Rolling out the tests in these 74 areas - almost one in four local authorities in England - would cost around £4m per year but would be cost effective over several decades based on criteria used by NICE, according to research based on 86,000 patients across 40 GP practices.
Researchers from Queen Mary University of London (QMUL) and the London School of Hygiene and Tropical Medicine called for the tests to be put in place urgently in the 74 areas where there are more than two diagnosed HIV infections per 1,000 adults.
They pointed out that 13,500 people in the UK are not aware that they have HIV, and that as a result they miss out on treatment, remain infectious and become more expensive to treat at a later stage. People with HIV who are diagnosed early have a near normal life expectancy, the researchers said.
The study, published in the Lancet HIV, looked at data from a trial in Hackney, east London, where HIV prevalence is high, at eight per 1,000 adults. The data showed that a quick finger-prick test as part of a standard health check during GP registration produced a four-fold higher HIV diagnosis rate.
Researchers factored in the full cost of HIV testing and treatment and found that HIV screening in primary care becomes cost-effective over 33 years under the £20,000 to £30,000 quality adjusted life year (QALY) benchmark used by NICE. Increased costs for treating patients diagnosed late could mean that screening becomes cost effective even earlier, they calculated.
Dr Werner Leber from QMUL said: 'We’ve shown that HIV screening in UK primary care is cost effective and potentially cost saving, which is contrary to widespread belief. This is an important finding given today’s austerity. Financial pressures, particularly within local authority’s public health budgets, mean that the costs of HIV testing are under intense scrutiny, and in some areas investment in testing has fallen.'
Dr Clare Highton from City and Hackney CCG said: 'Public health, specialist and CCG commissioners should take note of these important results showing the value for money of screening for HIV in primary care. This intervention means that people with HIV are able to live longer and healthier lives and the spread of infection to other people is halted.'
A draft quality standard published by NICE in March included a statement that adults and young people in high or extremely high prevalence areas should be offered an HIV test when they register with a GP or are sent for a blood test if they have not had an HIV test in the previous 12 months.