Update information

Recommendations are marked:

  • [new 2016] if the evidence has been reviewed and the recommendation has been added.

  • [2011] if the evidence has not been reviewed since 2011.

  • [2011, amended 2016] if the evidence has not been reviewed but either:

    • changes have been made to the recommendation wording that change the meaning or

    • NICE has made editorial changes to the original wording to clarify the action to be taken.

Recommendations from NICE guideline PH33 that have been amended

Recommendation in 2011 guideline

Recommendation in current guideline

Reason for change

Promoting HIV testing for black African communities

In areas where there is an identified need (see recommendation 2):

  • Produce promotional material tailored to the needs of local black African communities. It should:

    • provide information about HIV infection and transmission, the benefits of HIV testing and the availability of treatment

    • emphasise that early diagnosis is a route into treatment and a way to avoid complications and serious illness in the future

    • detail how and where to access local HIV testing services, including services offering rapid testing and genitourinary medicine clinics (where people do not have to give their real name)

    • dispel myths and common misconceptions about HIV diagnosis and treatment

    • present testing as a responsible act by focusing on trigger points, such as the beginning of a new relationship or change of sexual partner, or on the benefits of knowing one's HIV status

    • address the needs of non-English-speaking black African communities, for example through translated information.

  • Work with black African community organisations to promote HIV testing (see recommendation 1).

  • Use venues that local black African communities frequent (for example, prayer groups or cultural events).

(recommendation 4)

1.3.2 Produce promotional material tailored to the needs of local communities. It should:

  • provide information about HIV infection and transmission, the benefits of HIV testing and the availability of treatment

  • emphasise that early diagnosis is not only a route into treatment and a way to avoid complications and reduce serious illness in the future, but also reduces onward transmission

  • detail how and where to access local HIV testing services, including services offering POCT and self-sampling, and sexual health clinics

  • dispel common misconceptions about HIV diagnosis and treatment

  • present testing as a responsible act by focusing on trigger points, such as the beginning of a new relationship or change of sexual partner, or on the benefits of knowing one's HIV status

  • address the needs of non-English-speaking groups, for example through translated and culturally sensitive information.

Wording to describe population has been changed as the updated guideline has a broader population.

Self-sampling has been added to the updated guideline.

Wording clarifications have been made in line with NICE editorial style.

Reducing barriers to HIV testing for black African communities

  • Ensure staff offering HIV tests emphasise that the tests are confidential. They should be able to direct those who are concerned about confidentiality to a genitourinary medicine clinic, where people do not have to give their real name.

  • Ensure staff are able to recommend HIV testing and have the ability to discuss HIV symptoms and the implications of a positive or a negative test.

  • Ensure staff are familiar with existing referral pathways so that people who test positive receive prompt and appropriate support (see recommendation 7).

  • Ensure staff can provide appropriate information, including details of where to get free condoms or training in negotiation skills, if someone tests negative.

  • Ensure primary care staff can recognise the symptoms that may signify primary HIV infection or illnesses that often coexist with HIV. In such cases, they should be able to offer and recommend an HIV test.

  • Ensure HIV testing services are staffed by people who are aware of and sensitive to, the cultural issues facing black Africans. (For example, black Africans may be less used to preventive health services and advice or may fear isolation and social exclusion should they test positive for HIV.) Staff should also be able to challenge the stigma of, and dispel any myths surrounding, HIV and HIV testing and be sensitive to the individual needs of people.

  • Ensure HIV testing services can offer rapid tests to people who are reluctant to wait for results (or can refer people to a service that provides rapid tests). If people are unwilling to have a blood test, they should be offered less invasive options (such as a saliva test), or should be referred elsewhere for such a test.

(recommendation 5)

1.4.2 Staff offering HIV tests should:

  • Emphasise that the tests are confidential. If people remain concerned about confidentiality, explain that they can visit a sexual health clinic anonymously.

  • Be able to discuss HIV symptoms and the implications of a positive or a negative test.

  • Be familiar with existing referral pathways so that people who test positive receive prompt and appropriate support.

  • Provide appropriate information to people who test negative, including details of where to get free condoms and how to access local behavioural and preventive interventions.

  • Recognise and be sensitive to the cultural issues facing different groups (for example, some groups or communities may be less used to preventive health services and advice, or may fear isolation and social exclusion if they test positive for HIV).

