 to 862) in 2000, 2005, 2010 and 2015, respectively, and for non-pregnant women: 22.5 (95% CI 19 to 26); 134 (95% CI 125 to 143); 262 (95% CI 250 to 275); 190 (95% CI 179 to 201). For men aged 16–44 years rates were: 26 (95% CI 22 to 29); 107 (95% CI 100 to 115); 196 (95% CI 185 to 206); 137 (95% CI 127 to 146). Over the study period, there were approximately two positive results per 1000 HIV tests. Men were eightfold more likely to test positive than women. The percentage of HIV diagnoses among adults recorded in CPRD may be as low as 55% in London and 67% in the rest of the UK.ConclusionsHIV testing rates in primary care peaked in 2010 and subsequently declined. Access to testing was higher for women despite the prevalence of HIV being higher in men.Implications and further research neededOpportunities remain in primary care for increasing HIV testing to prevent costly late diagnoses and decrease HIV transmission. Interventions to improve targeting of tests and increase adherence to HIV testing guidelines are needed in primary care.
AbstractList Objectives To estimate trends in HIV testing, positivity and prevalence in UK primary care for 2000–2015 as part of a wider investigation into reasons for late diagnosis of HIV.Design Retrospective cohort study using the Clinical Practice Research Datalink (CPRD) which is derived from computerised clinical records produced during consultations in primary care.Setting 404 general practices in England.Participants 5 979 598 adults aged ≥16 years registered between 2000 and 2015 with 45 093 761 person years of observation.Outcomes Annual HIV testing rates, proportion of positive tests and prevalence of HIV-infected people recorded in primary care 2000–2015.Results HIV testing in primary care increased from 2000 to 2010, but then declined. Testing was higher in females than in males and in those aged 16–44 years compared with older adults. Rates per 100 000 in women aged 16–44 years were 177 (95% CI 167 to 188); 1309 (95% CI 1282 to 1336); 1789 (95% CI 1757 to 1821) and 839 (95% CI 817 to 862) in 2000, 2005, 2010 and 2015, respectively, and for non-pregnant women: 22.5 (95% CI 19 to 26); 134 (95% CI 125 to 143); 262 (95% CI 250 to 275); 190 (95% CI 179 to 201). For men aged 16–44 years rates were: 26 (95% CI 22 to 29); 107 (95% CI 100 to 115); 196 (95% CI 185 to 206); 137 (95% CI 127 to 146). Over the study period, there were approximately two positive results per 1000 HIV tests. Men were eightfold more likely to test positive than women. The percentage of HIV diagnoses among adults recorded in CPRD may be as low as 55% in London and 67% in the rest of the UK.Conclusions HIV testing rates in primary care peaked in 2010 and subsequently declined. Access to testing was higher for women despite the prevalence of HIV being higher in men.Implications and further research needed Opportunities remain in primary care for increasing HIV testing to prevent costly late diagnoses and decrease HIV transmission. Interventions to improve targeting of tests and increase adherence to HIV testing guidelines are needed in primary care.
ObjectivesTo estimate trends in HIV testing, positivity and prevalence in UK primary care for 2000–2015 as part of a wider investigation into reasons for late diagnosis of HIV.DesignRetrospective cohort study using the Clinical Practice Research Datalink (CPRD) which is derived from computerised clinical records produced during consultations in primary care.Setting404 general practices in England.Participants5 979 598 adults aged ≥16 years registered between 2000 and 2015 with 45 093 761 person years of observation.OutcomesAnnual HIV testing rates, proportion of positive tests and prevalence of HIV-infected people recorded in primary care 2000–2015.ResultsHIV testing in primary care increased from 2000 to 2010, but then declined. Testing was higher in females than in males and in those aged 16–44 years compared with older adults. Rates per 100 000 in women aged 16–44 years were 177 (95% CI 167 to 188); 1309 (95% CI 1282 to 1336); 1789 (95% CI 1757 to 1821) and 839 (95% CI 817 to 862) in 2000, 2005, 2010 and 2015, respectively, and for non-pregnant women: 22.5 (95% CI 19 to 26); 134 (95% CI 125 to 143); 262 (95% CI 250 to 275); 190 (95% CI 179 to 201). For men aged 16–44 years rates were: 26 (95% CI 22 to 29); 107 (95% CI 100 to 115); 196 (95% CI 185 to 206); 137 (95% CI 127 to 146). Over the study period, there were approximately two positive results per 1000 HIV tests. Men were eightfold more likely to test positive than women. The percentage of HIV diagnoses among adults recorded in CPRD may be as low as 55% in London and 67% in the rest of the UK.ConclusionsHIV testing rates in primary care peaked in 2010 and subsequently declined. Access to testing was higher for women despite the prevalence of HIV being higher in men.Implications and further research neededOpportunities remain in primary care for increasing HIV testing to prevent costly late diagnoses and decrease HIV transmission. Interventions to improve targeting of tests and increase adherence to HIV testing guidelines are needed in primary care.
