Tag Archives: National Health Service

Audit shows many high HIV prevalence areas in England are failing to expand HIV testing

HIV TESTING

Most sexual health commissioners for areas in England with a high HIV prevalence have introduced some form of expanded HIV testing, a study published in the online edition of HIV Medicine shows. However, only a small minority were following national guidance, with just a third having commissioned testing for new registrants in general practice and 14% commissioning testing for people admitted to hospital.

“The results of this audit confirm that routine HIV testing in these settings has been commissioned in only a minority of high-prevalence areas”, comment the authors. “Prioritizing the introduction of routine testing in these settings will be necessary to fully implement national testing guidelines.”

Late diagnosis of HIV is a major concern in the UK. Approximately half of people newly diagnosed with HIV have a CD4 cell count below the threshold for the initiation of antiretroviral therapy (350 cells/mm3) recommended by the British HIV Association (BHIVA) and between a fifth and a quarter of all HIV infections are undiagnosed. Improving HIV diagnosis rates is key to strategies to reduce rates of HIV-related illness and also the continued spread of the virus.

National HIV testing guidelines were issued in 2008 and were endorsed in 2011 by the National Institute for Health and Care Excellence (NICE). These recommend that HIV testing should be expanded beyond traditional settings (sexual health clinics and antenatal services) in areas with a high HIV prevalence – an infection rate of above 2 per 1000. In these circumstances, the guidelines recommend the universal testing of all patients newly registering with a GP, the screening of all new medical admissions to hospital and targeted outreach programmes.

Investigators wanted to assess the level of adherence to these guidelines and to see if there were any obstacles to the expansion of testing.

Between May and June 2012, the investigators contacted sexual health commissioners in the 40 English primary care trusts (PCTs) with a HIV prevalence above 2 per 1000. There was an 88% response rate (35 of 40).

All the respondents were aware of the testing guidelines and the majority (80%; 23 of 35) has introduced some form of expanded testing.

In most cases, this was testing in the community (51%; 18 of 35), followed by testing in general practice (49%; 17 of 35) and testing in hospitals (37%; 13 of 35). However, only four PCTs (11%) had commissioned expanded testing services in all three settings.

Areas with especially high prevalence were more likely to have commissioned services. All but one of the PCTs with a prevalence above 5 per 1000 (92%, 11 of 12) had commissioned some form of expanded testing. More worryingly, a third of PCTs with background prevalence between 2-3 per 1000 had commissioned any form of expanded testing and only 33% had introduced testing at GPs, with just one commissioning testing in hospitals.

When the investigators examined adherence to the specific recommendations of the guidelines, they found that only 31% of PCTs (11 of 35) had commissioned routine testing of new registrants at GPs. Moreover, only a small minority (10 to 20%) of GP practices in these areas participated in expanded testing. In a fifth of PCTs, testing was limited to high-risk groups. PCTs in London, compared to PCTs elsewhere in England, were somewhat more likely to have commissioned the routine testing of new GP registrants (38 vs 18%). HIV testing was incorporated into general sexual health screening at GPs in 17% of PCTs (6 of 35).

An even lower proportion of PCTs had commissioned the routine testing of new admissions to hospital (14%; 5 of 35).

Over half of PCTs (51%) had commissioned community testing via outreach programmes carried out by charities and the voluntary sector. This testing targeted high-risk or marginalised populations including men who have sex with men (six PCTs), African people (four), sex workers (two), people who inject drugs (one) and the homeless (one). Settings for community testing included saunas, polyclinics, pharmacies, prisons, churches and health centres.

Almost all PCTs (94%; 33 of 35) cited lack of resources as a barrier to introducing expanded testing, with two-thirds (23 of 35) also stating that the re-organisation of the NHS was an obstacle. Approximately 75% of commissioners (26 of 35) expected the rate of HIV testing carried out in their area to increase over the next year. None expected a decrease.

“Modelling of the UK HIV epidemic has shown that higher rates of testing combined with timely initiation of antiretroviral therapy can result in reduced HIV incidence”, write the authors. They note that most respondents had introduced some form of expanded testing, “however, only a minority covered the two medical settings mentioned in national testing guidelines…new registrants in general practice…and general medical admissions.” The authors conclude that recent organisational changes in the NHS make it important to monitor “changes in the commissioning of testing over time”.

HIV TESTING WEEK

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Did you know it’s National HIV Testing week from 25th? – If you’ve never had a HIV Test and had sex at least once, without a condom, then YOU need a test!

Check out the details of HIV Testing week and remember, you can pop in to LASS for a free and confidential rapid HIV test.  It only takes a few minutes to get the result.  Call us on 0116 2559995 if you’re interested.