  • Be able to challenge stigmas and dispel misconceptions surrounding HIV and HIV testing and be sensitive to people's needs.

  • Be able to recognise the symptoms that may signify primary HIV infection or illnesses that often coexist with HIV. In such cases, they should be able to offer and recommend an HIV test.

1.1.12 If a venous blood sample is declined, offer a less invasive form of specimen collection, such as a mouth swab or finger-prick.

1.2.1 Offer point-of-care testing (POCT) in situations where it would be difficult to give people their results, for example if they are unwilling to leave contact details

Wording to describe population has been changed as the updated guideline has a broader population.

Wording about confidentiality has been changed to improve clarity.

Bullet point 7 from this PH33 recommendation has been changed into 2 standalone recommendations (1.2.1 and 1.1.12) for clarity and emphasis.

'Training in negotiation skills' in bullet 4 has been broadened to say 'how to access local behavioural and preventive interventions'.

Healthcare settings: offering and recommending an HIV test

  • In line with British HIV Association (BHIVA) guidelines[1], all health professionals should routinely offer and recommend an HIV test to:

    • men and women known to be from a country of high HIV prevalence

    • men and women who report sexual contact abroad or in the UK with someone from a country of high HIV prevalence

    • patients who have symptoms that may indicate HIV or where HIV is part of the differential diagnosis (see the BHIVA guidelines for a list of indicator diseases)

    • patients diagnosed with a sexually transmitted infection

    • the sexual partners of men and women known to be HIV positive

    • men who have disclosed that they have sexual contact with other men

    • the female sexual contacts of men who have sex with men

    • patients reporting a history of injecting drug use.

  • In addition, health professionals should (regardless of local HIV prevalence), routinely offer and recommend an HIV test to all those who may be at risk of exposure to the virus. For example, this may be as a result of having a new sexual partner or may be because they have previously tested negative during the 'window period'[4].

  • In line with BHIVA guidelines[1], all health professionals should routinely offer and recommend an HIV test to all patients attending:

    • genitourinary medicine or sexual health clinics

    • antenatal services

    • termination of pregnancy services

    • drug dependency programmes

    • tuberculosis, hepatitis B, hepatitis C and lymphoma services.

  • In areas where more than 2 in 1000 population have been diagnosed with HIV:

    • primary care and general medical admissions professionals should consider offering and recommending an HIV test when registering and admitting new patients (this is in line with BHIVA guidelines)[1]

    • all health practitioners should offer and recommend an HIV test to anyone who has a blood test (regardless of the reason).

[1] British HIV Association, British Association of Sexual Health and HIV, British Infection Society (2008) UK national guidelines for HIV testing 2008. London: British HIV Association.

[4] The window period is the time between infection and when antibodies to the virus are detectable by a test. Depending on the type of test it can take up to 3 months, although fourth generation testing can detect the virus much sooner.

(recommendation 6)

1.1.4 Routinely offer and recommend an HIV test to everyone attending their first appointment (followed by repeat testing in line with recommendation 1.2.6) at drug dependency programmes, termination of pregnancy services, and services providing treatment for:

  • hepatitis B

  • hepatitis C

  • lymphoma

  • tuberculosis

1.1.5 In all areas, offer and recommend HIV testing on admission to hospital, including emergency departments, to everyone who has not previously been diagnosed with HIV and who:

  • has symptoms that may indicate HIV or HIV is part of the differential diagnosis (for example, infectious mononucleosis-like syndrome), in line with HIV in Europe's HIV in indicator conditions

  • is known to be from a country or group with a high rate of HIV infection (see recommendation 1.1.1)

  • if male, discloses that they have sex with men, or is known to have sex with men and has not had an HIV test in the previous year

  • is a trans woman who has sex with men and has not had an HIV test in the previous year

  • reports sexual contact (either abroad or in the UK) with someone from a country with a high rate of HIV

  • discloses high-risk sexual practices, for example the practice known as 'chemsex'

  • is diagnosed with, or requests testing for, a sexually transmitted infection

  • reports a history of injecting drug use

  • discloses that they are the sexual partner of someone known to be HIV positive, or of someone at high risk of HIV (for example, female sexual contacts of men who have sex with men).

