Quality statement 2: General practice in areas of high and extremely high HIV prevalence

Quality statement

Young people and adults in areas of high or extremely high HIV prevalence are offered an HIV test by their GP practice when registering or when having a blood test if they have not had an HIV test in the past 12 months.

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 to other people. Offering HIV testing routinely in GP practices in areas of high or extremely high prevalence will help to ensure that having an HIV test is regarded as routine practice. This will help to reduce the stigma that can be associated with HIV testing. As the decision to offer an HIV test will be based on clinical judgement the expected level of achievement against the process measures may vary.

Quality measures

Structure

a) Evidence of local processes to offer an HIV test to young people and adults registering with a GP in areas of high or extremely high HIV prevalence.

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

b) Evidence of local processes to offer an HIV test to young people and adults having a blood test at their GP practice in areas of high or extremely high HIV prevalence if they have not had an HIV test in the past 12 months.

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

Process

a) Proportion of young people and adults newly registered with a GP in an area of high or extremely high HIV prevalence who receive an HIV test within 3 months of registration.

Numerator – the number in the denominator who receive an HIV test within 3 months of registration.

Denominator – the number of young people and adults newly registered with a GP in an area of high or extremely high HIV prevalence.

Data source: Local data collection, for example, an audit of patient health records. Following consultation, a 3-month timescale was suggested for measurement purposes.

b) Proportion of young people and adults who have not had an HIV test in the past 12 months having a blood test at their GP practice in an area of high or 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 who have not had an HIV test in the past 12 months having a blood test at their GP practice in an area of high or extremely high HIV prevalence.

Data source: Local data collection, for example, an audit of patient health records. Given that the decision to offer an HIV test will be based on clinical judgement, GP practices may wish to determine the expected level of achievement on the basis of local patient profile.

Outcome

a) HIV testing rate per 1,000 registered patients in GP practices in areas of high and extremely high HIV prevalence.

Data source: Local data collection from GP practices.

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

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

c) Number of new HIV diagnoses made at a late stage of infection in areas of high and extremely high HIV 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 (general practices) in areas of high or extremely high HIV prevalence ensure that staff offer and recommend an HIV test to young people and adults when they register or when they are having a blood test if they have not had an HIV test in the past 12 months. Providers could offer an HIV test by an opt-out testing system.

Healthcare professionals (such as GPs, practice nurses and healthcare assistants) in areas of high or extremely high HIV prevalence offer and recommend an HIV test to young people and adults when they register with the practice or when they are having a blood test if they have not had an HIV test in the past 12 months. Healthcare professionals 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, clinical commissioning groups and NHS England) work collaboratively to commission general practice services in areas of high or extremely high HIV prevalence that offer and recommend an HIV test to young people and adults at registration or when they are having a blood test if they have not had an HIV test in the past 12 months. Commissioners ensure that general practices are aware of local HIV prevalence and that training and resources are available to support general practices to implement increased HIV testing.

Young people and adults in areas with a high risk of HIV are offered an HIV test when they register with a GP or when they are having a blood test at their GP practice if they have not had an HIV test in the past 12 months. 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, recommendation 1.1.9

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 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]