Effectiveness and cost effectiveness of implementing HIV testing in primary care in east London: protocol for an interrupted time series analysis

Werner Leber, Lee Beresford, Claire Nightingale, Estela Capelas Barbosa, Stephen Morris, Farah El-Shogri, Heather McMullen, Kambiz Boomla, Valerie Delpech, Alison Brown, Jane Hutchinson, Vanessa Apea, Merle Symonds, Samantha Gilliham, Sarah Creighton, Maryam Shahmanesh, Naomi Fulop, Claudia Estcourt, Jane Anderson, Jose FigueroaChris Griffiths

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Abstract

Introduction: HIV remains underdiagnosed. Guidelines recommend routine HIV testing in primary care, but evidence on implementing testing is lacking. In a previous study, the Rapid HIV Assessment 2 (RHIVA2) cluster randomised controlled trial, we showed that providing training and rapid point-of-care HIV testing at general practice registration (RHIVA2 intervention) in Hackney led to cost-effective, increased and earlier diagnosis of HIV. However, interventions effective in a trial context may be less so when implemented in routine practice. We describe the protocol for an MRC phase IV implementation programme, evaluating the impact of rolling out the RHIVA2 intervention in a post-trial setting. We will use a longitudinal study to examine if the post-trial implementation in Hackney practices is effective and cost-effective, and a cross-sectional study to compare Hackney with two adjacent boroughs providing usual primary care (Newham) and an enhanced service promoting HIV testing in primary care (Tower Hamlets).

Methods and analysis: Service evaluation using interrupted time series and cost-effectiveness analyses. We will include all general practices in three contiguous high HIV prevalence East London boroughs. All adults aged 16 and above registered with the practices will be included. The interventions to be examined are: a post-trial RHIVA2 implementation programme (including practice-based education and training, external quality assurance, incentive payments for rapid HIV testing and incorporation of rapid HIV testing in the sexual health Local Enhanced Service) in Hackney; the general practice sexual health Network Improved Service in Tower Hamlets and usual care in Newham. Coprimary outcomes are rates of HIV testing and new HIV diagnoses.

Ethics and dissemination: The chair of the Camden and Islington NHS Research Ethics Committee, London, has endorsed this programme as an evaluation of routine care. Study results will be published in peer-reviewed journals and reported to commissioners.
Original languageEnglish
Article numbere018163
JournalBMJ Open
Volume7
Issue number12
DOIs
Publication statusPublished - 14 Dec 2017

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Cost-Benefit Analysis
Primary Health Care
HIV
HIV-2
General Practice
Reproductive Health
Interrupted Time Series Analysis
Costs and Cost Analysis
Research Ethics Committees
Program Evaluation
Ethics
Longitudinal Studies
Motivation
Early Diagnosis
Randomized Controlled Trials
Cross-Sectional Studies
Guidelines
Education

