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HIV tests should be seen as routine practice without stigma, says NICE

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Adults and young people in areas deemed to have extremely high HIV prevalence should be routinely offered a test for the virus when admitted to hospital or attending emergency and emergency, according to draft care standards.

In addition, they suggest such patients living in “high or extremely high prevalence areas” should be offered an HIV test when registering with a GP or having a blood test if they have not had an HIV test in the last 12 months.

The National Institute for Health and Care Excellence said today it hoped that its new draft quality standard would improve the uptake of testing among adults and young people who may have undiagnosed HIV.

The recommendations contained in the draft care standard back up latest NICE guidance on HIV testing, which was published in December.

The draft quality standard has six statements and is intended to help “reduce the stigma” associated with HIV and ensure that an HIV test is “regarded as routine”.

Statement 1 – Adults and young people admitted to hospital or who attend an emergency department are offered an HIV test in areas of extremely high HIV prevalence or in areas of high HIV prevalence if they have a blood test

Statement 2 – Adults and young people in areas of high or extremely high HIV prevalence are offered an HIV test by their GP when registering or when having a blood test if they have not had an HIV test in the last 12 months

Statement 3 – Adults and young people diagnosed with an indicator condition are offered an HIV test

Statement 4 – Adults and young people in at-risk groups in areas of high and extremely high HIV prevalence can find information about HIV testing services, including self-sampling

Statement 5 – Adults and young people in at-risk groups who test negative for HIV are advised to repeat the test at least annually

Statement 6 – People identified as at risk of HIV from contact with an adult or young person newly diagnosed with HIV are offered an HIV test

NICE said that increasing the uptake of HIV testing among people living in areas with a high or extremely high HIV prevalence was important to reduce late diagnosis.

There are 20 local authority areas with extremely high prevalence of HIV including Manchester, Brighton and Hove, and 18 London boroughs.

Compliance with the NICE care standards could mean that up to 3.7 million people in these areas were offered an HIV test when attending an emergency department or on admission to hospital.

In addition, there are 54 council areas where HIV rates are classed as high, including Leeds, Birmingham and Newcastle, which could result in up to 7.9 million people being offered an HIV test when registering with a GP.

NICE said its draft quality standard also recognised the importance of explaining to patients who tested negative that they may continue to be at risk of exposure to HIV and that regular tests will ensure early diagnosis.

For example, it highlighted that patients who have unprotected sex with new or casual partners were at high risk of exposure and should be advised to have an HIV test at least once a year.

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Gillian Leng

In 2015, around 100,000 people in the UK were living with HIV, including an estimated 13,500 people who were unaware of their infection, noted NICE.

Professor Gillian Leng, deputy chief executive and director of health and social care at NICE, said: “There can still be stigma and fear around having an HIV test. This needs to change so that HIV testing is seen as routine.

“This new draft quality standard sets out clear, practical steps to help encourage and increase uptake of HIV testing,” she said. “I would urge all healthcare professionals and organisations with an interest in this area to comment on the draft statements via the NICE website.”

A consultation on the draft care standards will close on Friday 21 April. The final quality standard is due to be published in August.

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