To estimate trends in HIV testing, positivity and prevalence in UK primary care for 2000-2015 as part of a wider investigation into reasons for late diagnosis of HIV.OBJECTIVESTo estimate trends in HIV testing, positivity and prevalence in UK primary care for 2000-2015 as part of a wider investigation into reasons for late diagnosis of HIV.Retrospective cohort study using the Clinical Practice Research Datalink (CPRD) which is derived from computerised clinical records produced during consultations in primary care.DESIGNRetrospective cohort study using the Clinical Practice Research Datalink (CPRD) which is derived from computerised clinical records produced during consultations in primary care.404 general practices in England.SETTING404 general practices in England.5 979 598 adults aged ≥16 years registered between 2000 and 2015 with 45 093 761 person years of observation.PARTICIPANTS5 979 598 adults aged ≥16 years registered between 2000 and 2015 with 45 093 761 person years of observation.Annual HIV testing rates, proportion of positive tests and prevalence of HIV-infected people recorded in primary care 2000-2015.OUTCOMESAnnual HIV testing rates, proportion of positive tests and prevalence of HIV-infected people recorded in primary care 2000-2015.HIV testing in primary care increased from 2000 to 2010, but then declined. Testing was higher in females than in males and in those aged 16-44 years compared with older adults. Rates per 100 000 in women aged 16-44 years were 177 (95% CI 167 to 188); 1309 (95% CI 1282 to 1336); 1789 (95% CI 1757 to 1821) and 839 (95% CI 817 to 862) in 2000, 2005, 2010 and 2015, respectively, and for non-pregnant women: 22.5 (95% CI 19 to 26); 134 (95% CI 125 to 143); 262 (95% CI 250 to 275); 190 (95% CI 179 to 201). For men aged 16-44 years rates were: 26 (95% CI 22 to 29); 107 (95% CI 100 to 115); 196 (95% CI 185 to 206); 137 (95% CI 127 to 146). Over the study period, there were approximately two positive results per 1000 HIV tests. Men were eightfold more likely to test positive than women. The percentage of HIV diagnoses among adults recorded in CPRD may be as low as 55% in London and 67% in the rest of the UK.RESULTSHIV testing in primary care increased from 2000 to 2010, but then declined. Testing was higher in females than in males and in those aged 16-44 years compared with older adults. Rates per 100 000 in women aged 16-44 years were 177 (95% CI 167 to 188); 1309 (95% CI 1282 to 1336); 1789 (95% CI 1757 to 1821) and 839 (95% CI 817 to 862) in 2000, 2005, 2010 and 2015, respectively, and for non-pregnant women: 22.5 (95% CI 19 to 26); 134 (95% CI 125 to 143); 262 (95% CI 250 to 275); 190 (95% CI 179 to 201). For men aged 16-44 years rates were: 26 (95% CI 22 to 29); 107 (95% CI 100 to 115); 196 (95% CI 185 to 206); 137 (95% CI 127 to 146). Over the study period, there were approximately two positive results per 1000 HIV tests. Men were eightfold more likely to test positive than women. The percentage of HIV diagnoses among adults recorded in CPRD may be as low as 55% in London and 67% in the rest of the UK.HIV testing rates in primary care peaked in 2010 and subsequently declined. Access to testing was higher for women despite the prevalence of HIV being higher in men.CONCLUSIONSHIV testing rates in primary care peaked in 2010 and subsequently declined. Access to testing was higher for women despite the prevalence of HIV being higher in men.Opportunities remain in primary care for increasing HIV testing to prevent costly late diagnoses and decrease HIV transmission. Interventions to improve targeting of tests and increase adherence to HIV testing guidelines are needed in primary care.IMPLICATIONS AND FURTHER RESEARCH NEEDEDOpportunities remain in primary care for increasing HIV testing to prevent costly late diagnoses and decrease HIV transmission. Interventions to improve targeting of tests and increase adherence to HIV testing guidelines are needed in primary care.
