title: Missed opportunities for earlier HIV diagnosis within primary and secondary healthcare settings in the UK.
abstract: OBJECTIVE
  To identify opportunities for earlier HIV diagnosis within primary and secondary care settings in the UK in Africans with newly diagnosed HIV infection.
  
  
  METHODS
  A survey of newly diagnosed HIV-positive Africans attending 15 HIV treatment centres across London was conducted between April 2004 and February 2006. The survey consisted of a confidential self-completed questionnaire linked to clinician-completed clinical records.
  
  
  RESULTS
  A total of 263 questionnaires were completed, representing an uptake rate of 79.5% of patients approached and 49.8% (131/263) of participants presented with advanced HIV disease (CD4 cell count < 200 cells/mul at diagnosis). In the year prior to HIV diagnosis 76.4% (181/237) had seen their GP, 38.3% (98/256) had attended outpatient services, and 15.2% (39/257) inpatient services, representing missed opportunities for earlier HIV diagnosis. Of those attending GP services the issue of HIV and/or HIV testing was raised for 17.6% (31/176) and 37.1% (78/210) had a previous negative HIV test, 32.5% of these within the UK. Medical attention was sought for wide ranging reasons, often not obviously connected to underlying HIV status. Despite the population predominantly coming from countries of high HIV prevalence personal appreciation of risk was comparatively low and knowledge of benefits of testing lacking.
  
  
  CONCLUSIONS
  Africans are accessing health services but clinicians are failing to use these opportunities effectively for preventive and diagnostic purposes with regards to HIV infection. Comparatively low appreciation of personal risk and lack of perceived ill health within this community means clinicians need to be more proactive in addressing HIV.
authors: Centre for Sexual Health and HIV Research, Department of Primary Care and Population Sciences, London, UK. fburns@gum.ucl.ac.uk
authors: Fiona M
authors: FM
authors: Burns
authors: Anne M
authors: AM
authors: Johnson
authors: James
authors: J
authors: Nazroo
authors: Jonathan
authors: J
authors: Ainsworth
authors: Jane
authors: J
authors: Anderson
authors: Ade
authors: A
authors: Fakoya
authors: Ibidun
authors: I
authors: Fakoya
authors: Andy
authors: A
authors: Hughes
authors: Eva
authors: E
authors: Jungmann
authors: S Tariq
authors: ST
authors: Sadiq
authors: Ann K
authors: AK
authors: Sullivan
authors: Kevin A
authors: KA
authors: Fenton
mesh_terms: D000293:Adolescent; D000328:Adult; D044383:Black People; D003695:Delivery of Health Care / Q000592:standards; D042241:Early Diagnosis; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000208:ethnology / Q000517:prevention & control*; D019538:Health Care Surveys; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D011795:Surveys and Questionnaires