1.1.8 In all areas, offer and recommend HIV testing to everyone who has not previously been diagnosed with HIV and who:

  • has symptoms that may indicate HIV or HIV is part of the differential diagnosis (for example, infectious mononucleosis-like syndrome), in line with HIV in Europe's HIV in indicator conditions

  • is known to be from a country or group with a high rate of HIV infection (see recommendation 1.1.1)

  • if male, discloses that they have sex with men, or is known to have sex with men and has not had an HIV test in the previous year

  • is a trans woman who has sex with men and has not had an HIV test in the previous year

  • reports sexual contact (either abroad or in the UK) with someone from a country with a high rate of HIV

  • discloses high-risk sexual practices, for example the practice known as 'chemsex'

  • is diagnosed with, or requests testing for, a sexually transmitted infection

  • reports a history of injecting drug use

  • discloses that they are the sexual partner of someone known to be HIV positive, or of someone at high risk of HIV (for example, female sexual contacts of men who have sex with men).

Recommendation 6 from PH33 and recommendation 4 from PH34 have been merged.

More up-to-date information about indicator conditions is available, thus the link to BHIVA has been replaced.

The committee clarified that testing people who were diagnosed with a sexually transmitted infection (STI) should include all people who ask for STI tests since this indicates that they see themselves as having been at risk.

Timing of offering and recommending HIV testing has been added to recommendations for clarity.

'Prevalence' has been replaced by 'rate' where it does not relate to the definition from Public Health England used in this guideline.

The recommendation about offering testing where more than 2 in 1000 people have been diagnosed with HIV is replaced by recommendations 1.1.5 to 1.1.10.

The following bullet has been added in the update:

  • is a trans woman who has sex with men and has not had an HIV test in the previous year.

HIV referral pathways

  • Ensure there are clear referral pathways for people with positive and negative HIV test results.

  • Ensure people who test positive are seen by an HIV specialist at the earliest opportunity, preferably within 48 hours, certainly within 2 weeks of receiving the result (in line with British HIV Association guidelines). They should also be given information about the diagnosis and about local support groups.

  • For people with positive and negative HIV test results, if appropriate, offer or provide information about further behavioural or health promotion interventions available from both voluntary and statutory services (for example, advice on safer sex, training in negotiating skills and providing condoms).

  • Encourage repeat testing after a negative result for those who are at risk of infection (for example, for those who have new or multiple partners).

  • Ensure people who choose not to take up the immediate offer of a test know how to access testing services.

(recommendation 7)

1.4.3 Ensure practitioners delivering HIV tests (including those delivering outreach POCT) have clear referral pathways available for people with both positive and negative test results, including to sexual health services, behavioural and health promotion services, HIV services and confirmatory serological testing, if needed. These pathways should ensure the following:

  • People who test positive are seen by an HIV specialist preferably within 48 hours, certainly within 2 weeks of receiving the result (in line with UK national guidelines for HIV testing 2008 British HIV Association). They should also be given information about their diagnosis and local support groups.

  • Practitioners in the voluntary or statutory sector can refer people from HIV prevention and health promotion services into services that offer HIV testing and vice versa.

1.2.8 If people choose not to take up the immediate offer of a test, tell them about nearby testing services and how to get self-sampling kits

Wording changes have been made for clarification. Wording merged with that of recommendation 7 in PH34.

Wording to describe population has been changed as the updated guideline has a broader population

Self-sampling has been added to the updated guideline.

This bullet point has been removed:

  • People who regularly engage in high-risk sexual behaviour or inject drugs (whatever their test result) are offered behavioural or health promotion interventions (for example, advice on safer sex or injecting, training in negotiating skills and providing condoms).

Recommendations from NICE guideline PH34 that have been amended

Recommendation in 2011 guideline

Recommendation in current guideline

Reason for change

Promoting HIV testing among men who have sex with men

  • Ensure interventions to increase the uptake of HIV testing are hosted by, or advertised at, venues that encourage or facilitate sex between men (such as some saunas or websites). This is in addition to general, community-based HIV health promotion (for example, at GP surgeries and in other locations such as bars).

  • Promote HIV testing when delivering sexual health promotion and HIV prevention interventions to men who have sex with men. This can be carried out in person (using printed publications such as leaflets, booklets and posters) or via electronic media.

  • Ensure that health promotion material about HIV testing encourages all sexually active men who have sex with men to test for HIV at least annually[1]. Testing should be presented as an empowering and responsible act. Promotional material could focus on getting tested at key life stages, such as at the beginning of a new relationship or when changing sexual partner.

