Article Text

Download PDFPDF

Effectiveness and cost-effectiveness of implementing HIV testing in primary care in East London: protocol for an interrupted time series analysis
  1. Werner Leber1,
  2. Lee Beresford1,
  3. Claire Nightingale2,
  4. Estela Capelas Barbosa3,
  5. Stephen Morris3,
  6. Farah El-Shogri1,
  7. Heather McMullen1,
  8. Kambiz Boomla1,
  9. Valerie Delpech4,
  10. Alison Brown4,
  11. Jane Hutchinson5,
  12. Vanessa Apea5,
  13. Merle Symonds5,
  14. Samantha Gilliham5,
  15. Sarah Creighton6,
  16. Maryam Shahmanesh3,
  17. Naomi Fulop3,
  18. Claudia Estcourt5,7,
  19. Jane Anderson6,
  20. Jose Figueroa8,
  21. Chris Griffiths1
  1. 1 Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
  2. 2 Population Health Research Institute, St George’s, University of London, London, UK
  3. 3 Department of Applied Health Research, University College London, London, UK
  4. 4 Department of HIV and STI, National Infection Service, Public Health England, London, UK
  5. 5 Barts Sexual Health Centre, Barts Health NHS Trust, London, UK
  6. 6 Centre for Sexual Health, Homerton University Hospital NHS Foundation Trust, London, UK
  7. 7 School of Health and Life Sciences, Glasgow Caledonian University, London, UK
  8. 8 Specialised Commissioning Team, NHS England, London, UK
  1. Correspondence to Dr Werner Leber; w.leber{at}


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.

  • HIV
  • HIV testing
  • HIV screening
  • HIV diagnosis
  • implementation
  • interrupted time series
  • cost-effectiveness

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

View Full Text

Statistics from


  • Contributors WL, LB, CN, ECB, SM, CE, JA, JF and CG significantly contributed to designing the study and drafted the protocol. FE-S, HM, KB, VD, AB, JH, VA, MS, SG, SC, MS and NF contributed to designing the study. All authors and contributors approved the submitted version of the manuscript.

  • 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.

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests JA reports fees and non-financial support from Bristol Myers Squibb, grants and personal fees from Gilead Sciences, personal fees from ViiV, personal fees from Merck Sharp & Dohme, grants from Janssen, and personal fees from AbbVie, outside the submitted work. CE and JH report grants from Gilead Sciences.

  • Ethics approval Camden and Islington NHS Research Ethics Committee, London.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.