P Benn

Royal Free London NHS Foundation Trust, Londinium, England, United Kingdom

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Publications (24)56.12 Total impact

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    ABSTRACT: There are currently over 30,000 HIV-positive individuals in London and over 25,000 on anti-retroviral therapy. In 2009/2010, this equated to £170m spent by London's NHS on anti-retroviral drugs. Ways employed to reduce this cost include standardising the drugs patients are on and delivering medication to patients at home. Home delivery (HD) medication is exempt from value-added tax. The savings made from 10 patients using the home delivery service would free up resources to provide anti-retroviral therapy to one further patient. Studies have shown that concerns surrounding potential breaches of confidentiality are a potential barrier to some people using the home delivery service. In order to challenge these concerns, a leaflet was devised highlighting the major benefits to both the patient and the NHS of home delivery and addressing concerns over confidentiality. The leaflet was handed out to patients at the Mortimer Market Centre who were currently on anti-retroviral medication but not on home delivery. They were asked to complete a survey on their views of the service before and after reading the leaflet, whether they had been previously aware of the service and whether their concerns had been addressed. Some 79% felt that the patient information leaflet addressed all of their concerns, and it helped 11% decide whether to consider using home delivery. However, as more patients were opposed to the service after reading the patient information leaflet than those considering it, more work needs to be done to explore patients' concerns and other factors influencing home delivery service uptake.
    International Journal of STD & AIDS 04/2014; DOI:10.1177/0956462414530107 · 1.04 Impact Factor
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    ABSTRACT: The numbers of individuals living with HIV in the UK continues to increase as a result of the benefits of antiretroviral therapy and continued high incident infection rates. It is estimated that the number of individuals living with HIV in the UK will exceed 100000 by the end of 2012 (Health Protection Agency, 2011).
    British journal of hospital medicine (London, England: 2005) 08/2013; 74(8):465-8. DOI:10.12968/hmed.2013.74.8.465 · 0.37 Impact Factor
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    ABSTRACT: There is currently no 'gold standard' for diagnosis of latent tuberculosis infection (LTBI), and both the tuberculin skin test and interferon-gamma release assays (IGRAs) are used for diagnosis; the latter have a higher sensitivity than tuberculin skin test for diagnosis of LTBI in HIV-infected individuals with lower CD4 counts. No evidence-base exists for selection of IGRA methodology to identify LTBI among human immunodeficiency virus-infected patients in the UK. We prospectively evaluated two commercially available IGRA methods (QuantiFERON-TB Gold In Tube (QFG) and T-SPOT.TB) for testing LTBI among HIV-infected patients potentially nosocomially exposed to an HIV-infected patient with 'smear-positive' pulmonary tuberculosis. Among the exposed patients median CD4 count was 550 cells/µL; 105 (90%) of 117 were receiving antiretroviral therapy, of who 104 (99%) had an undetectable plasma HIV load. IGRAs were positive in 12 patients (10.3%); QFG positive in 11 (9.4%) and T-SPOT.TB positive in six (5.1%); both IGRAs were positive in five patients (4.3%). There was one indeterminate QFG and one borderline T-SPOT.TB result. Concordance between the two IGRAs was moderate (κ = 0.56, 95% confidence interval (CI) = 0.27-0.85). IGRAs were positive in only 4 (29%) of 14 patients with previous culture-proven tuberculosis. No patient developed tuberculosis during 20 months of follow-up.
    International Journal of STD & AIDS 07/2013; 24(10). DOI:10.1177/0956462413486459 · 1.04 Impact Factor
  • Sexually Transmitted Infections 07/2013; 89(Suppl 1):A61-A61. DOI:10.1136/sextrans-2013-051184.0186 · 3.08 Impact Factor
  • Clinical Infectious Diseases 03/2013; 57(2). DOI:10.1093/cid/cit203 · 9.42 Impact Factor
