Recommendations for research
The guideline committee has made the following recommendations for research.
What interventions would be effective and cost effective among people at higher risk in the UK to increase uptake of HIV testing among people who may have undiagnosed HIV?
Improving the acceptability of HIV testing and increasing the uptake of HIV testing will reduce the pool of undiagnosed infection, improve outcomes for those affected (because of earlier diagnosis) and reduce onward transmission, particularly in some high-risk populations. There is a lack of evidence among some groups in the UK, such as people in prison, trans women and people accessing services through community and outreach settings.
What interventions are effective and cost effective to increase the likelihood of healthcare professionals offering and recommending an HIV test and of its subsequent uptake?
Evidence suggests that the uptake of HIV testing is high among people who are offered and recommended a test. However, healthcare professionals often do not offer or recommend HIV tests in situations in which guidelines suggest it would be appropriate to do so. Research exploring interventions to promote the offer of HIV testing among a variety of test providers would inform future iterations of the guideline.
Most of the evidence on increasing the uptake of HIV testing came from the USA, often from settings that do not exist in the UK, for example veterans' health clinics. Given the lack of UK-based evidence, it is also important to ascertain how applicable this research is to cultural and healthcare contexts in the UK.
How effective are self-sampling and self-testing in terms of accuracy of sampling, ability to reach different groups, test completion, receipt of results and subsequent care-seeking behaviour?
What is the UK prevalence of HIV in various indicator conditions, and how effective are interventions using indicator condition-targeted testing compared with other testing strategies?
There is a lack of evidence on the effectiveness of using indicator conditions to target HIV testing, an approach that may improve detection rates. Also, because it is targeted, there may be economies of scale, for example, HIV testing could be commissioned in clinics that treat people with indicator conditions.
What is the cost utility of increasing the offer or uptake of HIV testing in different settings, for different types of tests, using different strategies (for example opt-in or opt-out approaches) and in areas and groups with different background prevalence?