title: Testing initiatives increase rates of HIV diagnosis in primary care and community settings: an observational single-centre cohort study.
abstract: OBJECTIVE
  The primary objective was to examine trends in new HIV diagnoses in a UK area of high HIV prevalence between 2000 and 2012 with respect to site of diagnosis and stage of HIV infection.
  
  
  METHODS
  Single-centre observational cohort study.
  
  
  METHODS
  An outpatient HIV department in a secondary care UK hospital.
  
  
  METHODS
  1359 HIV-infected adults.
  
  
  METHODS
  Demographic information (age, gender, ethnicity, and sexual orientation), site of initial HIV diagnosis (Routine settings such as HIV/GUM clinics versus Non-Routine settings such as primary care and community venues), stage of HIV infection, CD4 count and seroconversion symptoms were collated for each participant.
  
  
  RESULTS
  There was a significant increase in the proportion of new HIV diagnoses made in Non-Routine settings (from 27.0% in 2000 to 58.8% in 2012; p<0.001). Overall there was a decrease in the rate of late diagnosis from 50.7% to 32.9% (p=0.001). Diagnosis of recent infection increased from 23.0% to 47.1% (p=0.001). Of those with recent infection, significantly more patients were likely to report symptoms consistent with a seroconversion illness over the 13 years (17.6% to 65.0%; p<0.001).
  
  
  CONCLUSIONS
  This is the first study, we believe, to demonstrate significant improvements in HIV diagnosis and a shift in diagnosis of HIV from HIV/GUM settings to primary practice and community settings due to multiple initiatives.
authors.affiliation: Department of GU Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
authors.forename: Prini
authors.initials: P
authors.lastname: Mahendran
authors.affiliation: Department of GU Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
authors.forename: Suneeta
authors.initials: S
authors.lastname: Soni
authors.affiliation: Clinical Investigations and Research Unit, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Goubet
authors.affiliation: Brighton and Sussex Medical School, Brighton, United Kingdom.
authors.forename: Emma
authors.initials: E
authors.lastname: Saunsbury
authors.affiliation: Department of GU Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Roberts
authors.affiliation: Department of GU Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom; Brighton and Sussex Medical School, Brighton, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Fisher
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D000328:Adult; D015331:Cohort Studies; D003153:Community Health Services / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000458:organization & administration*