Quality statement 1: Hospitals in areas of high and extremely high HIV prevalence

Quality statement

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.

Rationale

Increasing the uptake of HIV testing among people living in areas of high or extremely high HIV prevalence is important to reduce late diagnosis. Early diagnosis improves treatment outcomes and reduces the risk of transmission. Offering HIV testing more routinely in hospitals in areas of high or extremely high HIV prevalence will help to ensure that an HIV test is regarded as routine practice. This will help to reduce the stigma that can be associated with HIV testing.

Quality measures

Structure

a) Evidence of local processes to offer an HIV test to all young people and adults who are admitted to hospital or attend an emergency department in areas of extremely high HIV prevalence.

Data source: Local data collection, for example, service protocol.

b) Evidence of local processes to offer an HIV test to all young people and adults having a blood test when admitted to hospital or attending an emergency department in areas of high HIV prevalence.

Data source: Local data collection, for example, service protocol.

Process

a) Proportion of young people and adults admitted to hospital or attending an emergency department, in an area of extremely high HIV prevalence, who receive an HIV test.

Numerator – the number in the denominator who receive an HIV test.

Denominator – the number of young people and adults admitted to hospital or attending an emergency department in an area of extremely high HIV prevalence.

Data source: Local data collection, for example, an audit of patient health records.

b) Proportion of young people and adults having a blood test when admitted to hospital or attending an emergency department in an area of high HIV prevalence who receive an HIV test.

Numerator – the number in the denominator who receive an HIV test.

Denominator – the number of young people and adults having a blood test when admitted to hospital or attending an emergency department in an area of high HIV prevalence.

Data source: Local data collection, for example, an audit of patient health records.

Outcome

a) Number of new HIV diagnoses in areas of high and extremely high prevalence.

Data source: Local data collection for Public Health England's HIV and AIDS reporting system.

b) Number of new HIV diagnoses made at a late stage of infection in areas of high and extremely high prevalence.

Data source: Local data collection for Public Health England's HIV and AIDS reporting system. Late stage of infection is defined as a CD4 count less than 350 cells per mm3.

What the quality statement means for different audiences

Service providers (hospital services such as emergency departments and medical admissions units) in areas of extremely high HIV prevalence offer and recommend an HIV test to all young people and adults admitted to hospital or attending an emergency department. In areas of high HIV prevalence providers offer and recommend an HIV test to young people and adults having a blood test when admitted to hospital or attending an emergency department. Providers could offer an HIV test by an opt-out testing system.

Healthcare professionals (such as doctors and nurses) in hospitals in areas of extremely high HIV prevalence offer and recommend an HIV test to all young people and adults admitted to hospital or attending an emergency department. In hospitals in areas of high HIV prevalence healthcare professionals offer and recommend an HIV test to all young people and adults having a blood test when admitted to hospital or attending an emergency department. Healthcare professionals should emphasise that having an HIV test is a routine procedure but if the test is declined, they should provide information on how to access other local HIV testing services.

Commissioners (such as local authorities and clinical commissioning groups) include HIV testing in the service specification for hospitals, including emergency departments, in areas of extremely high or high HIV prevalence. Commissioners should work collaboratively to ensure that hospitals offer and recommend an HIV test to all young people and adults admitted to hospital or attending an emergency department in areas of extremely high HIV prevalence and to those having a blood test when admitted to hospital or attending an emergency department in areas of high prevalence.

Young people and adults admitted to hospital or seen in the emergency department (A&E) are offered an HIV test if the hospital is in an area that has a very high level of HIV. They are also offered an HIV test if they are already having a blood test and the hospital is in an area that has a high level of HIV. This will help to ensure that people with HIV are diagnosed and treated as early as possible.

Source guidance

HIV testing: increasing uptake among people who may have undiagnosed HIV (2016) NICE guideline NG60, recommendations 1.1.6 and 1.1.7

Definitions of terms used in this quality statement

Young people and adults

Young people are aged 16 and 17 years. Adults are aged 18 years and over.

[Expert opinion]

High/extremely high HIV prevalence

Local authorities with a diagnosed HIV prevalence of between 2 and 5 per 1,000 people aged 15 to 59 years have a high HIV prevalence. Those with a diagnosed HIV prevalence of 5 or more per 1,000 people aged 15 to 59 years have an extremely high HIV prevalence (based on modelling of diagnosed HIV prevalence distribution in local authorities in England; see Public Health England's sexual and reproductive health profiles for interactive maps, charts and tables).

[NICE's guideline on HIV testing]