Dr Werner Leber, an East London GP with a passion for driving earlier identification and diagnosis of HIV, has seen his work recognised by the European agency responsible for the continent’s defences against infectious disease – the European Centre for Disease Prevention and Control (ECDC).
Dr Leber (above) is a practising GP in Tower Hamlets as well as being an NIHR Clinical Lecturer in Primary Care. His work with the CLAHRC, based at the Queen Mary University of London, aims to improve the identification and management of people with HIV.
Werner’s research among East London’s GP practices will now have a Europe-wide impact after being highlighted as good practice by the ECDC in its first integrated European hepatitis B virus (HBV) hepatitis C virus (HCV) and HIV testing guidance. The trial is summarised on page 71 of the guidance.
“The results support the hypothesis that an education programme promoting rapid HIV testing in general practice leads to increased and earlier HIV diagnosis.”
Public health guidance on HIV, hepatitis B and C testing in the EU/EEA;
An integrated approach
European Centre for Disease Prevention and Control, 2018
The project consortium and a panel of experts highlighted work published by Dr Leber and his team – Promotion of rapid testing for HIV in primary care (RHIVA2): a cluster-randomised controlled trial as a case study to support the published evidence and advice for implementation for the new guidance.
Read the RHIVA2 case study as a stand-alone document.
In this trial in Hackney, general practices were randomly assigned to offer either opt-out rapid HIV testing to newly registering adults or continuing usual care. The study found that promotion of opt-out rapid testing in general practice led to an increased rate of diagnosis, and might increase early detection, of HIV.
In developing the guidance the ECDC looked for excellent examples of HBV, HCV and HIV testing services across EU/EEA Member States, reviewing the latest evidence and putting out two published calls for submissions of good practice.
Promotion of rapid testing for HIV in primary care (RHIVA2): a cluster-randomised controlled trial
Lancet HIV. 2015 Jun;2(6):e229-35. doi: 10.1016/S2352-3018(15)00059-4. Epub 2015 Apr 28.
Leber W, McMullen H, Anderson J, Marlin N, Santos AC, Bremner S, Boomla K, Kerry S, Millett D, Mguni S, Creighton S, Figueroa J, Ashcroft R, Hart G, Delpech V, Brown A,
Rooney G, Sampson M, Martineau A, Terris-Prestholt F, Griffiths C
Young Commissioners residential training for Dudley Council Integrated Commissioning hub, 2-4 November 2019
The “Young Commissioner” model – which sees children and young people work with funders and planners of local services to ensure they meet the needs of those in their age group – is gaining traction among local authorities and the NHS.
CLAHRC North Thames child and adolescent researchers are training and supporting staff and young people based at Dudley Council, West Midlands to establish and embed the Young Commissioner model in their Integrated Commissioning Hub. This follows our work with a previous cohort of young people in East London to improve diabetes services.
Over the weekend of 2-4 November this residential event kicked-off the training programme for the young people using the principles of ‘learning by doing’. This has involved blending training with real-time commissioning activities.
The Young Commissioners worked with graphic facilitator Penny Mendonca on public speaking and presentation skills, and the different communication channels they could use.
Adult learners have also accessed project-specific eCPDs developed by the team to help them better align Council systems, structures and processes to optimise the impact and sustainability of this initiative. The adoption of the Young Commissioners model marks an area of innovation in how they work together with the public to commission children and young people’s services.
There is a strong commitment in Dudley Children’s Services to the active involvement of children and young people – the initiative forms part of Dudley Children’s Services Active Involvement strategy 2017, and the Children and Young People Market Position Statement 2018-2022.
“Dudley is a Borough where co-production with children and young people’s their rights are realised, and their views shape decisions made about their lives and those of their families.”
Dudley Children’s Services Active Involvement strategy 2017
We’ve been working with young people to transform how local health diabetes services are designed and delivered for their age group.
CLAHRC researchers based at the University of East London worked with local young people to understand the options and barriers they face when given a diagnosis of diabetes and using NHS services.
We recruited a mixed young research team – in terms of age, ethnicity, faith-identities and backgrounds – who worked together over one year to help commissioners and providers better understand and address the options and barriers of delivering a ‘perfect’ care pathway.
You can see the results of this work in our latest BITE – a postcard summary of a CLAHRC research paper.
This is part of our wider work to co-design community-based diabetic services responsive to the needs of children and young people
Congratulations were in order for CLAHRC researcher Meredith Hawking after her poster won a prize at the 2018 Annual Scientific Meeting of the Society for Academic Primary Care at the Barbican Centre, London.
The prestigious SAPC event brings together researchers and educators from the primary care community in the UK and around the world to showcase their latest studies.
Meredith is based at Queen Mary University of London and her PhD focuses on Investigating patients’ perspectives and adherence to anticoagulants for atrial fibrillation.
