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Home > Late diagnosis of HIV in the United Kingdom: an evidence review.

Harris, Jane and Khatri, Rose (2015) Late diagnosis of HIV in the United Kingdom: an evidence review. Liverpool John Moores University.

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•Late diagnosis of HIV remains an important public health issue in the UK, with 40% of newly diagnosed individuals in 2014 diagnosed late
•Reducing the number of people presenting to care at a late stage of HIV infection is a key public health priority in the United Kingdom. It is one of only three sexual health indicators included on the Public Health Outcomes Framework for England and a key ambition of the Framework for Sexual Health Improvement in England
•Late diagnosis of HIV is defined as having a CD4 count of less than 350 cells per mm3 within 3 months of diagnosis and is associated with significantly heightened levels of HIV related morbidity and mortality, increased risk of onward HIV transmission (Halve it, 2011) and higher healthcare costs
•Evidence suggests that certain groups are disproportionally affected by late diagnosis, namely older adults, heterosexuals and non-national populations, in particular black Africans
•Evidence suggest that the majority of individuals have lowered perceptions of their risk of acquiring HIV and for those who have recent high risk behaviour, fear of disease is an important barrier to testing. Amongst black African populations, there are additional barriers to testing including a heightened fear of disclosure due to stigma
•Amongst healthcare professionals, missed diagnostic opportunities are well documented and are linked to clinician’s own perceptions of risk and a lack of knowledge of HIV and testing procedures
•Interventions to expand testing beyond routine settings have been shown as both acceptable and feasible to patients and staff and, cost effective. Pilots to expand testing in hospital and primary care settings have found varying levels of testing activity among clinicians suggesting that support and training for healthcare staff is necessary and effective in increasing testing
•Community outreach testing has been found particularly effective among MSM and black African populations. Research suggests that effective interventions must be: grounded in community mobilisation and outreach settings; normalise both testing and treatment for HIV and, address HIV related stigma. Emerging evidence also suggests that new home sampling and home testing methods will be particularly effective in accessing harder to reach groups particularly among MSM

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