Patients in areas with “extremely high prevalence” of HIV should be tested for the virus when they register with a new GP, have a blood test, are admitted to hospital or visit accident and emergency.
The recommendations come in new guidance published today by the National Institute for Health and Care Excellence to support increased uptake of HIV testing and help “normalise” it.
“We want to normalise HIV testing so it isn’t viewed any differently from any other blood test”
The guideline, which collates and updates two previous NICE guidelines, recommends HIV testing is offered and recommended in hospitals, A&Es and GP practices, depending on local HIV prevalence.
In areas of “high” and “extremely high” prevalence, NICE said HIV testing should be offered and recommended to all patients – not previously been diagnosed with the virus – when they register with a GP practice or have a blood test.
In addition, in “extremely high” prevalence areas, testing should also be offered and recommended on admission to hospital, including A&E departments, to all patients not previously been diagnosed with HIV, regardless of whether they are having blood tests.
The guidance added that point-of-care testing should be offered in situations where it would be difficult to give patients their results, for example if they are unwilling to leave contact details.
Providing self-sampling kits to patients in groups and communities with a high rate of HIV should also be considered, said the guidance, which has been published to coincide with World Aids Day.
“Prompt diagnosis of HIV not only saves lives but reduces transmission”
NICE highlighted that it had worked in partnership with Public Health England, which calculates the prevalence of HIV across the country, in order to help target its guidance at the areas most at risk.
For the first time, it has adopted new figures calculated by PHE for “extremely high prevalence” of HIV – equivalent to five or more diagnosed infections per 1,000 people aged 15-59 years. There are currently 20 local authorities in England with extremely high prevalence that have a total population of 3.7 million.
The guideline continues to use PHE’s existing definition of “high prevalence”, defined as two to five diagnosed infections per 1,000 aged 15-59 years. There are currently 54 local authorities in England with high prevalence that have an estimated total population of 7.9 million.
Meanwhile, the new NICE guideline noted that home self-sampling showed “great promise”, especially as a way to engage people less likely to visit services.
Data from a self-sampling service that PHE runs with local authorities showed that 32% of those tested had never had an HIV test before, said NICE.
Professor Gillian Leng, deputy chief executive of NICE, said: “It is easier than ever before to access testing for HIV, but with thousands living with undiagnosed HIV we know there is much more to do.
“This important new guideline, which draws together and updates two previous guidelines, makes a number of important recommendations to increase the awareness and uptake of HIV testing, “he said.
She added: “We want to normalise HIV testing so it isn’t viewed any differently from any other blood test. There are now highly effective treatments for HIV and it should no longer be seen with fear or stigma.”
The new guideline focuses on strategies to reduce barriers to HIV testing, such as advertising testing in locations that offer tests, for example, through posters in a GP practice.
Dr Valerie Delpech, head of HIV surveillance at PHE and member of the NICE guideline development group, said: “We are still seeing HIV having far too great an impact on certain communities. Prompt diagnosis of HIV not only saves lives but reduces transmission.
She highlighted that PHE had also published its first report into HIV testing in England today, which recommends that sexual health clinics should improve their HIV testing practices for all attendees, especially sexual partners of people with HIV and black African women.
She stated: “All hospitals and general practices, especially those in areas with extremely high levels of HIV should check that their HIV testing practices and policies are in line with the new NICE guidelines.”
“It is the responsibility of every clinician to implement these guidelines as quickly as possible”
Dr Ann Sullivan, consultant physician HIV/GUM at Chelsea and Westminster Hospital NHS Foundation Trust, who also worked on the guidelines, said: “Adding in an HIV test for people in high and extremely high prevalence areas when they’re already having blood taken is a ‘win win’ situation, and will cost next to nothing.
“Making this a routine part of standard care for all patients in these settings will begin to normalise HIV testing and hopefully reduce the unacceptably high rates of late diagnosis we still see in the UK,” she said.
She added that it was “the responsibility of every healthcare service and every clinician to implement these guidelines as quickly as possible”.