Quality statement 3: HIV indicator conditions

Quality statement

Young people and adults newly diagnosed with an HIV indicator condition are offered an HIV test.

Rationale

Increasing the uptake of HIV testing among people who may have been infected is important to reduce late diagnosis. Early diagnosis improves treatment outcomes and reduces the risk of transmission to other people. Offering HIV testing in primary and secondary care to people newly diagnosed with conditions that may indicate HIV infection could mean that potentially serious consequences of HIV infection are avoided. It may also improve response to treatment for the indicator condition.

Quality measures

Structure

a) Evidence of local systems that alert healthcare professionals to the need to offer an HIV test when an indicator condition is diagnosed.

Data source: Local data collection, for example, system specification.

b) Evidence of local processes to offer an HIV test to young people and adults newly diagnosed with an indicator condition.

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

Process

Proportion of young people and adults newly diagnosed with an indicator condition who receive an HIV test.

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

Denominator – the number of young people and adults newly diagnosed with an indicator condition.

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

Outcome

a) Number of new HIV diagnoses.

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.

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 (such as hospitals including outpatient departments, general practices and sexual health services) ensure that staff are trained to offer and recommend an HIV test to young people and adults who are newly diagnosed with an indicator condition. Providers ensure that systems are in place to alert healthcare professionals to the need to offer and recommend an HIV test when a relevant diagnosis is made. Providers could offer an HIV test by an opt-out testing system.

Healthcare professionals (such as clinicians, GPs and nurses) offer and recommend an HIV test to young people and adults with HIV who are newly diagnosed with an indicator condition. If the test is declined, healthcare professionals should provide information on how to access other local HIV testing services.

Commissioners (such as local authorities, clinical commissioning groups and NHS England) include HIV testing in the service specification for hospitals and GP practices. Commissioners ensure that providers have processes in place to offer and recommend an HIV test to all young people and adults who are newly diagnosed with an indicator condition.

Young people and adults with a health condition that may suggest they have HIV are offered an HIV test. This is so that they can be diagnosed and treated as early as possible if they are infected.

Source guidance

HIV testing: increasing uptake among people who may have undiagnosed HIV (2016) NICE guideline NG60, recommendations 1.1.5 and 1.1.8

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]

HIV indicator conditions

HIV testing is recommended as identified in HIV in Europe's guidance on HIV indicator conditions. Service providers may wish to focus on the following priorities:

Conditions in which the prevalence of undiagnosed HIV is more than 0.1%
  • Sexually transmitted infections

  • Malignant lymphoma

  • Herpes zoster

  • Hepatitis B or C (acute or chronic)

  • Unexplained lymphadenopathy

  • Mononucleosis-like illness

  • Community-acquired pneumonia

  • Unexplained leukocytopenia/thrombocytopenia lasting more than 4 weeks

  • Seborrheic dermatitis/exanthema

Conditions likely to have an undiagnosed prevalence of HIV of more than 0.1%
  • Subcortical dementia

  • Peripheral neuropathy

  • Unexplained weight loss

  • Unexplained chronic diarrhoea

Potentially AIDS-defining conditions

Neoplasms

  • Cervical cancer

  • Non-Hodgkin's lymphoma

  • Kaposi's sarcoma

Bacterial infections

  • Mycobacterium tuberculosis, pulmonary or extrapulmonary

  • Mycobacterium avium complex or Mycobacterium kansasii, disseminated or extrapulmonary

  • Mycobacterium, other species or unidentified species, disseminated or extrapulmonary

  • Pneumonia, recurrent (2 or more episodes in 12 months)

  • Salmonella septicaemia, recurren

Viral infections

  • Cytomegalovirus retinitis

  • Cytomegalovirus, other (except liver, spleen, glands)

  • Herpes simplex, ulcer(s) for more than 1 month/bronchitis/pneumonitis

  • Progressive multifocal leucoencephalopathy

Parasitic infections

  • Cerebral toxoplasmosis

  • Cryptosporidiosis diarrhoea for more than 1 month

  • Isosporiasis for more than 1 month

  • Atypical disseminated leishmaniasis

  • Reactivation of American trypanosomiasis (meningoencephalitis or myocarditis)

Fungal infections

  • Pneumocystis carinii pneumonia

  • Candidiasis, oesophageal

  • Candidiasis, bronchial/tracheal/lungs

  • Cryptococcosis, extrapulmonary

  • Histoplasmosis, disseminated/extrapulmonary

  • Coccidiodomycosis, disseminated/extrapulmonary

  • Penicilliosis, disseminated

[HIV in indicator conditions HIV in Europe and expert consensus]