Positively Together
Patient pathways
Dr Anna Pryce
GUM SpR, Royal Hallamshire Hospital
February 2011
Patient Pathways: Outline
 HIV in Sheffield
 Testing pathways
 Local innovation
 Care pathways
 Discussion
HIV in Sheffield
 1 in 700 people in Sheffield have been diagnosed
with HIV
 Around 750 people receive care in Sheffield
(including non-residents)
 People of African origin and men who have sex
with men are disproportionately affected
 47 % are diagnosed late (CD4<200)
Late diagnoses by PCT Yorkshire and the
Humber
Guidance on testing:
 HIV in the United Kingdom: 2009 Report (HPA):
 “Initiatives to expand HIV testing in clinical and community
settings should be promoted”
 2008 National Guidelines for HIV testing:
 Tests should be offered to all adults registering in general practice
and to all general medical admissions where HIV prevalence is
>2/1000 (Sheffield 1.4/1000)
 NICE guidelines: Increasing uptake of HIV testing
amongst black Africans and MSM (due March 2011).
Opportunities for testing
 Screen in high prevalence areas >2/1000
 Test if risk factors (may need episodic testing)
 Test if symptoms of primary HIV infection/seroconversion
illness
 Test if indicator diseases
De-mystifying HIV testing
 All healthcare professionals should be able to obtain
informed consent
 Lengthy pre-test counselling un-necessary
 Testing should be normalised
 All those offering testing should be aware of referral
pathways to specialist services
Testing for HIV
• HIV test
• may be positive from 2.5 weeks
• repeat test at 3/12 still recommended
 Send serum sample with virology form specifying
“HIV test”
 Organise follow-up with patient in 1 week
 Support is available for all REACTIVE results
Local innovation
•HIV sampling for MSM in Sheffield
•Salivary sampling pilot 2009
•126 kits distributed (60 returned)
•38% never tested before
•28% bisexual
•No HIV diagnoses
Other local innovations
 Gilead UK and Ireland Fellowship funded outreach
testing in Black African communities
 Partner testing study
 Routine testing in General Practice
 Targeted HIV testing in ITU
The routine offer and recommendation of HIV testing
in primary care and hospital settings is feasible and
acceptable to patients and staff.
Shared care pathways
 Intra hospital care pathways
 e.g. Karposi sarcoma, antenatal, renal, hepatitis co-infection etc.
 Joint care pathways with General Practice
 Not yet established
 Great scope for joint expertise in long term clinical management
e.g. hyperlipidaemia, hypertension, eczema, asthma/COPD etc.
 Cytology and vaccinations
 Partnerships with other care providers
 IVDU, alcohol, asylum seekers
 Partnerships with voluntary organisations
HIV care pathways
 Use CD4 count to decide if health problem likely to be
related to HIV
 If poor CD4 count discuss with HIV specialist
 Encourage communication between GP and HIV
specialist
 Important both ways – we want to know about non-HIV
health problems!
Further information
 http://www.medfash.org.uk/publications/documents/
HIV_in_Primary_Care.pdf
 http://www.bashh.org (National Guidelines for HIV
testing)
 http://www.bhiva.org/TreatmentofHIV1_2008.aspx
(HIV Treatment Guidelines)
 http://guidance.nice.org.uk/PHG/Wave19/3 (Draft
NICE Guidelines for black Africans)
 http://guidance.nice.org.uk/PHG/Wave19/4 (Draft
NICE Guidelines for MSM)
Discussion
 Barriers to HIV testing and accessing care
 Communication between HIV specialists and
other care providers
 Development of shared care pathways
Contact details: anna.pryce@sth.nhs.uk