Following NICE’s recommendations on increasing the offer of HIV tests in primary care

Late diagnosed HIV is a key public health issue in the UK. In 2015, nearly 2 out of 5 adults were diagnosed with HIV at a late stage of infection and 1 in 5 were severely immunocompromised at the time of their diagnosis.1 Early detection can not only help people to live a normal life expectancy2, but can also help reduce onward transmission.3

Author: The HIV Awareness in Primary Care working group

Added on: 12/12/2016

Tags: HIV Testing, NICE Guidance, Primary Care

We can do a lot more to help diagnose HIV earlier and this NICE guideline is a huge step forward in helping us achieve this goal. Have a look at our website to access useful resources that can help you put this guideline into practice by supporting you to offer the test.

Evidence shows that those diagnosed late have often presented to primary care in the years running up to diagnosis with HIV-related signs or symptoms.4 We are missing crucial chances to diagnose HIV in primary care and therefore, it is important that we make the most of every opportunity we have to detect HIV early. 

The new National Institute for Health and Care Excellence (NICE) guideline: HIV testing: increasing uptake among people who may have undiagnosed HIV, published on World AIDS Day (1st December) 2016, helps us do exactly that.

The new guideline underlines the importance of increasing awareness and uptake of HIV testing in primary care by recommending:3

  • GP surgeries in all areas to offer and recommend HIV testing to everyone who has not previously been diagnosed with HIV and has symptoms that may indicate HIV or HIV is part of the differential diagnosis
  • GP surgeries in areas of high and extremely high prevalence to offer and recommend HIV testing to everyone who has not previously been diagnosed with HIV and who registers with the practice or is undergoing blood tests for another reason and has not had a HIV test in the previous year
  • Additionally, GP surgeries in areas of extremely high prevalence to consider HIV testing opportunistically at each consultation (whether bloods are being taken for another reason or not), based on clinical judgement

If you want to know the diagnosed prevalence of HIV in your area, you can check here: sexual and reproductive health profiles. You might find that you are practising in one of the 20 local authority areas with extremely high HIV prevalence which includes Manchester, Brighton and Hove and 18 of the London boroughs. Or you might be practising in one of the 54 local authority areas with high HIV prevalence which include Leeds, Birmingham, Newcastle and the other 15 London boroughs.

UK/HIV/0021/16(1)c, Date of preparation: December 2016

References:

1. HIV in the UK - 2016 report. December 2016. Public Health England, London.

2. May M, Gompels M, Delpech V, et al. (2014). Impact on life expectancy of HIV-1 positive individuals of CD4+

cell count and viral load response to antiretroviral therapy. AIDS. 28(8):1193-1202.

3. National Institute for Health and Clinical Excellence (2016) HIV testing: increasing uptake among people

who have undiagnosed HIV. Joint NICE and Public Health England guideline. (NG60). 

4. Burns F et al. (2008). Missed opportunities for earlier HIV diagnosis within primary and secondary healthcare

settings in the UK. AIDS. 22(1):115-22.