NICE calls for routine offer of HIV tests in high prevalence areas
GPs in areas of high HIV prevalence should offer routine HIV testing when registering new patients and to anyone who has a blood test, says NICE.
Advances in medicine mean that HIV is no longer the death sentence it once was 30 years ago, and can now be successfully managed with antiretroviral therapies.
But too often people are diagnosed late, by which time the virus has already damaged their immune system. Late diagnosis is one of the biggest contributing factors to illness and death for people with HIV.
Currently, almost half of people in the UK who are diagnosed as HIV positive are diagnosed late.
The NICE guidance aims to encourage an earlier diagnosis by reinforcing the message that GPs in areas of high prevalence, where more than 2 in 1,000 of the population have been diagnosed with HIV, routinely offer and recommend an HIV test when registering new patients.
Although routine testing at GP registration is already recommended in guidance from the British HIV Association, not all practices in high prevalence areas are currently offering it.
The guidance on increasing the uptake of HIV testing among black Africans recommends that all GPs continue to routinely offer and recommend an HIV test to men and women known to be from a country of high HIV prevalence, and to men and women who report sexual contact (abroad or in the UK) with someone from a country of high HIV prevalence.
GPs who offer the HIV tests should emphasise that the tests are confidential and should be able to direct those who are concerned about confidentiality to a genitor-urinary medicine (GUM) clinic.
The guidance on increasing the uptake of HIV testing among men who have sex with men recommends HIV testing for all men not previously diagnosed with HIV who register with a practice in an area with a large community of men who have sex with men, and for those who disclose that they have sexual contact with men.
HIV testing should also be offered by GPs at least annually to all men who are known to have sex with men.
Professor Mike Kelly, Director of the Centre for Public Health at NICE, said: “This new guidance makes a number of practical recommendations which aim to increase HIV testing by encouraging healthcare professionals to offer it routinely to people in areas where there are a high number of people living with HIV.
“For the individual, there are obvious health benefits to being diagnosed quickly, they can start treatment if they need to and look after their own health. But HIV testing and treatment can also help reduce transmission of the virus.”
Professor Jane Anderson, Consultant Physician at Homerton University Hospital NHS Foundation Trust who was involved in the development of the guidance, said: “This is a real opportunity to increase the uptake of HIV testing that we really need to grasp.
“Although patients find it acceptable to be offered an HIV test, many doctors are often reluctant to do so. These recommendations encourage healthcare professionals to be more proactive in offering HIV testing.”
Dr Matt Kearney, a GP in Runcorn who was also involved with the guidance, said: “Eight out of 10 new cases come from these two population groups so it makes sense to focus resources on them.
“The new guidance brings clarity which is very helpful for GPs,” he added.
Dr Clare Gerada, Chair of the Royal College of General Practitioners said: “HIV can be successfully managed in ways that can improve quality of life and reduce complications and transmission of infection.
“It is important therefore that all health professionals do everything possible to encourage testing amongst high risk groups. The RCGP welcomes the new NICE guidelines and we are sure that GPs will help patients come forward for testing.”
Costing tools and a slide set outlining the main recommendations relevant to primary care are available on the NICE website to help put this guidance into practice.
23 March 2011