Keywords

  • HIV testing
  • primary care
  • virology

Cite this

Leber, W., Beresford, L., Nightingale, C., Capelas Barbosa, E., Morris, S., El-Shogri, F., ... Griffiths, C. (2017). Effectiveness and cost effectiveness of implementing HIV testing in primary care in east London: protocol for an interrupted time series analysis. BMJ Open, 7(12), [e018163]. https://doi.org/10.1136/bmjopen-2017-018163
Leber, Werner ; Beresford, Lee ; Nightingale, Claire ; Capelas Barbosa, Estela ; Morris, Stephen ; El-Shogri, Farah ; McMullen, Heather ; Boomla, Kambiz ; Delpech, Valerie ; Brown, Alison ; Hutchinson, Jane ; Apea, Vanessa ; Symonds, Merle ; Gilliham, Samantha ; Creighton, Sarah ; Shahmanesh, Maryam ; Fulop, Naomi ; Estcourt, Claudia ; Anderson, Jane ; Figueroa, Jose ; Griffiths, Chris. / Effectiveness and cost effectiveness of implementing HIV testing in primary care in east London: protocol for an interrupted time series analysis. In: BMJ Open. 2017 ; Vol. 7, No. 12.
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abstract = "Introduction: HIV remains underdiagnosed. Guidelines recommend routine HIV testing in primary care, but evidence on implementing testing is lacking. In a previous study, the Rapid HIV Assessment 2 (RHIVA2) cluster randomised controlled trial, we showed that providing training and rapid point-of-care HIV testing at general practice registration (RHIVA2 intervention) in Hackney led to cost-effective, increased and earlier diagnosis of HIV. However, interventions effective in a trial context may be less so when implemented in routine practice. We describe the protocol for an MRC phase IV implementation programme, evaluating the impact of rolling out the RHIVA2 intervention in a post-trial setting. We will use a longitudinal study to examine if the post-trial implementation in Hackney practices is effective and cost-effective, and a cross-sectional study to compare Hackney with two adjacent boroughs providing usual primary care (Newham) and an enhanced service promoting HIV testing in primary care (Tower Hamlets).Methods and analysis: Service evaluation using interrupted time series and cost-effectiveness analyses. We will include all general practices in three contiguous high HIV prevalence East London boroughs. All adults aged 16 and above registered with the practices will be included. The interventions to be examined are: a post-trial RHIVA2 implementation programme (including practice-based education and training, external quality assurance, incentive payments for rapid HIV testing and incorporation of rapid HIV testing in the sexual health Local Enhanced Service) in Hackney; the general practice sexual health Network Improved Service in Tower Hamlets and usual care in Newham. Coprimary outcomes are rates of HIV testing and new HIV diagnoses.Ethics and dissemination: The chair of the Camden and Islington NHS Research Ethics Committee, London, has endorsed this programme as an evaluation of routine care. Study results will be published in peer-reviewed journals and reported to commissioners.",
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Leber, W, Beresford, L, Nightingale, C, Capelas Barbosa, E, Morris, S, El-Shogri, F, McMullen, H, Boomla, K, Delpech, V, Brown, A, Hutchinson, J, Apea, V, Symonds, M, Gilliham, S, Creighton, S, Shahmanesh, M, Fulop, N, Estcourt, C, Anderson, J, Figueroa, J & Griffiths, C 2017, 'Effectiveness and cost effectiveness of implementing HIV testing in primary care in east London: protocol for an interrupted time series analysis', BMJ Open, vol. 7, no. 12, e018163. https://doi.org/10.1136/bmjopen-2017-018163

Effectiveness and cost effectiveness of implementing HIV testing in primary care in east London: protocol for an interrupted time series analysis. / Leber, Werner; Beresford, Lee; Nightingale, Claire; Capelas Barbosa, Estela; Morris, Stephen; El-Shogri, Farah; McMullen, Heather; Boomla, Kambiz; Delpech, Valerie; Brown, Alison; Hutchinson, Jane; Apea, Vanessa; Symonds, Merle; Gilliham, Samantha; Creighton, Sarah; Shahmanesh, Maryam; Fulop, Naomi; Estcourt, Claudia; Anderson, Jane; Figueroa, Jose; Griffiths, Chris.

In: BMJ Open, Vol. 7, No. 12, e018163, 14.12.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effectiveness and cost effectiveness of implementing HIV testing in primary care in east London: protocol for an interrupted time series analysis

AU - Leber, Werner

AU - Beresford, Lee

AU - Nightingale, Claire

AU - Capelas Barbosa, Estela

AU - Morris, Stephen

AU - El-Shogri, Farah

AU - McMullen, Heather

AU - Boomla, Kambiz

AU - Delpech, Valerie

AU - Brown, Alison

AU - Hutchinson, Jane

AU - Apea, Vanessa

AU - Symonds, Merle

AU - Gilliham, Samantha

AU - Creighton, Sarah

AU - Shahmanesh, Maryam

AU - Fulop, Naomi

AU - Estcourt, Claudia

AU - Anderson, Jane

AU - Figueroa, Jose

AU - Griffiths, Chris

N1 - Acceptance email in SAN; author will forward on the AAM (C.E. email 27-9-17) OA, so used VoR Funding note: Funding WL, FE-S, LB, CN, ECB were supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Barts Health NHS Trust. HM was supported by an NIHR Doctoral Fellowship from 2013 to 2016. HM was supported by a National Institute of Health Research Doctoral Fellowship from 2013 to 2016.

