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NICE encourages increase in HIV testing in ‘at risk’ areas

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Patients living in areas of England with a high prevalence of HIV should routinely be offered HIV tests during routine healthcare appointments, according to new guidance.

The National Institute for Health and Care Excellent has this week published a new quality standard, which comprises five statements that are designed to encourage the uptake of HIV testing – though it is not mandatory for the NHS to adopt.

“There can be stigma and fear around having an HIV test. This needs to change”

Gillian Leng

It recommended that young people and adults be offered an HIV test when admitted to hospital or attending an emergency department in areas of extremely high HIV prevalence.

They should also be offered a test when having a blood test when admitted to hospital or attending an emergency department in areas of high HIV prevalence, said the institute.

In addition, it said young people and adults in areas of high or extremely high HIV prevalence should be offered an HIV test by their GP practice when registering or when having a blood test if they have not had an HIV test in the past 12 months.

The NICE document follows a draft version consulted on earlier this year, as well as clinical guidance on the same issue published in 2016, as reported by Nursing Times.

The new standard aims to improve diagnosis in those at increased risk of exposure, said NICE, highlighting that around 13,500 people in the UK were unaware they were HIV positive in 2015.

“We urgently need new approaches to HIV testing that are delivered on a large scal”

Michael Brady

It noted there were 20 local authority areas in the UK with an “extremely high prevalence” of HIV, covering a population of around 3.7 million people.
Of these areas, 18 are in London, including Lambeth and City of London, while those outside the capital are Manchester and Brighton and Hove.

In addition, there are 54 local authority areas where HIV rates are classed as high, including Luton, Birmingham, Southampton and Newcastle, covering a population of around 8.5 million people.

Offering HIV tests to people in these settings should help reduce the stigma associated with HIV to ensure that a HIV test is regarded as routine, said NICE.

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

Leng_Gillian2_co.jpg

Gillian Leng

“This new quality standard sets out clear, practical steps to help encourage and increase the uptake of HIV testing,” she said.

The charity the Terrence Higgins Trust welcomed the new standards but called for new approaches to testing, such as primary care settings in high prevalence areas, to be common practice.

Dr Michael Brady, medical director at Terrence Higgins Trust, described the quality standard published by NICE as a “very welcome step”.

“It gives practical advice for commissioners, service providers and healthcare professionals on what processes need to be in place to improve our approach to HIV testing and how to ensure the guidelines are implemented,” he said.

“But increased testing and early treatment is essential to ensure everyone can benefit from this,” he added. “Rates of undiagnosed HIV and late diagnoses remain unacceptably high and we urgently need new approaches to HIV testing that are delivered on a large scale and targeted at those at risk.

Michael Brady

Michael Brady

Michael Brady

“Testing in GPs and A&Es in high prevalence areas are essential components because, whilst people with undiagnosed HIV may not be using existing HIV testing services, they do visit their GP or hospital, where they could be tested,” said Dr Brady.

“National guidelines have recommended HIV testing in GPs and A&E departments in high prevalence areas for nearly a decade now; but it’s still not common practice and this must change,” he said. “We have the tools to end HIV transmission in the UK but the first step must be an increase in HIV testing. Hopefully the quality standard… means we’re a step closer to making that a reality.”

NICE HIV quality standard statements

  • Statement 1 – Young people and adults are offered an HIV test when admitted to hospital or attending an emergency department in areas of extremely high HIV prevalence, or when having a blood test when admitted to hospital or attending an emergency department in areas of high HIV prevalence
  • Statement 2 – Young people and adults in areas of high or extremely high HIV prevalence are offered an HIV test by their GP practice when registering or when having a blood test if they have not had an HIV test in the past 12 months
  • Statement 3 – Young people and adults newly diagnosed with an HIV indicator condition are offered an HIV test
  • Statement 4 – Young people and adults in at-risk groups who test negative for HIV are advised that the test should be repeated at least annually
  • Statement 5 – People who may have been exposed to HIV by a person newly diagnosed with HIV are offered an HIV test

 

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