  • Ensure health promotion material presents a positive test result as a route into treatment and a way to avoid complications and serious illness in the future. In addition, it should aim to reduce the stigma associated with HIV testing and living with HIV, both among men who have sex with men and among health professionals. It should also dispel any myths about the need to disclose HIV status for insurance or legal purposes.

  • Ensure health promotion material includes information on how and where to access HIV testing locally. It should also provide up-to-date information on modern HIV tests, in particular, the availability of POCT. In addition, it should highlight the significantly reduced 'window period'[5] resulting from the introduction of newer tests such as 'fourth generation' p24 antigen testing (if these tests are available).

[1] British HIV Association, British Association of Sexual Health and HIV, British Infection Society (2008) UK national guidelines for HIV testing 2008. London: British HIV Association.

[5] The window period is the time between infection and when antibodies to the virus are detectable by a test. Depending on the type of test it can take up to 3 months, although fourth generation testing can detect the virus much sooner.

(recommendation 2)

1.3.2 Produce promotional material tailored to the needs of local communities. It should:

  • provide information about HIV infection and transmission, the benefits of HIV testing and the availability of treatment

  • emphasise that early diagnosis is not only a route into treatment and a way to avoid complications and reduce serious illness in the future, but also reduces onward transmission

  • detail how and where to access local HIV testing services, including services offering POCT and self-sampling and sexual health clinics

  • dispel common misconceptions about HIV diagnosis and treatment

  • present testing as a responsible act by focusing on trigger points, such as the beginning of a new relationship or change of sexual partner, or on the benefits of knowing one's HIV status

  • address the needs of non-English-speaking communities, for example through translated and culturally sensitive information.

1.3.3 Ensure interventions to increase the uptake of HIV testing are hosted by, or advertised at, venues that encourage or facilitate sex (such as some saunas or websites or geospatial apps that allow people to find sexual partners in their proximity). This should be in addition to general community-based HIV health promotion.

1.3.4 Promote HIV testing when delivering sexual health promotion and HIV prevention interventions. This can be carried out in person (using printed publications such as leaflets, booklets and posters) or through electronic media.

1.3.5 Ensure health promotion material aims to reduce the stigma associated with HIV testing and living with HIV, both among communities and among healthcare professionals.

1.3.6 Ensure health promotion material provides up-to-date information on the different kinds of HIV tests available. It should also highlight the significantly reduced window period resulting from the introduction of newer tests such as fourth-generation serological testing.

1.2.6 Recommend annual testing to people in groups or communities with a high rate of HIV, and more frequently if they are at high risk of exposure (in line with Public Health England's HIV in the UK: situation report 2015). For example:

  • men who have sex with men should have an HIV and sexually transmitted infections test at least annually, and every 3 months if they are having unprotected sex with new or casual partners

  • black African men and women should have an HIV test and regular HIV and sexually transmitted infections tests if having unprotected sex with new or casual partners

Wording to describe population has been changed as the updated guideline has a broader population.

Wording merged with that of recommendation 4 in PH33.

Wording clarifications have been made in line with NICE editorial style.

Genitourinary medicine clinics changed to sexual health clinics for consistency throughout.

Clarifications and additions added to the recommendations on repeat testing. Repeat testing has been recommended in line with Public Health England's HIV in the UK: situation report 2015.

Additional examples added to recommendation 1.3.3.

Specialist sexual health services: offering and recommending an HIV test

  • Ensure all men who attend a specialist sexual health service for screening or treatment are offered and recommended an HIV test[6]. This includes those who have previously tested negative for HIV or have never been tested. This should happen whether or not they disclose that they have sex with men.

  • Ideally, offer both fourth generation serological testing and POCT.

  • Ensure practitioners directly involved with testing for HIV and other sexually transmitted infections are trained to routinely offer and recommend an HIV test. They should be able to:

    • provide information on HIV testing and discuss why it is recommended (including to those who indicate that they may wish to decline the test)

    • conduct post-test discussions, this includes giving positive test results and delivering post-test and general health promotion interventions

    • recognise illnesses that may signify primary HIV infection and clinical indicator diseases that often coexist with HIV

    • assess the man's level of knowledge about HIV and refer him to a service where health promotion interventions can be provided, if necessary.

