Using comprehensive routinely collected surveillance data, we present quality of care measures for persons diagnosed with HIV infection at the national level for the first time. Almost all (97%) adults diagnosed with HIV infection in 2011 were linked to HIV care within 3 months, and 88% within 4
weeks. Furthermore, among adults diagnosed in 2010, 85% were retained in care in 2011 and 92% of those diagnosed late were receiving treatment. Collectively, these findings indicate that the NHS provides high-quality DAPT care to persons newly diagnosed with HIV infection in the UK. Importantly, there was little variation of linkage to care, retention and treatment coverage by sociodemographic characteristics and exposure category. There was no evidence of health inequalities with regard to access to and retention Raf phosphorylation in HIV care in the UK. These findings are strikingly different from those of studies carried out in the USA, which show lower rates of linkage to and retention in care following diagnosis, with important inequalities in access
to health care . Despite excellent HIV care, in 2011 almost half of adults diagnosed with HIV infection had a CD4 count at or below the threshold at which treatment should have been initiated. Patients diagnosed late have an 8-fold increased risk of mortality within a year of diagnosis compared with those diagnosed promptly. Reducing late diagnosis is also a public health priority, as HIV diagnosis provides awareness of infection and access to drugs to reduce viral load. Late HIV diagnosis is a key indicator for monitoring the success of testing interventions and is included in the Public Health Outcome Framework for England . Methamphetamine Heterosexual men had the highest rate of late diagnosis compared
with other risk groups. This is probably a consequence of the impact of the universal offer of an HIV test during antenatal care and targeted testing campaigns aimed at MSM. The proportions of late diagnoses in both pregnant women and MSM have declined slightly over the past decade . Nevertheless, an estimated 1000 MSM (a third of diagnoses] in 2011 were diagnosed late. The elevated proportion of late diagnoses among black men and women is largely the result of the high numbers of new diagnoses reported among adults of sub-Saharan origin, who acquired their infection before arriving in the UK . Our analyses indicate that the reduction of late HIV diagnoses requires urgent investment to increase testing coverage and frequency among groups at highest risk of HIV infection. In addition, we demonstrate exceptionally high 1-year mortality rates among persons diagnosed late. These data highlight the importance of early ART, with the magnitude of the benefit of ART being greatest among older adults . BHIVA Standards of Care guidelines recommend linkage to HIV care within 14 days of HIV diagnosis .