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    ABSTRACT: We estimated the burden of HIV-associated neurocognitive disorders (HAND) in a UK clinic. From a random sample, and referrals to specialist services over one year (neurology, clinical psychology, hospital admissions), we determined whether patients were diagnosed with HIV-associated dementia (HAD) and whether they reported symptoms suggesting neurocognitive impairment (NCI). In the first sample, 2/150 (prevalence 1.3%; 95% confidence interval [CI] 0.2-4.7%) had documented HAD. Eleven patients (7.3%; CI 3.7-12.7%) reported recent symptoms suggesting NCI; most of these individuals were diagnosed with a psychiatric or substance-use disorder. Among specialist referrals with symptoms suggesting NCI, 11 were diagnosed with HAD from a clinic population of 3129 individuals (annual incidence 0.4%; CI 0.2-0.6%). No patients with mildly symptomatic or asymptomatic HAND were identified in either sample, suggesting that such patients remain undetected in current clinical practice. Evidence-based screening for HAND in HIV clinics may be needed.
    International Journal of STD & AIDS 03/2013; 24(3). DOI:10.1177/0956462412472452 · 1.04 Impact Factor
  • Clinical medicine (London, England) 06/2012; 12(3):300-1. DOI:10.7861/clinmedicine.12-3-300 · 1.69 Impact Factor
  • Sexually Transmitted Infections 05/2012; 88(Suppl 1):A44-A44. DOI:10.1136/sextrans-2012-050601c.103 · 3.08 Impact Factor
  • L. Snell, S. G. Edwards, P. D. Benn
    Sexually Transmitted Infections 05/2012; 88(Suppl 1):A17-A17. DOI:10.1136/sextrans-2012-050601c.20 · 3.08 Impact Factor
  • Sexually Transmitted Infections 05/2012; 88(Suppl 1):A42-A43. DOI:10.1136/sextrans-2012-050601c.98 · 3.08 Impact Factor
  • Thorax 12/2011; 66(Suppl 4):A72-A73. DOI:10.1136/thoraxjnl-2011-201054c.14 · 8.56 Impact Factor
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    ABSTRACT: We present the updated British Association for Sexual Health and HIV (BASHH) guidelines for post-exposure prophylaxis (PEPSE) to HIV. This document includes a review of the current data to support the use of PEPSE, considers how to calculate the risks of infection after a potential exposure, and provides recommendations on when PEPSE would and would not be considered. We review which agents to use for PEPSE including the potential for drug-drug interactions and make recommendations for monitoring individuals receiving PEPSE. Other areas included are the possible impact on sexual behaviour, cost-effectiveness and issues relating to service provision. Throughout the document, consideration is given to the place of PEPSE within the broader context of HIV prevention strategies and sexual health.
    International Journal of STD & AIDS 12/2011; 22(12):695-708. DOI:10.1258/ijsa.2011.171011 · 1.04 Impact Factor
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    ABSTRACT: Thymidine nucleoside reverse transcriptase inhibitors (NRTIs) are associated with subcutaneous fat loss. Facial changes cannot be assessed by dual-energy X-ray absorptiometry (DEXA) scans. There are limited objective data on the reversibility of facial lipoatrophy. We performed a facial volume substudy of a randomized thymidine NRTI replacement study carried out in HIV-infected subjects with moderate to severe lipoatrophy. Facial volume changes were assessed using validated 3D laser imaging. Changes in body composition were measured using DEXA scans. The association between changes in facial volume and body composition parameters at 48 weeks was measured using Spearman's rank correlation. Forty-seven individuals (46 male), 11 receiving zidovudine and 36 receiving stavudine, switched to either tenofovir disoproxil fumarate (DF) (n=23) or abacavir (ABC) (n=24). Thirty-nine of these 47 patients (84.8%) reported facial lipoatrophy at baseline. The median volume increase in both cheeks from baseline was 1857.3 mm(3). These volume changes and increases in limb fat at 48 weeks were similar in the two groups and correlated significantly (Spearman's r=0.41, P=0.004). Facial volume in lipoatrophic individuals was found to increase after thymidine NRTI replacement. We demonstrated a significant correlation between improvements in facial and limb fat parameters. Switching from thymidine NRTIs in patients with facial lipoatrophy could potentially reduce the need for cosmetic interventions.
    HIV Medicine 08/2009; 10(6):351-5. DOI:10.1111/j.1468-1293.2009.00694.x · 3.45 Impact Factor
