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To evaluate HIV testing of patients aged ≥50 years presenting to secondary care with clinical indicator conditions (CICs) for HIV.Retrospective audit of electronic records for patients aged ≥50 years discharged from hospital between January 1st and July 31st 2019 who had at least one documented CIC. Patient demographics and HIV testing data were collected from clinical systems (excluding sexual health databases).2478 patients with a CIC were identified. 222 (9.0%) received an HIV test within 31 days of discharge. Patients receiving a test were significantly younger (mean 68.6 versus 75.3 years; P 0.001) and significantly more men underwent testing than women (60.4% versus 39.6%; P = 0.001). 32 CICs were identified across nine disease systems. By system, those with a haematological CIC were significantly more likely to undergo testing compared with all other CICs combined (P 0.001). Of individual CICs, patients with Kaposi's sarcoma, hepatitis C, neutropenia, lymphadenopathy, pyrexia of unknown origin and thrombocytopenia (P 0.001), and seborrhoeic dermatitis, hepatitis B, other unexplained blood dyscrasia, and non-Hodgkin's lymphoma (P 0.05) were more likely to undergo testing than those presenting with other CICs. Patients with dementia and lung cancer were less likely to undergo testing (P 0.001). Patients presenting with a greater number of CICs were significantly more likely to undergo testing (P = 0.002).HIV testing among patients aged ≥50 years presenting to secondary care with a CIC is low. Work is needed to improve HIV testing practice in this patient group.

We assessed attitudes to disclosure to new sexual partners and association with sexual behaviours among HIV-diagnosed gay, bisexual, and other men who have sex with men (GBMSM) in the UK Antiretrovirals, Sexual Transmission Risk and Attitudes (ASTRA) study in 2011-12. Among 1373 GBMSM diagnosed with HIV for ≥3 months and reporting sex in the past three months (84% on antiretroviral therapy (ART), 75% viral load (VL) ≤50c/mL), 56.3% reported higher sexual disclosure ("agree" or "tend to agree" with "I'd expect to tell a new partner I'm HIV-positive before we have sex"). GBMSM on ART with self-reported undetectable VL had lower disclosure than those on ART without self-reported undetectable VL and those not on ART. Higher sexual disclosure was associated with higher prevalence of CLS in the past three months; this was due to its association with CLS with other HIV-positive partners. Higher sexual disclosure was more common among GBMSM who had CLS with other HIV-positive partners only (72.1%) compared to those who had higher-risk CLS with HIV-serodifferent partners (55.6%), other CLS with HIV-serodifferent partners (45.9%), or condom-protected sex only (47.6%). Findings suggest mutual HIV-disclosure and HIV-serosorting were occurring in this population. Knowledge of VL status may have impacted on disclosure to sexual partners.

Introduction: Comorbidities are increasingly common among people living with HIV (PLWH) as they age. There is no evidence regarding models of care. We aimed to assess feasibility of a novel methodology to investigate care processes for serious medical events in PLWH. Method: The method was based on the National Confidential Enquiry into Patient Outcome and Death (NCEPOD). Data were extracted from medical records and questionnaires completed by general practitioners (GPs), HIV physicians, and non-HIV specialist physicians. A panel reviewed anonymized cases and gave feedback on the review process. Results: Eleven of 13 patients consented to the study. Questionnaires were completed by 64% of HIV physicians, 67% of non-HIV specialist physicians, and 55% of GPs. The independent review panel (IRP) advised improvement in the methodology including data presentation and timing. Conclusion: This method was acceptable to patients and secondary care physicians. Further work is needed to the improve GP responses and facilitate IRP.

Approximately 13% of people living with HIV in the UK are undiagnosed which has significant implications in terms of onward transmission and late diagnosis. HIV testing guidelines recommend routine screening in anyone presenting to healthcare with an HIV indicator condition (IC); however, this does not occur routinely. This study aimed to assess the feasibility and effectiveness of using case note prompts highlighting the presence of an IC to increase HIV testing. Clinicians in three outpatient departments received case note prompts either before or after a period of clinician-led identification. Test offer and uptake rates were assessed. A parallel anonymous seroprevalence study estimated the prevalence of undiagnosed HIV. A total of 4191 patients had an appointment during the study period; 608 (14.5%) had an IC. HIV test offer was significantly higher when a prompt was inserted into notes (34.3% versus 3.2%, p