To estimate trends in HIV testing, positivity and prevalence in UK primary care for 2000-2015 as part of a wider investigation into reasons for late diagnosis of HIV. Retrospective cohort study using the Clinical Practice Research Datalink (CPRD) which is derived from computerised clinical records produced during consultations in primary care. 404 general practices in England. 5 979 598 adults aged ≥16 years registered between 2000 and 2015 with 45 093 761 person years of observation. Annual HIV testing rates, proportion of positive tests and prevalence of HIV-infected people recorded in primary care 2000-2015. HIV testing in primary care increased from 2000 to 2010, but then declined. Testing was higher in females than in males and in those aged 16-44 years compared with older adults. Rates per 100 000 in women aged 16-44 years were 177 (95% CI 167 to 188); 1309 (95% CI 1282 to 1336); 1789 (95% CI 1757 to 1821) and 839 (95% CI 817 to 862) in 2000, 2005, 2010 and 2015, respectively, and for non-pregnant women: 22.5 (95% CI 19 to 26); 134 (95% CI 125 to 143); 262 (95% CI 250 to 275); 190 (95% CI 179 to 201). For men aged 16-44 years rates were: 26 (95% CI 22 to 29); 107 (95% CI 100 to 115); 196 (95% CI 185 to 206); 137 (95% CI 127 to 146). Over the study period, there were approximately two positive results per 1000 HIV tests. Men were eightfold more likely to test positive than women. The percentage of HIV diagnoses among adults recorded in CPRD may be as low as 55% in London and 67% in the rest of the UK. HIV testing rates in primary care peaked in 2010 and subsequently declined. Access to testing was higher for women despite the prevalence of HIV being higher in men. Opportunities remain in primary care for increasing HIV testing to prevent costly late diagnoses and decrease HIV transmission. Interventions to improve targeting of tests and increase adherence to HIV testing guidelines are needed in primary care.
Author Davies, Charlotte
Jones, Tim
Gompels, Mark
May, Margaret
Macleod, John
Michael, Skevi
AuthorAffiliation 4 The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) , University Hospitals Bristol NHS Foundation Trust , Bristol , UK
5 The National Institute of Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions , University of Bristol , Bristol , UK
1 Department of Immunology, Southmead Hospital , North Bristol NHS Trust , Bristol , UK
3 Department of Population Health Sciences, Bristol Medical School , University of Bristol , Bristol , UK
2 Institute of Statistical Science, School of Mathematics , University of Bristol , Bristol , UK
AuthorAffiliation_xml – name: 4 The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) , University Hospitals Bristol NHS Foundation Trust , Bristol , UK
– name: 5 The National Institute of Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions , University of Bristol , Bristol , UK
– name: 1 Department of Immunology, Southmead Hospital , North Bristol NHS Trust , Bristol , UK
– name: 2 Institute of Statistical Science, School of Mathematics , University of Bristol , Bristol , UK
– name: 3 Department of Population Health Sciences, Bristol Medical School , University of Bristol , Bristol , UK
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  orcidid: 0000-0002-9733-1003
  surname: May
  fullname: May, Margaret
  organization: The National Institute of Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions, University of Bristol, Bristol, UK
BackLink https://www.ncbi.nlm.nih.gov/pubmed/31767577$$D View this record in MEDLINE/PubMed
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Issue 11
Keywords CPRD
HIV testing
primary care
HIV & AIDS
Language English
License This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Snippet ObjectivesTo estimate trends in HIV testing, positivity and prevalence in UK primary care for 2000–2015 as part of a wider investigation into reasons for late...
To estimate trends in HIV testing, positivity and prevalence in UK primary care for 2000-2015 as part of a wider investigation into reasons for late diagnosis...
Objectives To estimate trends in HIV testing, positivity and prevalence in UK primary care for 2000–2015 as part of a wider investigation into reasons for late...
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StartPage e027744
SubjectTerms Acquired immune deficiency syndrome
AIDS
Clinical medicine
Cohort analysis
CPRD
Drug therapy
General practice / Family practice
Health care
Health surveillance
HIV
HIV & AIDS
HIV testing
Hospitals
Human immunodeficiency virus
Infections
Life expectancy
Medical tests
Patients
Primary care
Public health
Trends
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Title Trends in HIV testing in the UK primary care setting: a 15-year retrospective cohort study from 2000 to 2015
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Volume 9
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