BHIVA 2019 audit shows early access to ART but U=U and peer support both need to be improved

Simon Collins, HIV i-Base

The main BHIVA audit for 2019 focused on timelines from HIV diagnosis to assessment by a specialist HIV doctor and to starting ART, based on case-note review of newly diagnosed adults (age 16 or over) who were first seen between 1 January 2018 and 31 March 2019.

Participation in the audit was good, with data being provided for 2281 individuals from 132 clinic sites, and a further three sites reporting no eligible individuals.

Key findings

  • That nationally, only 67% of individuals were seen by an HIV specialist doctor within two weeks of their initial diagnosis, which is the standard of care. This varied widely between sites. Delays were more common among individuals tested in general practice or in non-GUM/HIV outpatient departments.
  • Benefits of ART to the individual and partner notification were each covered for 85% of individuals at, or before, the first discussion of starting ART.
  • However, information about U=U: undetectable equals untransmittable, was only discussed by 56%.
  • The availability of peer/community support was discussed in 61% cases. There was wide variation between sites for both U=U and peer support.
  • Most individuals (83%) met the NHS England measure of starting ART within 91 days of diagnosis. Excluding those with missing data, 51% started within 4 weeks and 79% within 8 weeks.


Following these results, BHIVA made three key recommendations for specialist HIV services.

  1. Ensure pathways into HIV care are readily accessible with clear guidance for all healthcare professionals and peer/community support organisations. This should be kept updated and communicated to colleagues, especially general practice.
  2. Routinely discuss and document all relevant topics, including U=U and availability of peer/community support, with newly diagnosed individuals.
  3. Review individuals who have not started ART within 6–8 weeks of diagnosis to identify possible support needs.


BHIVA. BHIVA Audit annual report, December 2019. (PDF)


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