[6] This is in line with the British HIV Association 'UK national guidelines for HIV testing 2008'

(recommendation 3)

Replaced by:

1.1.2 Offer and recommend an HIV test to everyone who attends for testing or treatment.

1.1.3 Ensure both fourth-generation serological testing and point-of-care testing (POCT) are available.

Wording to describe population has been changed as the updated guideline has a broader population.

Wording updated to reflect current NICE style.

Reference to training has been removed.

Primary and secondary care: offering and recommending an HIV test

  • Primary care providers should offer and recommend HIV testing to all men who have not previously been diagnosed HIV positive and who:

    • register with a practice in an area with a large community of men who have sex with men, or

    • register with a practice in an area with a high HIV prevalence (high prevalence means more than two diagnosed cases per 1000 people), or

    • disclose that they have sex with other men, or

    • are known to have sex with men and have not had a HIV test in the previous year, or

    • are known to have sex with men and disclose that they have changed sexual partner or disclose high risk sexual practices, or

    • have symptoms that may indicate HIV or HIV is part of the differential diagnosis (see national guidelines[1] for HIV indicator diseases), or

    • are diagnosed with, or request screening for, a sexually transmitted infection, or

    • live in a high prevalence area and are undergoing blood tests for another reason.

  • Primary care providers should ensure annual HIV testing is part of the integrated healthcare offered to men who are known to have sex with men.

  • Secondary and emergency care providers should offer and recommend HIV testing to all men admitted to hospital who have previously tested negative for HIV, or have never been tested, and who:

    • are admitted in areas with a high prevalence of HIV (more than two diagnosed cases per 1000 people), or

    • disclose that they have sex with other men, or

    • have symptoms that may indicate HIV or HIV is part of the differential diagnosis (see British HIV Association guidelines for HIV indicator diseases[1]).

  • Ideally, test providers should offer both fourth generation serological testing and POCT.

  • Ensure practitioners directly involved with testing for HIV and other sexually transmitted infections are trained to routinely offer and recommend an HIV test. They should be able to:

    • provide information on HIV testing and discuss why it is recommended (including to those who indicate that they may wish to decline the test)

    • conduct post-test discussions, including giving positive test results and delivering post-test and general health promotion interventions

    • recognise illnesses that may signify primary HIV infection and clinical indicator diseases that often coexist with HIV

    • assess the man's level of knowledge about HIV and refer him to a service where health promotion interventions can be provided, if necessary.

[1] British HIV Association, British Association of Sexual Health and HIV, British Infection Society (2008) UK national guidelines for HIV testing 2008. London: British HIV Association

(recommendation 4)

1.1.8 In all areas, offer and recommend HIV testing to everyone who has not previously been diagnosed with HIV and who:

  • has symptoms that may indicate HIV or HIV is part of the differential diagnosis (for example, infectious mononucleosis-like syndrome), in line with HIV in Europe's HIV in indicator conditions

  • is known to be from a country or group with a high rate of HIV infection (see recommendation 1.1.1)

  • if male, discloses that they have sex with men, or is known to have sex with men and has not had an HIV test in the previous year

  • is a trans woman who has sex with men and has not had an HIV test in the previous year

  • reports sexual contact (either abroad or in the UK) with someone from a country with a high rate of HIV

  • discloses high-risk sexual practices, for example the practice known as 'chemsex'

  • is diagnosed with, or requests testing for, a sexually transmitted infection

  • reports a history of injecting drug use

  • discloses that they are the sexual partner of someone known to be HIV positive, or of someone at high risk of HIV (for example, female sexual contacts of men who have sex with men).

1.2.6 Recommend annual testing to people in groups or communities with a high rate of HIV, and more frequently if they are at high risk of exposure (in line with Public Health England's HIV in the UK: situation report 2015). For example:

  • men who have sex with men should have HIV and sexually transmitted infections tests at least annually, and every 3 months if they are having unprotected sex with new or casual partners

  • black African men and women should have an HIV test and regular HIV and sexually transmitted infections tests if having unprotected sex with new or casual partners

1.1.5 In all areas, offer and recommend HIV testing on admission to hospital, including emergency departments, to everyone who has not previously been diagnosed with HIV and who:

  • has symptoms that may indicate HIV or HIV is part of the differential diagnosis (for example, infectious mononucleosis-like syndrome), in line with HIV in Europe's HIV in indicator conditions