Background Despite a decline in the number of new HIV infections in the UK overall, the number and proportion of new HIV diagnoses in people aged ≥50 years continues to increase. People aged ≥50 years are disproportionately affected by late diagnosis, which is associated with poorer health outcomes, increased treatment complexity and increased healthcare costs. Late HIV diagnosis also has significant public health implications in terms of onward HIV transmission. It is not fully understood what factors affect the decision of an older person to test for HIV. The aim of this study was to identify factors associated with testing for HIV in people aged ≥50 years who tested late for HIV. Methods We interviewed 20 people aged ≥50 years diagnosed late with HIV to identify factors associated with HIV testing. Interviews were audio recorded, transcribed verbatim and thematically analysed. Results Seven themes associated with HIV testing in people aged ≥50 years were identified: experience of early HIV/AIDS campaigns, HIV knowledge, presence of symptoms and symptom attribution, risk and risk perception, generational approaches to health and sexual health, stigma, and type of testing and testing venue. Conclusion Some factors associated with testing identified in this study were unique to older individuals. People aged ≥50 years often do not perceive themselves to be at risk of HIV. Further, stigma and a lack of knowledge of how to access HIV testing suggest a need for health promotion and suggest current sexual health services may need to adapt to better meet their needs.

Objectives: To identify aspects of healthcare that are most valued by people with HIV; and to describe their concerns and preferences for the future delivery of services for non-HIV related illness amongst people living with HIV (PLWHIV). \ud Methods: Twelve focus groups of people receiving HIV care were conducted in community settings in South-East England. Groups were quota sampled based on age, sex, sexual orientation, and ethnicity. Data were analysed using Framework Analysis.\ud Results: Among the 74 respondents (61% male) a preference for maintaining all care within specialist HIV clinics was commonplace, but was highest among participants with more extensive histories of HIV and comorbidities. Participants valued care-coordination, inter-service communication, and timely updates to medical notes. There were high levels of concern around HIV skills in general practices and the capacity of general practitioners (GP) to manage patient confidentiality or deal appropriately with the emotional and social changes of living with HIV. \ud Implications: Participants valued, and had an overall preference for, the specialist knowledge and skills of HIV services, suggesting that non-HIV-specialist services will need to build their appeal if they are to have a greater future role in the care of people with HIV. Particular concerns that should be addressed include: patient confidence in the HIV knowledge and skills of non-specialist service providers; clear processes for prescribing and referrals; improved levels of care-coordination and communication between services; increased patient confidence in the capacity of primary care to maintain confidentiality and to appreciate the stigma associated with HIV.

There is an ongoing need for effective methods for prevention of HIV infection. A wide range of tools is needed, in varying social and economic contexts, and against different modes of transmission. Recent advances have concentrated on biomedical approaches to prevention, including the use of antiretroviral therapy (ART) prior to possible exposure to HIV: pre-exposure prophylaxis (PrEP).

Background:\ud Approximately 13% of people living with HIV in the UK are unaware of their infection. New diagnoses among people ≥50 years is increasing. Unique factors may be associated with testing in this group. This review aims to identify patient and clinician-related barriers/facilitators to HIV testing in people aged ≥50 years. \ud Methods: \ud A systematic electronic search was conducted. Papers were assessed for eligibility and data from eligible studies were extracted. Barriers/facilitators were grouped, and number of times reported was noted. Due to considerable heterogeneity, a narrative approach has been undertaken to synthesise data. \ud Findings: \ud 17 studies were included. Main barriers to testing were low perceived risk, and clinicians’ preconceptions about older people. Main facilitators were regular use of healthcare services or being offered/encouraged to test by a healthcare provider.\ud Interpretation: \ud Although being encouraged to test was a common facilitator, clinicians’ preconceptions about older people was the biggest barrier, showing a divide between clinicians’ preconceptions and patient’s expectations, which may impact on testing rates. This review is an important first step to identify potential barriers/facilitators for further study or to be addressed in the design of future interventions.