Atrial fibrillation is a heart condition affecting a million people in the UK that causes an irregular and often abnormally fast heart rate. AF is associated with 1 in 8 strokes (1 in 3 over 80 years). More than half these strokes could be averted by oral anticoagulants (OAC), but the proportion of patients receiving oral anticoagulants has improved by only 1.5% per year over the last 25 years and was only 50% in 2012.
Meredith’s poster- entitled Adherence to direct oral anticoagulants for non-valvular atrial fibrillation in real world settings: a systematic review and meta-analysis – outlines her work to explore how widespread nonadherenece to anticoagulants is.
New CLAHRC research highlights a simple intervention that could improve detection of atrial fibrillation (AF) – a potentially dangerous heart condition affecting a million people in the UK and associated with 1 in 8 strokes (1 in 3 strokes among those aged over 80 years).
East London GP and CLAHRC researcher Dr John Robson led an investigation into the impact of regular pulse checks in general practice on AF detection among patients aged 65 and over. This work, published in the British Journal of General Practice, offers evidence that these checks – a cheap and straightforward intervention – rapidly improved the detection and prevalence of AF, meaning quicker access to treatment and reduced risk of stoke for those diagnosed.
The condition causes an irregular and often abnormally fast heart rate and is a leading cause of stroke – with strokes caused by underlying AF twice as likely to be fatal. AF is common in older people, but often shows no symptoms – meaning earlier detection and access to treatment means reduced risk of stroke and the health problems stroke victims have to live with afterwards.
Dr Robson and his team checked historical GP records to investigate the impact of a programme promoting pulse regularity checks across three groups of East London GP practices (or Clinical Commissioning Groups) – City and Hackney, Newham, and Tower Hamlets.
An analysis of electronic primary care patient records before (2007–2012) and after (2012–2017) checks were introduced showed significant increases in AF detection.
Br J Gen Pract. 2018 Jun;68(671):e388-e393. doi: 10.3399/bjgp18X696605
Opportunistic pulse checks in primary care to improve recognition of atrial fibrillation: a retrospective analysis of electronic patient records.
Cole J, Torabi P, Dostal I, Homer K, Robson J
The end of any year sees a number of “best of” charts published and research is no exception!
We’re delighted to report that a paper produced by the CLAHRC’s Dr Werner Leber and Professor Chris Griffiths and others is 2017’s most downloaded in The Lancet HIV. Dr Werner ‘s groundbreaking work represents the first time a model to explore the cost effectiveness of screening for HIV in primary care has been applied to the UK.
The work generated great media interest (below) and offers a model to measure cost-effectiveness for commissioners and providers of HIV care.
Read the paper:
Cost-effectiveness of screening for HIV in primary care: a health economics modelling analysis
Baggaley, Rebecca F et al.
The Lancet HIV , Volume 4 , Issue 10 , e465 – e474
Read the most downloaded list
Read a BITE sized summary of Werner’s work.
Angela Harden is a Professor of Community and Family Health. She is a social scientist with expertise in public health and evidence-informed policy and practice. She has conducted extensive research into the health of young people and the communities in which they live. Key themes in her research include sexual and reproductive health, mental health, health inequalities, the wider determinants of health and the evaluation of complex interventions. Angela has a keen interest in research synthesis, transfer and exchange. She is widely known for her methodological work integrating qualitative research into systematic reviews. Motivated by a desire to learn from the views and experiences of those targeted by public health interventions, this work has received international acclaim.
Before joining UEL Angela held research and teaching positions in a number of universities including the Institute of Education at the University of London, Kings College, and Middlesex University. In 2003 she was awarded a four year senior research fellowship by the Department of Health on the promotion of young people’s health. Her most recent post was as Associate Director of the Evidence for Policy and Practice Information and Co-ordinating Centre at the Social Science Research Unit, Institute of Education. Here she ran a number of large research projects as well as contributing to the design and delivery of a new MSc in Evidence Informed Policy and Practice. Between 2005 and 2008 she co-directed the Methods for Research Synthesis Node of the ESRC National Centre for Research Methods. Internationally, Angela is an active contributor to the Cochrane and Campbell collaborations. She is a co-convenor of the Cochrane Qualitative Methods Research Group and was a co-director of the Cochrane Health Promotion and Public Health Field until it became the Cochrane Public Health Review Group in 2008. She now serves on the methodological advisory board for this new research group.
As a newly appointed Professor of Community and Family Health, Angela’s remit is to develop a programme of research linked to improving the health of Newham. Working closely with colleagues in UEL, Newham University Hospital Trust and relevant external partners, she will focus on research with local relevance for improving health and reducing inequalities. Please click here for more details on this research programme.