  • is known to be from a country or group with a high rate of HIV infection (see recommendation 1.1.1)

  • if male, discloses that they have sex with men, or is known to have sex with men and has not had an HIV test in the previous year

  • is a trans woman who has sex with men and has not had an HIV test in the previous year

  • reports sexual contact (either abroad or in the UK) with someone from a country with a high rate of HIV

  • discloses high-risk sexual practices, for example the practice known as 'chemsex'

  • is diagnosed with, or requests testing for, a sexually transmitted infection

  • reports a history of injecting drug use

  • discloses that they are the sexual partner of someone known to be HIV positive, or of someone at high risk of HIV (for example, female sexual contacts of men who have sex with men).

Recommendation 6 from PH33 and recommendation 4 from PH34 have been merged.

More up-to- date information about indicator conditions is available, thus the link from BHIVA from the original guideline (2011) has been replaced.

Clarifications and additions have been added to the recommendations on repeat testing. Repeat testing has been recommended in line with Public Health England's HIV in the UK: situation report 2015.

'Prevalence' has been replaced by 'rate' where it does not relate to the definition from Public Health England used in this guideline.

The recommendation about offering testing where more than 2 in 1,000 people have been diagnosed with HIV is replaced by recommendations 1.1.5 to 1.1.10.

The following bullet has been added in the update:

  • is a trans woman who has sex with men and has not had an HIV test in the previous year

Outreach: providing rapid point-of-care tests

  • Set up outreach services in a sensitive manner in consultation with men who have sex with men. (For example, be aware that not all community settings are appropriate for POCT.)

  • Offer tests via outreach in venues where there is high-risk sexual behaviour or in venues sited in areas where there is high local prevalence of HIV. This could include community or voluntary sector premises, public sex environments (such as saunas or cruising areas) or other venues identified during the planning exercise (see recommendation 1). Tests should be undertaken in a secluded or private area, in line with British HIV Association guidelines[1].

  • In appropriate settings, offer rapid POCT to men who have previously tested negative for HIV, or who have never been tested. Use a less invasive form of the test such as a mouth swab or finger-prick. CE-marked[7] POCT kits should be used.

  • Provide men who refuse, or who may not be able to consent to, a test with information about other local testing services. (Inability to consent may be due to alcohol or drugs, for example. A refusal might be because of the setting or concerns about privacy.)

  • Ensure non-clinical practitioners delivering POCT are trained to collect blood spots and mouth swabs, handle test material and administer the test. Training should be supervised and signed off by an appropriate clinician. It should be updated annually. Staff should also have access to clinical advice and supervision.

  • Ensure non-clinical practitioners delivering POCT are aware of local referral systems and services for people who test positive. They should be trained to provide appropriate information and support, including information about the relatively poor specificity and sensitivity of POCT. In addition, they should be able to assess the client's level of knowledge about HIV and provide appropriate health promotion interventions (or refer them to a service that can).

[1] British HIV Association, British Association of Sexual Health and HIV, British Infection Society (2008) UK national guidelines for HIV testing 2008. London: British HIV Association

[7] The CE mark is a declaration by the manufacturer that the product meets all of the appropriate requirements of the In Vitro Diagnostic (IVD) Medical Device Directive (98/79/EC). It is illegal to place on the market or supply in the EU any IVD that is not CE marked

(recommendation 5)

1.1.14 Providers of community testing services (including outreach and detached services) should set up testing services in:

  • areas with a high prevalence or extremely high prevalence of HIV, using venues such as pharmacies or voluntary sector premises (for example, those of faith groups)

  • venues where there may be high-risk sexual behaviour, for example, public sex environments, or where people at high risk may gather, such as nightclubs, saunas and festivals.

1.1.15 Recognise that not all community settings are appropriate for providing testing services, for example because tests should be undertaken in a secluded or private area (in line with British HIV Association guidelines).

1.1.12 If a venous blood sample is declined, offer a less invasive form of specimen collection, such as a mouth swab or finger-prick.

1.1.16 Ensure that people who decline or are unable to consent to a test are given information about other local testing services, including self-sampling. See making decisions using NICE guidelines for more information about consent.

1.1.17 Ensure that lay testers delivering tests are competent to do so and have access to clinical advice and supervision.