Introduction: While the care of HIV-positive patients, including the detection and management of comorbidities, has historically been provided in HIV specialist outpatient clinics, recent years have seen a greater involvement of non-HIV specialists and general practitioners (GPs). The aim of this study is to determine whether patients would prefer to see their GP or HIV physician given general symptoms, and to understand what aspects of care influence their preferences.\ud Methods/analysis: We have developed and piloted a discrete choice experiment (DCE) to better understand patients’ preferences for care of non-HIV-related acute symptoms. The design of the DCE was informed by our exploratory research, including the findings of a systematic literature review and a qualitative study. Additional questionnaire items have been included to measure demographics, service use and experience of non HIV illnesses and quality of life (EQ5D). We plan to recruit 1000 patients from 14 HIV clinics across South East England. Data will be analysed using random-effects logistic regression and latent class analysis. ORs and 95% CIs will be used to estimate the relative importance of each of the attribute levels. Latent class analysis will identify whether particular groups of people value the service attribute levels differently. Ethics/dissemination: Ethical approval for this study was obtained from the Newcastle and North Tyneside Research Ethics Committee (reference number 14/NE/1193. The results will be disseminated at national and international conferences and peer-reviewed publications. A study report, written in plain English, will be made available to all participants. The Patient Advisory Group will develop a strategy for wider dissemination of the findings to patients and the public.

Objectives: To understand which aspects of general practitioner (GP) and HIV clinic appointments people living with HIV (PLWHIV) most value when seeking advice for new health problems.\ud \ud Methods: A discrete choice experiment using a convenience sample of people diagnosed with HIV. Participants were recruited from 14 general HIV clinics in the South East of England between December 2014 and April 2015. ORs were calculated using conditional logit (CLOGIT) and latent class models (LCMs).\ud \ud Results: A total of 1106 questionnaires were returned. Most participants were male (85%), white (74%) and were men who have sex with men (69%). The CLOGIT analysis showed people particularly valued shorter appointment waiting times (ORs between 1.52 and 3.62, p

Background Effective therapy means that HIV-positive individuals can now experience a near normal life expectancy. Despite these advances in treatment, about one in six people living with HIV in the UK are unaware of their infection. Although the overall number of new HIV diagnoses has decreased, the number of people diagnosed at age 50 years and older is increasing. There might be unique factors associated with the decision to test for HIV in this group. This systematic review aimed to identify patient and clinician related barriers and facilitators to HIV testing in people aged 50 and above. Methods A systematic electronic search of Medline, Embase, PsycINFO, and CINAHL was conducted on April 7, 2016. Search terms included combinations of words describing HIV, old age, and testing. Papers were assessed for eligibility (published since Jan 1, 1997, describing barriers or facilitators to testing, research in people ≥50 years, written in English). Data from eligible studies were extracted (including study design, sample size and characteristics, analysis, and reported barriers or facilitators to testing). Reported barriers and facilitators were grouped into themes, and the number of times each was reported was noted. Findings Electronic searches identified 1752 articles, of which 14 primary studies met the inclusion criteria. A further three eligible papers were identified from reference and citation searching. 17 papers were included in the review. Most of the studies (n=14) were from the USA. The main patient barriers to non-testing were low perceived risk and not being offered or encouraged to test by a health-care professional (reported five and three times, respectively). The main clinician barrier was preconceptions about older people and discomfort discussing sexuality and risk (reported five times). Main facilitators of testing were being offered or encouraged to test by a health-care professional, previous interactions with health-care services, and high perceived risk (all reported more than five times). Interpretation Clinicians' beliefs that people aged 50 years and older are not at risk of HIV infection, or will feel uncomfortable discussing risk and sexuality, were among the most commonly cited barriers to offering a test. However, being offered or encouraged to test by a health-care professional was the most commonly cited facilitator to testing. The divide between clinicians' preconceptions and patients' expectations might impact on testing rates. Funding This work is part of a National Institute for Health Research doctoral research fellowship (ref DRF-2015-08-086).

Background/introduction There is a need for evidence - based models of care to effectively manage the increasing numbers of the people with HIV (PWH) who have comorbid conditions. This study was part of an NIHR Programme Development Grant to inform the development of HIV services to meet the needs of an ageing population. Aim(s)/objectives To explore the healthcare experiences of PWH who have comorbid conditions and the staff involved in their care to identify priorities for service improvement. Methods Experience-based co-design methodology was used to understand the experiences of PWH accessing General Practice, HIV, Cardiology, Liver, Renal and Rheumatology services. Patients were recruited from the HIV clinic and staff purposively sampled from the service areas. Experiences were gathered through observation, diaries, audio and filmed interviews. Thematic analysis was undertaken and filmed patient interviews analysed for emotional touchpoints. Staff and patient feedback events were utilised to validate data and identify areas for service development. A joint staff and patient co-design event was held to agree shared priorities for future services. Results 22 patients (with 110 comorbidities) and 18 staff were recruited. A composite film was produced from the patient interviews. Examples of touchpoints were communication, burden of appointments and repetition across services. Patients identified 6 areas for service improvement and staff identified 3. The agreed priorities for future service development were care co-ordination, shared medical records/results and systems to manage multiple appointments. Discussion/conclusion Experience-based co-design methodology was effective in identifying future service models for PWH who have comorbid conditions.