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    ABSTRACT: Background: The availability of Atripla since December 2007 in the UK has afforded HIV+ patients a one pill once a day regimen. We undertook an audit to determine the reasons for and outcomes of individuals switching to Atripla. Methods: From the electronic pharmacy information system (PIMS) we identified HIV + patients who commenced Atripla between 01.02.08 - 30.06.08. Information regarding demographics, disease stage, antiretroviral therapy (ART) and outcomes following the switch was obtained from a retrospective case notes review. Results: A total of 177 patients (157 men, 20 women) were identified. The majority were Caucasian (63%), 18% Black African. At the time of switch the median (range) age was 42 years (24 -69), CD4 count; 435 (170 -1710) and HIV viral load (VL) <50 (<50 – 1200 copies/ml). Patients switched from the following regimens: 83% from truvada and efavirenz (EFV), 10% from EFV and two nucleosides (combivir n=7, kivexa n=11), 4% from a boosted protease inhibitor regimen (rPI). One person switched from trizivir to Atripla. 14/17 who were taking abacavir switched due to concerns regarding cardiovascular risk. Outcomes following switching include continuing Atripla with no side effects (S/E) (86%), continuing Atripla but reporting increased/new S/Es (5%). 7 of 9 had previously received EFV for a median of 10 months, discontinued EFV after experiencing S/Es after a median of 8 weeks (8%). 12 of 14 had previously received EFV for a median of 10 months and one individual stopped due to difficulty swallowing Atripla. Of those individuals reporting S/Es after switching from EFV to Atripla 65% had increased central nervous system S/Es. Viral rebound occurred in one patient which was attributed to pre-exisitng resitance. Discussion: We report a suprisingly high level of discontinuation of Atripla among our patients despite many having previously tolerated both truvada and EFV. Furthermore simplification to Atripla was uncommon in patients stable on a boosted PI regimen.
    BHIVA 2009; 05/2009
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    ABSTRACT: Serious adverse events and medication errors are common in clinical practice and are associated with significant morbidity and mortality. Management of HIV-positive patients is likely to become more complex as people age, developing multiple medical conditions and thus requiring polypharmacy. We undertook a casenote review and interview of patients on antiretroviral therapy (ART) to audit the safety of devolving statin prescribing to general practitioners (GPs). Of 26 patients only 50% had their statin prescribing successfully been devolved to GPs. Many experienced significant difficulties and two of 26 (8%) were switched to simvastatin while receiving a protease inhibitor. We demonstrate that prescribing ART and non-ART medication by different practitioners on different sites can potentially expose patients to serious life-threatening adverse events. We make recommendations to minimize these risks and suggest that care pathways are reviewed to ensure they remain both convenient and user-friendly without compromising patient safety.
    International Journal of STD & AIDS 04/2009; 20(3):202-4. DOI:10.1258/ijsa.2008.008273 · 1.04 Impact Factor
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    ABSTRACT: In July 2004, British Association of Sexual Health and HIV (BASHH) published guidelines for post-exposure prophylaxis following sexual exposure (PEPSE) and the Terence Higgins Trust (THT) launched a campaign promoting PEPSE among men who have sex with men (MSM). We evaluated subsequent changes in PEPSE attendances. Individuals requesting PEPSE in 2004 were identified from clinic databases. Comparisons of clinical data, exposure characteristics and follow-up were made pre and post campaign. Data were available for 197/216 (91%) PEP attendances. The proportion requesting PEP following sexual exposure increased significantly following the campaign. The majority commencing PEPSE were MSM, with the proportion of MSM increasing significantly from 36/46 (78%) pre to 76/80 (95%) following the campaign. Most prescriptions were in high-risk groups and within guidelines. Times to initiation and completion rates were unchanged. Access to PEPSE following the THT campaign and introduction of BASHH guidelines increased. Promotion of earlier initiation of PEPSE and improvement of completion and follow-up is required.
    International Journal of STD & AIDS 05/2008; 19(4):241-2. DOI:10.1258/ijsa.2007.007216 · 1.04 Impact Factor
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    ABSTRACT: Lymphogranuloma venereum (LGV) has recently been reported in men who have sex with men. In a case-control study we compared behavioural and clinical features of 32 men with LGV (cases) and 31 men with non-LGV chlamydial proctitis (controls). LGV was associated with rectal discharge (odds ratio [OR] 4.15, 95% confidence interval [CI] 1.42, 12.2), and there was a tendency to association with HIV infection (OR 3.60, CI 0.67-19.4), sexual contact in the UK (OR 3.03, CI 1.02-9.01) and fisting (OR 5.04, CI 0.98-26.1). LGV should be considered a possible diagnosis in men with rectal discharge.