1.2.2 Explain to people at the time of their test about the specificity and sensitivity of the POCT being used and that confirmatory serological testing will be needed if the test is reactive.

Wording to describe population has been changed as the updated guideline has a broader population.

Wording changes have been made to improve clarity.

Self-sampling added to recommendations in updated guideline.

In recommendation 1.1.12, 'venous' added to differentiate blood sample from finger-prick test.

In recommendation 1.1.17, 'lay testers' replaces non-clinical practitioners as this term is now in common usage. Minor wording changes have also been added to the recommendation to improve clarity.

Timing and wording clarification added to recommendation 1.2.2.

Repeat testing

  • Recommend that all men who have tested negative but who may have been exposed to HIV have another test, once they are past the 'window period'[4].

  • Recommend annual testing to all men who have sex with men, and more frequent testing for those who have a high risk of exposure to the virus, for example, through multiple sexual partners or unsafe sexual practices.

[4] A national survey of gay men conducted annually by Sigma Research (recommendation 6)

1.2.5 When giving results to people who have tested negative but who may have been exposed to HIV recently, recommend that they have another test once they are past the 'window period'.

1.2.6 Recommend annual testing to people in groups or communities with a high rate of HIV, and more frequently if they are at high risk of exposure (in line with Public Health England's HIV in the UK: situation report 2015). For example:

  • men who have sex with men should have HIV and sexually transmitted infections tests at least annually, and every 3 months if they are having unprotected sex with new or casual partners

  • black African men and women should have an HIV test and regular HIV and sexually transmitted infection tests if having unprotected sex with new or casual partners.

Wording to describe population has been changed as the updated guideline has a broader population.

Clarifications and additions added to the recommendations on repeat testing. Repeat testing has been recommended in line with Public Health England's HIV in the UK: situation report 2015.

Timing added to recommendation 1.2.5 for clarity.

HIV referral pathways

  • Ensure there are clear referral pathways for practitioners delivering HIV tests (including those delivering outreach, rapid POCT), for both positive and negative test results. They should be able to refer clients quickly and easily to suitable sexual health services, confirmatory HIV testing, and post-test care and treatment services. These pathways should include ensuring the following:

    • Men who test positive are seen by an HIV specialist at the earliest opportunity, preferably within 48 hours, certainly within 2 weeks of receiving the result[1]. They should also be given information about the diagnosis and about local support groups.

    • Men who regularly engage in high-risk sexual behaviour (whatever their test result) are offered behavioural or health promotion interventions (for example, advice on safer sex, training in negotiating skills and providing condoms). Some men (including under-16s) may need additional psychological support and should be referred to counselling services that are totally accepting of their sexuality.

    • Repeat testing is encouraged after a negative result (see recommendation 6).

    • Practitioners in the voluntary or statutory sector are able to refer men from HIV prevention and health promotion services for HIV testing and vice versa.

    • People who choose not to take up the immediate offer of a test know how to access testing services.

[1] British HIV Association, British Association of Sexual Health and HIV, British Infection Society (2008) UK national guidelines for HIV testing 2008. London: British HIV Association (recommendation 7)

1.4.3 Ensure practitioners delivering HIV tests (including those delivering outreach POCT) have clear referral pathways available for people with both positive and negative test results, including to sexual health services, behavioural and health promotion services, HIV services and confirmatory serological testing, if needed. These pathways should ensure the following:

  • People who test positive are seen by an HIV specialist preferably within 48 hours, certainly within 2 weeks of receiving the result (in line with UK national guidelines for HIV testing 2008 British HIV Association). They should also be given information about their diagnosis and local support groups.

  • Practitioners in the voluntary or statutory sector can refer people from HIV prevention and health promotion services into services that offer HIV testing and vice versa.

1.2.8 If people choose not to take up the immediate offer of a test, tell them about nearby testing services and how to get self-sampling kits.

Wording to describe population has been changed as the updated guideline has a broader population.

Self-sampling added to recommendation 1.2.8 in updated guideline and wording changes added for editorial style and clarity.

This bullet has been removed:

  • People who regularly engage in high-risk sexual behaviour or inject drugs (whatever their test result) are offered behavioural or health promotion interventions (for example, advice on safer sex or injecting, training in negotiating skills and providing condoms).

ISBN: 978-1-4731-2202-4

  • Public Health England
  • National Institute for Health and Care Excellence (NICE)