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Prestigious GlaxoSmithKline IMPACT Award, Awarded to LASS

 

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Leicestershire AIDS Support Services has won a prestigious GlaxoSmithKline IMPACT Award for its outstanding contribution to improving health in Leicestershire, GSK and The King’s Fund announced last night at the award ceremony held at London’s Science Museum. LASS provides rapid HIV testing, support, information and advocacy to people affected by HIV and AIDS in one of the most diverse areas in England. Leicester has many different communities and an above average population of HIV positive people.

To slow down the spread of HIV and help people to access treatment, LASS invests in rapid testing services in community settings. There is particularly low uptake in some African communities, so LASS trains volunteers from these communities to carry out testing and provide information. They provide testing at a range of events and venues including African football tournaments to reach people who otherwise wouldn’t be tested. LASS also provides services for people with the virus and maybe coping with other issues like poor mental health, and they provide healthy living training.

The GSK IMPACT Awards, GSK’s flagship UK corporate responsibility programme organised in partnershop with The King’s Fund, is seen as a ‘seal of excellence’ in the sector. As well as as receiving £30,000 in funding during a difficult financial climate, the winners can take part in a training programme hosted by The King’s Fund that provides training, development and networking opportunities. Feedback has shown that this opportunity is as important to the winning charities as the funding as it helps them develop the skills to carry on building their organisation.

Katie Pinnock, Director of UK Corporate Contributions at GSK, OR Lisa Weaks, Third Sector Programme Manager at The King’s Fund said:
‘Congratulations to LASS, a strong winner in these awards. Their work providing, support for people with HIV and bringing testing into local communities, is making a real difference tobpeople lives in hard-to-reach groups. It is sharing best practice to further improve outcomes for its service users as well.’

Patrick Bowe, Chair of LASS Board of Trustees , said:

We are absolutely delighted to be recognised at this high level for the impact of our local work supporting and empowering people living with HIV, and challenging and breaking down stigma and discrimination. Our community HIV testing programme is contributing to government public health targets and has already saved the health service more than £3million through encouraging more people to have an HIV test and know their HIV status.
This huge achievement for Leicester, Leicestershire and Rutland is due to the continued commitment by a great team of staff and volunteers. They are determined to deliver the highest standard of services possible and make a significant diference in HIV provision locally with a relatively small budget. This award will make a significant difference to the profile of our work and the reputation of LASS and our new social enterprise.

The calibre of award is reflected in its judging panel who chose the winners, which this year includes Professor Steve Field, Deputy National Medical Director at NHS England (health inequalities); the journalist, Fiona Philips; Peter Wanless, CEO of The Big Lottery; Gilly Green, Head of UK Grants at Comic Relief; Sir Christopher Gent, Chairman of GSK; and, Sir Chris Kelly, Chair of The King’s Fund.

Please note that case studies and spokespeople are available for interview, along with photographs. For further information or interviews, please contact Saskia Kendall at The King’s Fund press office on 020 7307 2603 or by email on s.kendall@kingsfund.org.uk.

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NICE recommends IVF for older women, and for people with HIV


Since the original recommendations on fertility were published in 2004 there have been many advances in both treatments and in the understanding of different techniques.

– DR GILL LENG, NICE’S DEPUTY CHIEF EXECUTIVE

Childless women aged between 40 and 42 will be able to receive IVF on theNHS for the first time under proposals by the treatment regulator to help more people become parents.

Experts welcomed the National Institute for Health and Clinical Excellence‘s (NICE) planned new policy, which follows the emergence of evidence that IVF can benefit women of that age.

Since 2004 women aged 23 to 39 in England and Wales with an identified cause of infertility, or who have been infertile for at least three years, should have been offered up to three cycles of IVF.

But a squeeze on NHS spending and controversial restrictions mean many have been denied treatment.

Click to read ITV news, with video featuring ITV Daybreak’s Michelle Morrison on the proposed changes to who can get IVF on the NHS.

Under draft revised guidelines issued by NICE on Tuesday, eligibility for IVF – though only one cycle – will be extended to include women aged 40-42 who are deemed to suffer from “absolute infertility” and have no chance of conceiving by other means.

The regulator conceded, however, its stipulation that such women must not have previously undergone IVF was likely to mean that “quite small” numbers would actually benefit.

“Only a small minority of women aged 40-42 may benefit from the chance to have one cycle of IVF at that age,” said Susan Seenan, deputy director of patient group Infertility Network UK .

“It is good to see that the upper age limit for women has been raised as the evidence shows that we can have success with older women, though that should not take away from the clear message that age is still a major factor in fertility and that the longer one waits the greater the likelihood of problems”, said Professor Chris Barratt of Dundee University‘s school of medicine.

