title: A novel strategy to reduce very late HIV diagnosis in high-prevalence areas in South-West England: serious incident audit.
abstract: Very late diagnosis of HIV is a serious public health issue. We used serious incident reporting (SIR) to identify and address reasons for late diagnoses across the patient pathway.
  
  
  
  Cases of very late HIV diagnosis were reported via SIR in two 6-month batches between 2011 and 2012 in Bournemouth, Poole and Bristol. Case notes were reviewed for missed opportunities for earlier diagnosis using a root-cause analysis tool.
  
  
  
  A total of 33 patients (aged 30-67 years, 66% male) were diagnosed very late. Although the majority were white British (n = 17), Black African (n = 9) and Eastern European (n = 4) ethnicities were over-represented. Twenty-four (73%) patients had clinical indicator conditions for HIV, 30 (91%) had a risk factor for HIV acquisition, with 13 (39%) having 2 or more (men-who-have-sex-with-men (n = 11), partner HIV positive (n = 11), from high-prevalence area (n = 12)). Actions resulting from SIR included increasing awareness of indicator conditions, HIV education days within primary care, and initiatives to increase testing within hospital specialities.
  
  
  
  SIR allowed identification of reasons for very late HIV diagnosis and provided an impetus for initiatives to address them. SIR may be part of an effective strategy to prevent late diagnosis of HIV which would have important benefits for individual and population health.
authors.affiliation: Public Health England, 2 Rivergate, Temple Quay, Bristol BS1 6EH, UK.
authors.forename: J
authors.initials: J
authors.lastname: Womack
authors.affiliation: GUM/HIV Royal Bournemouth and Christchurch NHS Foundation Trust, Bournemouth BH7 7DW, UK.
authors.forename: E
authors.initials: E
authors.lastname: Herieka
authors.affiliation: Department of Immunology, Southmead Hospital, North Bristol NHS Trust, Westbury-on-Trym, Bristol BS10 5NB, UK.
authors.forename: M
authors.initials: M
authors.lastname: Gompels
authors.affiliation: NHS Dorset, Bournemouth and Poole, Canford House, Discovery Court Business Centre 551-553 Wallisdown Road, Poole, Dorset BH12 5AG, UK.
authors.forename: S
authors.initials: S
authors.lastname: Callaghan
authors.affiliation: Property and Infrastructure, Capita, West Building, Pinesgate, Lower Bristol Road, Bath BA2 3DP, UK.
authors.forename: E
authors.initials: E
authors.lastname: Burt
authors.affiliation: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
authors.forename: C F
authors.initials: CF
authors.lastname: Davies
authors.affiliation: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
authors.forename: M T
authors.initials: MT
authors.lastname: May
authors.affiliation: Public Health England, 2 Rivergate, Temple Quay, Bristol BS1 6EH, UK.
authors.forename: N
authors.initials: N
authors.lastname: O'Brien
authors.affiliation: School of Social and Community Medicine, University Of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK.
authors.forename: J
authors.initials: J
authors.lastname: Macleod
mesh_terms: D000328:Adult; D000368:Aged; D057210:Delayed Diagnosis / Q000517:prevention & control*; D004739:England; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D015995:Prevalence; D015980:Public Health Practice
keywords: AIDS; HIV; late diagnosis; public health practice; serious incident reporting