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

Study Overview
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Brief Summary
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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.

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

Conditions
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Human Immunodeficiency Virus

Intervention / Treatment
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* Other: No intervention


Participation Criteria
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Eligibility Criteria
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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

Ages Eligible for Study
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Minimum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Newly diagnosed individuals with HIV<br>Individuals newly diagnosed with HIV in Grampian between January 2009 and December 2014 | Other: No intervention<br> <br> |

What is the study measuring?
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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 | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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HIV, Human immunodeficiency virus, Late diagnosis