NICE also wants to cut the time women aged up to 39 should have been trying to conceive from three to two years. Seenan said that would reduce the frustration felt by childless couples and enable them to access IVF more quickly and thus increase their chances of starting a family.

The new proposals will also rule that only a single embryo should be transferred where possible.

It will also recommend for the first time that doctors can advise HIV-positive male patients that they can have unprotected sex with their female partner in order to conceive as long as the man meets certain criteria, such as being up to date with his antiretroviral medication, and agrees that they only do so when she is ovulating.

Catherine Murphy, head of policy at the Terrence Higgins Trust, welcomed the proposed change. “HIV medications have improved enormously in the last decade, making mother to baby transmission of HIV preventable and ensuring people can live long and healthy lives. It also means that natural conception is now a possibility for HIV positive men and HIV negative women in the right circumstances.

“An HIV diagnosis should no longer be a barrier to parenthood and we are very encouraged that NICE have recognised this in their consultation”, she added.

Original Article via The Guardian

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Free HIV treatment for asylum seekers and non-UK citizens

Asylum seekers and other non-British citizens are set to be given free HIV treatment after the government indicated it was willing to accept an amendment from Lord Fowler to the health bill.

Doctors working with people who have HIV have long argued that refusing free HIV drugs on the NHS to overseas visitors, including asylum seekers, is morally wrong and risks spreading the virus. Fowler, who chaired a House of Lords inquiry into the state of the HIV epidemic in Britain, nearly 25 years after he launched, as a Tory health secretary, the first major campaign warning of the the dangers of Aids, agreed with them.

His amendment to the bill will allow overseas visitors to be treated for HIV on the NHS if they have been here for six months. This brings England into line with Scotland and Wales. Experts believe the cost of providing drugs from a clinic will be far less than the possible costs of treating someone in hospital for Aids. The drugs also prevent new infections.

Ministers have indicated they will accept the amendment without a vote later this week. Anne Milton, the public health minister, said: “This measure will protect the public and brings HIV treatment into line with all other infectious diseases. Treating people with HIV means they are very unlikely to pass the infection on to others.” Perhaps anticipating possible criticism from some sections of the press, she added: “Tough guidance will ensure this measure is not abused.”

Professor Jane Anderson, chair of the British HIV Association – which represents doctors who have been placed in a dilemma by the current rules – said: “This is good news, both for people living with HIV and for public health in general. For too long access to treatment and care for some of the most vulnerable people has been compromised by the English charging arrangements.

“There is no ethical or economic reason to leave people living with HIV without appropriate treatment. Recent research shows that proper treatment can also reduce infectiousness and so stop other people becoming infected.

“I am delighted that Lord Fowler has finally won the argument on this point. It’s a decision that will certainly save lives and improve the quality of life of many who were previously shut out from appropriate treatment.”

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Original Article by Sarah Boseley at The Guardian

UKBA proposals to deny entry or stay to migrants with NHS debt: a public health disaster waiting to happen

The changes to the Immigration Rules later this month will include a new provision allowing refusal of entry or stay where a migrant has an unpaid NHS debt.  While the Government has brought out the familiar narrative of ‘health tourism’ to justify using immigration controls as a form of punishment for people with NHS debts, Sarah from National AIDS Trust, writes that these plans are likely to have a detrimental impact of public health in the UK.

Sarah Radcliffe is Senior Policy and Campaigns Officer at NAT (National AIDS Trust). NAT is the UK’s HIV policy charity. They champion the rights of people living with HIV and campaign for change.  Sarah works on policy issues around migration and asylum, access to healthcare, poverty and welfare.  Her words follow:

The biannual announcement of changes to the Immigration Rules this month will include a new provision allowing refusal of immigration applications for entry or stay where a migrant has an unpaid NHS debt. The Department of Health have agreed to share information about individuals’ NHS debts with UKBA to make this possible.

The Government has brought out the familiar narrative of ‘health tourism’ to justify using immigration controls as a form of punishment for people with NHS debts. The DH and UKBA consultation documents outlined a plan of deterring people who are not entitled to free NHS secondary care from accessing it, by escalating the personal consequences of leaving an NHS debt unpaid.

Of course, what these proposals do not acknowledge is that it often in the best interest of the NHS, and the public generally, for chargeable migrants to access secondary healthcare. A key illustration of this is accessing treatment for HIV, the only STI and communicable disease which is subject to treatment charges.

HIV treatment is highly effective at keeping people well and out of hospital.  It is also highly effective at helping prevent onwards transmission of HIV – being on treatment reduces the probability that someone will pass on HIV by 96%. To get maximum benefit from HIV treatment, it is important that someone is diagnosed in good time.  People who are diagnosed late, or not at all, are most likely to become unwell and need to access more expensive treatment options.  The majority of new HIV cases come from someone who has not been diagnosed.