    International Journal of STD & AIDS 08/2007; 18(7):472-5. DOI:10.1258/095646207781147319 · 1.04 Impact Factor
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    BHIVA 2007; 05/2007
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    ABSTRACT: Rates of bacterial sexually transmitted infections (STIs) continue to rise among men who have sex with men (MSM) in the UK. To evaluate factors associated with Chlamydia trachomatis and Neisseria gonorrhoeae among MSM attending a genitourinary medicine clinic in inner London. 599 MSM undergoing testing for STIs were recruited. Specimens for ligase chain reaction (LCR), strand displacement amplification (SDA) assay and culture were collected from the pharynx, urethra and rectum for the detection of C trachomatis and N gonorrhoeae. Details regarding demographics, symptoms, signs and sexual behaviour were recorded. Associations of these factors with each infection were tested, adjusting for other risk factors. The prevalence of C trachomatis and N gonorrhoeae was 11.0% and 16.0%, respectively. LCR and SDA performed well for the detection of C trachomatis and N gonorrhoeae from urethra and rectum. Using either method, compared with our current testing policy, over 18% of those with C trachomatis and N gonorrhoeae would not have had their infection diagnosed or treated. Age, sexual behaviour, urethral and rectal symptoms and signs were strongly associated with both infections. A total of 33.7% of men reported at least one episode of unprotected anal intercourse in the previous month. Men reporting multiple episodes were markedly more likely to be HIV positive. The prevalence of infection, rates of partner acquisition and unprotected anal intercourse reported among these MSM are alarming. Improved detection of C trachomatis and N gonorrhoeae using nucleic acid amplification tests has major public health implications for STI and possibly HIV transmission in this population.
    Sexually Transmitted Infections 05/2007; 83(2):106-12. DOI:10.1136/sti.2006.021329 · 3.08 Impact Factor
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    ABSTRACT: Introduction: The success of antiretroviral therapy (ARV) and ongoing incident infection has led to many UK HIV treatment centres experiencing annual increases in cohort size of 10%. In the absence of additional clinical space we describe how an inner London unit safely managed these capacity issues. Methods: With the involvement of the multidisciplinary team and service users we 1) evaluated existing care pathways, 2) modified appointment duration, frequency and method of follow up, and expanded nursing roles, 3) re-evaluated after implementation. Cohort data regarding attendance patterns, CD4 counts, viral load (VL) and ARV use was obtained from clinic databases. Comparison of virological control according to use of service innovations were made. Complaints and user feedback were monitored. Results: Under the existing model of care we estimated that we would exceed capacity by 2006 and our cohort would reach 4100 by 2010. Reducing half of all appointments duration to 20 from 30 minutes could delay reaching capacity until 2008. In a subset of stable patients (on first line ARV with VL<50 for > 12 months, n=415) attending three or less vs four or more times/year, or receiving follow up by a specialist nurse was not associated with virological failure (p=0.9 and p=0.57 respectively) over a 12-month period. Those using alternative methods of follow up (e.g. telephone) were no more likely to experience virological failure. Discussion: HIV services need to evaluate new care pathways to manage increasing demand. We demonstrated major changes in service provision without compromising safety, efficiency or patient acceptability.
    BASHH 2007; 01/2007

Publication Stats

173 Citations
56.12 Total Impact Points

Institutions

  • 2013
    • Royal Free London NHS Foundation Trust
      Londinium, England, United Kingdom
  • 2011–2013
    • Central and North West London NHS Foundation Trust
      Londinium, England, United Kingdom
  • 2007
    • University College London Hospitals NHS Foundation Trust
      • Department of Clinical Microbiology
      Londinium, England, United Kingdom
  • 2001
    • Camden and Islington NHS Foundation Trust
      Londinium, England, United Kingdom