GP-based testing for HIV is cost-effective in areas of high prevalence and should be rolled out in 74 local authorities

New CLAHRC research published in The Lancet HIV has found that offering HIV testing to people on registration with a new GP in areas of high prevalence of the disease is cost-effective and will save lives.

Researchers based at the London School of Hygiene & Tropical Medicine and Queen Mary University of London (QMUL) carried out the study in areas with high prevalence of HIV – involving 86,000 people from 40 GP surgeries.

The promising results prompted CLAHRC researchers to call for a roll-out of HIV screening to all 74 high HIV prevalence local authorities in England (those with more than two diagnosed HIV infections per 1,000 adults).

HIV treatment is expensive, particularly when diagnosis is late. Early diagnosis means earlier intervention and treatment, saving the NHS money.

Building on earlier research from a trial in Hackney – a socioeconomically deprived inner London borough with an HIV prevalence rate of 8 per 1000 adults – the trial involved 40 general practices where they tested the effect of rapid fingerprick HIV testing as part of the standard health check during registration. They found it led to a four-fold higher HIV diagnosis rate.

Using a mathematical model that includes all the costs associated with HIV testing and treatment, the team now show that primary care HIV screening in high prevalence settings becomes cost-effective in 33 years (according to National Institute for Health and Care Excellence [NICE] criteria).

The CLAHRC North Thames study was carried out in partnership with NHS City and Hackney and involved University College London, Homerton University Hospital NHS Foundation Trust, University of Warwick, and University of British Columbia.

Dr Werner Leber from QMUL said: “We’ve shown that HIV screening in UK primary care is cost effective and potentially cost saving, which is contrary to widespread belief. This is an important finding given today’s austerity. Financial pressures, particularly within local authority’s public health budgets, mean that the costs of HIV testing are under intense scrutiny, and in some areas investment in testing has fallen.”

Read the full paper

Rebecca F Baggaley, Michael A Irvine, Werner Leber, Valentina Cambiano, Jose Figueroa, Heather McMullen, Jane Anderson, Andreia C Santos, Fern Terris-Prestholt, Alec Miners, T. Déirdre Hollingsworth, Chris J Griffiths.

Cost-effectiveness of screening for HIV in primary care: a health economics modelling analysis.

The Lancet HIV. DOI:10.1016/S2352-3018(17)30123-6

Evaluating a Healthy Schools programme – our report and recommendations published

School-based interventions to increase health and wellbeing

The health and wellbeing of school children is a pressing concern in England, with a  growing prevalence of obesity and diabetes in childhood. It is also widely recognised that a child’s emotional health and wellbeing influences their cognitive development and learning, as well as their physical and social health and mental wellbeing in adulthood.

These increased concerns, aligned with a better recognition of the emotional and mental health needs of children, led the Greater London Authority (GLA) to develop and co-ordinate a school based health programme to improve health and wellbeing for all pupils in London.

The result was the development of the GLA’s Healthy Schools London programme (HSL) launched in April 2013 and co-ordinated by the Greater London Authority (GLA). The programme encourages schools to adopt a whole school approach to combat the specific health and wellbeing needs of their pupils by developing their policies and procedures.  HSL recognises and rewards the schools’ endeavours through a system of awards: Bronze, Silver, and Gold.

A CLAHRC North Thames project recently completed a two-year evaluation of the programme. The aim of the evaluation was to assess the contribution of the programme to improving educational attainment, and health and well-being, among schoolchildren in London. It was funded jointly by the GLA and the CLAHRC, and was conducted between 2014 and 2016 by Dr Harry Rutter and Dr Andrew Barnfield from the London School of Hygiene and Tropical Medicine (LSHTM).

We conducted literature reviews, focus groups in 20 schools, interviews with 6 directors of public health and directors of children’s services, focus groups with borough leads, interviews with the GLA core team and borough leads, and two assessment visits to special schools. We also conducted an online survey across all participating schools, with a total of over 450 responses.

Was HSL effective in its aims?

Our evaluation

  • Assessed the potential for the HSL programme to influence educational achievement, promote healthy lifestyle behaviours, and reduce health inequalities in London
  • Investigated the extent to which becoming a Healthy School is associated with changes in school-level policies, and activities.
  • Assessed the nature and level of engagement with the HSL programme by schools, including any differential uptake by socio-economic factors, and to understand the drivers and barriers to becoming a Healthy School
  • Provided recommendations to inform the ongoing development of the HSL programme

The evaluation concluded that HSL provides a valuable mechanism to encourage change at school level. Among a suite of recommendations, the evaluation suggested that:

  • HSL would be strengthened by encouraging schools to work more closely together.
  • A mentoring programme could help to spread best practice between schools,
  • There is scope for stronger links between school sand local communities.
  • The implementation of a programme to enhance health and wellbeing provision in early year’s settings could provide an additional mechanism for health improvement, and promote school preparedness among the capital’s children.

Read the full report and recommendations

 

NEON project makes the news

Our innovative Nurture Early for Optimal Nutrition (NEON) project has made the headlines..in India!. The project is exploring whether a South Asian model proven to promote healthy nutrition in children can “travel” successfully to the UK and help children of Bangladeshi origin in East London.Professor Monica Lakhanpaul is leading the project and spoke to The Goan newspaper about the bi-directional exchange of knowledge that is making a difference in one of London’s less advantaged communities.

 

 

 

 

 

 

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