Charging for HIV treatment is highly effective in deterring people from accessing the individual and community benefits of treatment. It also is an effective way of deterring people from accessing testing, even though this is free, because why find out you are living with a lifelong condition if you won’t be able to afford treatment?  Migrant communities affected by HIV are already very likely to be diagnosed late, after they should have already started treatment.  In 2009, two thirds of new HIV diagnoses among African migrants were ‘late’.

This deterrence effect goes beyond those who are actually chargeable. Charging regulations are complex and it is not always clear to an individual migrant if they will or won’t be charged for their treatment. If they know that others in their community are pursued for debts that they can’t pay, they may assume they will also be charged and never seek treatment.  By the same token, it may not be clear to a migrant that they can still access treatment for other infectious diseases such as TB for free, if they have been charged for HIV. Patients stay away from TB treatment for this very reason.

Far from the image of the ‘health tourist’, entering the UK for the sole aim of using the NHS, most chargeable migrants with HIV are in the UK precariously, as refused asylum seekers or irregular migrants, and are living in destitution. Their NHS debts could be written off, but are often pursued, due to inconsistent application of the charging rules.

Threatening migrants with refusal of further applications for entry or stay in the UK will add to the deterrence effect already created by NHS charging rules – the Government has got that much right. What they are yet to acknowledge, though, is that these plans will succeed to the detriment of public health.

To find out more about the entitlement to healthcare for migrants read Wayne Farah’s blog “Access to Primary Healthcare for migrants” and visit our Health4Migrants website.

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THT Asks Government to Legalise and Regulate HIV Home Testing Kits

Almost two-thirds of people would consider using HIV home testing kits if they were legally available and regulated, according to a survey.

The poll, by Terrence Higgins Trust (THT), comes as the charity urged the Government to legalise and regulate home testing in a bid to cut the number of cases of undiagnosed HIV in the UK.

The sale of HIV home testing kits is currently illegal in the UK. While they can be bought over the internet, THT says they are unregulated, often of poor quality and do not direct users to places where they can get support.

Of 490 people surveyed who have not tested HIV-positive, 63% said they would consider using the kits if they were legalised and 51% thought legalisation would make them test more often.

Among gay men, one of the groups most at risk of HIV in the UK, 60% thought legalisation would make them test themselves more often.

In 2009, 22,200 people were estimated to be living with undiagnosed HIV in the UK.

Lisa Power, policy director for THT, said: “Reducing undiagnosed HIV is a major challenge. A quarter of those with HIV in the UK remain undiagnosed, and so are more likely to pass the virus on. One way to bring this number down is by increasing the opportunities for people to test outside of traditional settings.”

A spokeswoman for the Department of Health said: “We are considering our current policy on HIV home testing and whether we need to repeal the current regulations.

“Key to any repeal will be the availability of a quality-assured testing kit suitable for home use. We are working with the THT and others in taking forward our review.

“HIV testing is widely available from open-access NHS sexual health clinics. Our advice is clear – if you think you might be at risk from HIV, contact your local sexual health service or your GP for a test.”

Original Article by the Press Association

The Terence Higgins Trust policy document: HIV and Sexual Health: 12 things the Government can do was launched a few days ago, at this year’s Conservative Party Conference. The document, which includes a section on home testing, is available to download from here www.tht.org.uk/12things.

Are you interested in having a HIV test?  We offer a completely free and confidential rapid HIV test and you’ll get the results within 60 seconds from a simple finger prick test. We use the Insti HIV test produced by BioLytical laboratories. The test is 99.96% accurate from 90 days post contact for detecting HIV 1 and 2 antibodies. We also have a mobile testing van which is often out in communities providing mobile rapid HIV tests. Appointments are not always necessary, if you would like a test, please contact us on 0116 2559995

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NHS Has ‘Outdated Attitude’ Towards HIV Patients

HIV positive patients still have to deal with the stigma associated with the disease.

This is the view of Catherine Murphy, head of parliamentary and public affairs at the Terrence Higgins Trust. Ms Murphy believes that the stigma is particularly acute in the healthcare sector.

She said an assortment of research has been conducted and results show HIV patients still experience discrimination by healthcare workers.

“We do know that still happens quite regularly and that people have poor experiences in the NHS, in primary care,” Ms Murphy commented.

She cited the example of dentists telling HIV sufferers that their appointment needs to be the final one of the day so equipment can be sterilised, as well as some dentists rejecting them altogether. According to Ms Murphy, this is a very outdated attitude and people should expect healthcare professionals to know better.

The Terrence Higgins Trust estimated 86,500 people who had HIV were living in the UK in 2009, a 4.2 per cent rise on the previous year.

Via Private Health Care News

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