UK guidelines recommend routine HIV testing in general medical admissions where HIV prevalence exceeds 2/1000.1 Brighton has the highest UK HIV prevalence (7.96/1000) outside London.2 A previous study in Brighton showed that 39.7% of medical admissions were offered HIV tests in a physician-led testing programme, and the acceptance was 91%.3 Since February 2013, Royal Sussex County Hospital, Brighton has offered routine HIV testing in general medical admissions aged 18–79, not known …

Background High rates of infectious syphilis have been reported in MSM. Locally 1:10 of the population are estimated MSM and high rates of HIV and sexually transmitted infections are seen. Methods We identified cases of infectious syphilis in MSM per month from February-2013 to June-2014 attending sexual health services. Age, ethnicity, HIV status and syphilis re-infection were noted. The total number of MSM seen in sexual health was used as a denominator for incidence calculations and rates were compared using Chi-square and Mann-Whitney test. Results 207 new cases of infectious syphilis were identified over the study period. The median age was 36 years (19–60), 96/207(46.4%) were HIV+ and 3/207(1.4%) had syphilis re-infection. The median incidence of syphilis from February to October 2013 was 8.6/1000 MSM; this increased significantly to 25.9/1000 MSM from November–June 2014 [chi-square 67.447 (p < 0.0001). There was no significant difference in the percentage co-infected with HIV between these time points (February-October = 57%, November-June = 46% [Mann-Whitney = 16.5, p = 0.0581). Conclusion We describe a significant increase in the incidence of infectious syphilis in MSM from November 2013. This rise is likely attributable to changes in sexual behaviour among MSM: increased accessibility to sex driven by social media, increased anonymous and group sex and growing use of party drugs. Locally we are working with the Terrence Higgins Trust and public health teams to increase awareness among MSM and primary care.

Background/introduction UK national guidelines recommend routine HIV testing in general medical admissions and primary care in areas where the HIV prevalence exceeds 2/1000 in the local population. The guidelines recommend further operational research to assess the feasibility and efficacy of different approaches to routine testing. A recent study showed that when a physician led model of testing is in place, 39.7% of all general medical patients are offered HIV tests. Aim(s)/objectives Assess the feasibility and acceptability of a non-physician directed (NPD) model of HIV testing. Methods Retrospective cohort study involving a review of the proportion of all medical admissions offered tests by a NPD model of HIV testing. Results 57.9% (1973/3409) of all general medical admissions aged 18–79 were offered HIV tests. Acceptability was high with 96.7% (1908/1973) of offered patients having HIV tests. The mean age of patients offered and tested was 56.8 years. Discussion/conclusion This study demonstrates superior feasibility and efficacy of a non-physician directed model of routine HIV testing. Although cost and culture remain important barriers of employing this strategy in many hospitals, the use of allied health professionals may be an important step in achieving National and International guidelines for HIV testing.

Background/introduction Alcohol and recreational drug misuse is an increasing problem in sexual health clinics, particularly MSM where it is often associated with unsafe sexual practices and increasing prevalence of sexually transmitted infections (STIs). Aims/objectives To determine the proportion of MSM testing positive for STIs reporting substance misuse in a dedicated sexual health clinic, compared to the proportion attending THT services reporting high risk sexual activity requiring support for substance misuse. Methods Case notes of patients attending a MSM clinic testing positive for STIs over a 6 month period were reviewed. Data was collected on type of STI, recreational drug and alcohol use. Over the same period, data on high-risk sexual activity and referral to specialist drug and alcohol services was collected for MSM attending THT services. Results 285 MSM attended the sexual health clinic, whereby 97 (34%) tested positive for 1 or more STI. 88 cases of gonorrhoea were seen, 49 cases of chlamydia, 20 cases of syphilis and 7 new HIV infections. Of those testing positive for STIs, 45 (46%) reported alcohol and/or recreational drug misuse. Of the 162 MSM attending THT services, 90 (56%) reported high risk sexual behaviour with concurrent substance misuse. 27 (30%) were referred to specialist substance misuse services. Discussion/conclusions High rates of substance misuse associated with high risk sexual activity were seen in the MSM clinic and at THT. This reinforces the importance of screening and brief intervention/referral for substance misuse as a risk reduction strategy for STIs and HIV.