Agenda item

Report ACH24-011

The Board considered a report presenting the review on HIV Late and Very Late Diagnoses which related to people who presented and were tested late in the course of their disease.

The Director of Public Health said that this work had been planned for some time following the surveillance programme which highlighted that although Bromley had relatively low incidents of HIV there tended to be late diagnosis and the demographic of patients had changed. They had undertaken in depth audits of individual cases to identify anything that could be improved, or any opportunities missed, to make an earlier diagnosis.

The Head of Public Health Intelligence and Performance provided a summary of the findings from the audit. It was noted that the data had been received from the UKHSA (UK Health Security Agency) – HIV Late and Very Late Diagnoses were defined based on the T cells present in the blood, known as CD count. CD4 count less than 350 cells per mm3 of blood was defined as Late HIV diagnosis and CD4 Count with less than 200 cells/mm3 was Very Late HIV diagnosis. The audit had concluded that comparisons between all new HIV diagnoses locally, regionally and nationally had not revealed any statistically significant differences. Nor had the comparison between those diagnosed late or not. This may be because of the small numbers involved although it may also mean such differences do not exist – they were unable to draw conclusions. However, the review data had indicated that those diagnosed late may not be being tested enough.

The Head of Public Health Intelligence and Performance advised that the testing regime had since changed and people attending Emergency Departments must now opt out of testing for HIV. Unfortunately, 2022 review data was missing to understand better the impact of this on late diagnosis, but there was data from the PRUH showing the number of tests completed and number of new diagnoses found. In response to a question from the Chairman, the Head of Public Health Intelligence and Performance said that the review data had shown that all but one of the patients with a new HIV diagnoses had not used PrEP before. The benefits of PrEP to reduce the risk of acquiring HIV were known and indicated the need for wider promotion. It was considered that it would be beneficial to include data from 2022 in the analysis as well as widening the review to include all providers diagnosing HIV for Bromley residents. With regards to late presentations, the Director of Public Health said that a number of patients presented with different diseases and respiratory conditions.

In response to questions, the Head of Public Health Intelligence and Performance said that postcode data indicated that the distribution of diagnosis was widespread across the borough – new diagnoses were in 14 different wards, however the numbers were too low to indicate any clusters. The Assistant Director of Public Health advised that, as the sample was so small it was difficult to draw meaningful conclusions, they had been speaking with colleagues across SEL to consider undertaking a wider audit of HIV data. However, following the review there were some markers that could be taken forward – such as education and training of general practices and health professionals, to promote testing and PrEP and make them more aware of the presence of any indicator conditions.

The Assistant Director of Public Health said that more work needed to be undertaken in relation to better understanding the data – a deep dive would help identify areas of higher concentration. This would allow targeted approach to be developed, raising awareness of late diagnosis and promoting early testing. The Chairman considered that a general campaign may be needed, and looked at PAN London. The Bromley Place Executive Director agreed that this would benefit from a wider approach and suggested that this included looking at the testing in place. The Director of Public Health noted that the review had provided reassurance in that no particular issues had been identified relating to missed opportunities. However they could look at raising awareness amongst clinicians and ensuring that those patients presenting with unusual respiratory conditions/infections were tested as early as possible, and the promotion of testing and PrEP. The Sexual Health Programme Lead informed Board Members that a Bromley GP had joined Fast-Track Cities, a global initiative to end the HIV by 2030 and they were keen to communicate with other colleagues. Instant testing was being offered in some practices and they would continue to promote awareness and testing.

The Chairman thanked the Director of Public Health, Assistant Director of Public Health, Head of Public Health Intelligence and Performance and Sexual Health Programme Lead for their presentation. It was suggested that a further update be provided in 6 months’ time.

RESOLVED that the report be noted.