PITCH: Promotion of HIV testing in primary care in east London through a research programme. An MRC phase IV implementation study

Problem

HIV remains underdiagnosed. Guidelines recommend routine HIV testing in primary care but evidence on implementing testing is lacking. We aimed to determine the effectiveness of post-trial implementation of a cluster randomised controlled trial (RHIVA2) promoting HIV testing in Hackney general practice.

Approach

The RHIVA2 trial intervention (2010-12) comprised initial education and training, nomination of a practice lead nurse, external quality assurance, and referral of newly diagnosed patients to HIV services. Post-trial implementation (2012-15) included additional intervention training, and audit of antiretroviral co-prescribing and missed HIV diagnoses. Monthly computerised HIV testing data, remotely extracted by the clinical effectiveness group, were analysed using interrupted time series analysis.

Findings

Following the RHIVA2 trial (20 intervention and 20 control practices), an additional 12 practices (11 former trial control, one former non-participating) received the intervention, and training was reinforced in six former trial intervention practices; a total of 31 practices (13 former trial intervention, 15 former trial control, and three former non-participating) completed the audit. HIV testing rates in intervention practices (trial or post-trial) increased immediately following the intervention by 85% (IRR = 1.85, 95% CI 1.72 to 1.99), and a similar effect (IRR 1.82, 95% CI 1.72 to 1.93) was observed when including comparator practices that didn’t receive the intervention at any point. The change in the effect of the intervention during the three years following the intervention implementation decreased significantly (IRR = 0.99, 95% CI 0.99 to 0.99).

Consequences

Post-trial implementation of a research intervention significantly increased testing activity but may require regular support for sustainability.