BHIVA Audit 2023: Prior engagement in HIV care among people living with HIV admitted to hospital

Objectives To describe prior engagement in HIV care among people with HIV admitted to hospital in the United Kingdom and to examine clinical characteristics and causes of admission by engagement status. Methods A national audit of adult HIV services was conducted across the United Kingdom in 2023. Participating centres undertook case‐note review of up to 20 recent hospital admissions involving people with HIV. Individuals were categorized into groups based on engagement in care: new diagnosis, regularly attending, irregularly attending (missed ≥1 HIV clinic appointment in past 12 months) and not attending (not seen in HIV care for >12 months). Demographic, clinical and psychosocial data were collected. Analyses were descriptive. Results Data were available for 975 admissions from 85 centres. Overall, 22% of people were a new diagnosis, 21% irregular attenders and 17% not in HIV care. People with sub‐optimal engagement more frequently had viraemia and immunosuppression; 86% of those not attending and 92% of newly diagnosed individuals had viral load >200 copies/mL, and 73% in both groups had CD4 ≤ 200 cells/mm 3 . AIDS‐defining illnesses accounted for 29% of admissions and were more commonly observed among those newly diagnosed (53%) and not attending care (40%). Psychosocial factors were frequently reported, particularly among irregular attenders (mental health issues 51%, substance use 42%, housing instability 34%). Missed opportunities for earlier diagnosis or re‐engagement were identified in 17% of cases. Conclusions Hospital admissions in people with HIV commonly occur in the context of late diagnosis and sub‐optimal engagement in care. Interventions to improve testing, retention and re‐engagement, particularly those addressing psychosocial barriers, may help reduce preventable morbidity and support progress towards HIV elimination.