PY - 2017/12/14

Y1 - 2017/12/14

N2 - Introduction: HIV remains underdiagnosed. Guidelines recommend routine HIV testing in primary care, but evidence on implementing testing is lacking. In a previous study, the Rapid HIV Assessment 2 (RHIVA2) cluster randomised controlled trial, we showed that providing training and rapid point-of-care HIV testing at general practice registration (RHIVA2 intervention) in Hackney led to cost-effective, increased and earlier diagnosis of HIV. However, interventions effective in a trial context may be less so when implemented in routine practice. We describe the protocol for an MRC phase IV implementation programme, evaluating the impact of rolling out the RHIVA2 intervention in a post-trial setting. We will use a longitudinal study to examine if the post-trial implementation in Hackney practices is effective and cost-effective, and a cross-sectional study to compare Hackney with two adjacent boroughs providing usual primary care (Newham) and an enhanced service promoting HIV testing in primary care (Tower Hamlets).Methods and analysis: Service evaluation using interrupted time series and cost-effectiveness analyses. We will include all general practices in three contiguous high HIV prevalence East London boroughs. All adults aged 16 and above registered with the practices will be included. The interventions to be examined are: a post-trial RHIVA2 implementation programme (including practice-based education and training, external quality assurance, incentive payments for rapid HIV testing and incorporation of rapid HIV testing in the sexual health Local Enhanced Service) in Hackney; the general practice sexual health Network Improved Service in Tower Hamlets and usual care in Newham. Coprimary outcomes are rates of HIV testing and new HIV diagnoses.Ethics and dissemination: The chair of the Camden and Islington NHS Research Ethics Committee, London, has endorsed this programme as an evaluation of routine care. Study results will be published in peer-reviewed journals and reported to commissioners.

AB - Introduction: HIV remains underdiagnosed. Guidelines recommend routine HIV testing in primary care, but evidence on implementing testing is lacking. In a previous study, the Rapid HIV Assessment 2 (RHIVA2) cluster randomised controlled trial, we showed that providing training and rapid point-of-care HIV testing at general practice registration (RHIVA2 intervention) in Hackney led to cost-effective, increased and earlier diagnosis of HIV. However, interventions effective in a trial context may be less so when implemented in routine practice. We describe the protocol for an MRC phase IV implementation programme, evaluating the impact of rolling out the RHIVA2 intervention in a post-trial setting. We will use a longitudinal study to examine if the post-trial implementation in Hackney practices is effective and cost-effective, and a cross-sectional study to compare Hackney with two adjacent boroughs providing usual primary care (Newham) and an enhanced service promoting HIV testing in primary care (Tower Hamlets).Methods and analysis: Service evaluation using interrupted time series and cost-effectiveness analyses. We will include all general practices in three contiguous high HIV prevalence East London boroughs. All adults aged 16 and above registered with the practices will be included. The interventions to be examined are: a post-trial RHIVA2 implementation programme (including practice-based education and training, external quality assurance, incentive payments for rapid HIV testing and incorporation of rapid HIV testing in the sexual health Local Enhanced Service) in Hackney; the general practice sexual health Network Improved Service in Tower Hamlets and usual care in Newham. Coprimary outcomes are rates of HIV testing and new HIV diagnoses.Ethics and dissemination: The chair of the Camden and Islington NHS Research Ethics Committee, London, has endorsed this programme as an evaluation of routine care. Study results will be published in peer-reviewed journals and reported to commissioners.

KW - HIV testing

KW - primary care

KW - virology

U2 - 10.1136/bmjopen-2017-018163

DO - 10.1136/bmjopen-2017-018163

M3 - Article

VL - 7

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 12

M1 - e018163

ER -