The Cost-Effectiveness of Early Access to HIV Services and Starting cART in the UK 1996–2008

To calculate use, cost and cost-effectiveness of people living with HIV (PLHIV) starting routine treatment and care before starting combination antiretroviral therapy (cART) and PLHIV starting first-line 2NRTIs+NNRTI or 2NRTIs+PI(boosted), comparing PLHIV with CD4≤200 cells/mm3 and CD4>200 cells/mm3. Few studies have calculated the use, cost and cost-effectiveness of routine treatment and care before starting cART and starting cART above and below CD4 200 cells/mm3.Use, costs and cost-effectiveness were calculated for PLHIV in routine pre-cART and starting first-line cART, comparing CD4≤200 cells/mm3 with CD4>200 cells/mm3 (2008 UK prices).cART naïve patients CD4≤200 cells/mm3 had an annual cost of £6,407 (95%CI £6,382 to £6,425) PPY compared with £2,758 (95%CI £2,752 to £2,761) PPY for those with CD4>200 cells/mm3; cost per life year gained of pre-cART treatment and care for those with CD4>200 cells/mm3 was £1,776 (cost-saving to £2,752). Annual cost for starting 2NRTIs+NNRTI or 2NRTIs+PI(boosted) with CD4≤200 cells/mm3 was £12,812 (95%CI £12,685-£12,937) compared with £10,478 (95%CI £10,376-£10,581) for PLHIV with CD4>200 cells/mm3. Cost per additional life-year gained on first-line therapy for those with CD4>200 cells/mm3 was £4639 (£3,967 to £2,960).PLHIV starting to use HIV services before CD4≤200 cells/mm3 is cost-effective and enables them to be monitored so they start cART with a CD4>200 cells/mm3, which results in better outcomes and is cost-effective. However, 25% of PLHIV accessing services continue to present with CD4≤200 cells/mm3. This highlights the need to investigate the cost-effectiveness of testing and early treatment programs for key populations in the UK

LEARN: A multi-centre, cross-sectional evaluation of Urology teaching in UK medical schools

OBJECTIVE: To evaluate the status of UK undergraduate urology teaching against the British Association of Urological Surgeons (BAUS) Undergraduate Syllabus for Urology. Secondary objectives included evaluating the type and quantity of teaching provided, the reported performance rate of General Medical Council (GMC)-mandated urological procedures, and the proportion of undergraduates considering urology as a career. MATERIALS AND METHODS: LEARN was a national multicentre cross-sectional study. Year 2 to Year 5 medical students and FY1 doctors were invited to complete a survey between 3rd October and 20th December 2020, retrospectively assessing the urology teaching received to date. Results are reported according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). RESULTS: 7,063/8,346 (84.6%) responses from all 39 UK medical schools were included; 1,127/7,063 (16.0%) were from Foundation Year (FY) 1 doctors, who reported that the most frequently taught topics in undergraduate training were on urinary tract infection (96.5%), acute kidney injury (95.9%) and haematuria (94.4%). The most infrequently taught topics were male urinary incontinence (59.4%), male infertility (52.4%) and erectile dysfunction (43.8%). Male and female catheterisation on patients as undergraduates was performed by 92.1% and 73.0% of FY1 doctors respectively, and 16.9% had considered a career in urology. Theory based teaching was mainly prevalent in the early years of medical school, with clinical skills teaching, and clinical placements in the later years of medical school. 20.1% of FY1 doctors reported no undergraduate clinical attachment in urology. CONCLUSION: LEARN is the largest ever evaluation of undergraduate urology teaching. In the UK, teaching seemed satisfactory as evaluated by the BAUS undergraduate syllabus. However, many students report having no clinical attachments in Urology and some newly qualified doctors report never having inserted a catheter, which is a GMC mandated requirement. We recommend a greater emphasis on undergraduate clinical exposure to urology and stricter adherence to GMC mandated procedures

Demographic characteristics and baseline viral load and CD4 count for all patients on first-line regimens.

<p>Demographic characteristics and baseline viral load and CD4 count for all patients on first-line regimens.</p

CD4 T-cell count changes at 6 and 12months for non-AIDS and AIDS patients on different first-line regimens.

<p>CD4 T-cell count changes at 6 and 12months for non-AIDS and AIDS patients on different first-line regimens.</p

Change in CD4 count from baseline for AIDS patients at 12 months for the four treatment regimens.

<p>Change in CD4 count from baseline for AIDS patients at 12 months for the four treatment regimens.</p

Multivariable Cox's proportional hazards regression model showing likelihood of first line treatment failure for the four treatment combinations at 12 months.

*<p>Adjusted for sex, age, ethnic group, baseline CD4 count, baseline viral load, stage of HIV at start of ART and year of starting first-line ART.</p

Multivariable Cox's proportional hazards regression model showing likelihood of first line treatment failure for the four treatment combinations at 6 months.

*<p>Adjusted for sex, age, ethnic group, baseline CD4 count, baseline viral load, stage of HIV at start of ART and year of starting first-line ART.</p

Change in CD4 count from baseline for non-AIDS patients at 12 months for the four treatment regimens.

<p>Change in CD4 count from baseline for non-AIDS patients at 12 months for the four treatment regimens.</p

Change in CD4 count from baseline for AIDS patients at 6 months for the four treatment regimens.

<p>Change in CD4 count from baseline for AIDS patients at 6 months for the four treatment regimens.</p

Change in CD4 count from baseline for non-AIDS patients at 6 months for the four treatment regimens.

<p>Change in CD4 count from baseline for non-AIDS patients at 6 months for the four treatment regimens.</p