GPs should offer HIV tests to all new patients in high prevalence areas, NICE says

GP practices in areas of high HIV prevalence should offer and recommend HIV testing to new patients who register and those that come in for blood tests, NICE has said.

NICE deputy chief executive Professor Gillian Leng

Updated guidance launched on Thursday to coincide with World Aids Day collates and updates two previous NICE guidelines and aims to support increased uptake of HIV testing.

An estimated 101,200 people are living with HIV in the UK, but around one in eight people with the disease are thought to be undiagnosed.

It advocates offering HIV testing more widely in GP practices, depending on local HIV prevalence.

The RCGP backed the recommendations to make better use of opportunities to test for HIV, but warned GPs' lack of resources and the ‘constraints of the 10-minute consultation’ could be barriers to implementing the measures.

HIV testing

GP practices in areas of high and extremely high HIV prevalence are advised to offer and recommend HIV testing to everyone not previously been diagnosed who registers with the practice or comes in for a blood test.

The guideline uses Public Health England’s (PHE) definitions of ‘high’ and ‘extremely high’ prevalence – defined as two to five diagnosed infections per 1,000 aged 15-59 and more than five per 1,000, respectively.

It is the first of NICE’s guidelines to be officially ‘co-badged’ by PHE. PHE says 54 local authorities can be classified as having high prevalence based on these criteria, with 20 identified as extremely high.

It recommends point-of-care testing should be offered in situations where it would be difficult to give people their results, for example if they are unwilling to leave contact details.

Self-sampling kits could also be offered to people in groups and communities with a high rate of HIV.

Dr Philippa Matthews, RCGP clinical lead for HIV, sexual and reproductive health, said: ‘We welcome the emphasis in today’s NICE guidance on using appropriate opportunities to offer tests to patients, with an emphasis on additional approaches in areas of high and extremely high prevalence rates of HIV.

‘This is something that the college supports, and is promoting through our new programme, which aims to develop and support a range of strategies for increasing HIV testing in primary care.

‘However, as the guidelines acknowledge, there are barriers for GP surgeries to offer wide-scale HIV testing. Funding for such initiatives is currently decided by local councils, and there is no uniformity across the country.

High prevalence

‘It is also the case that GPs and our teams are already under immense resource and workforce pressures making it incredibly difficult to implement any new programme, this is compounded by the lack of a clear national approach.

‘Furthermore, there are sensitivities that GPs need to take into account when offering HIV tests to patients who are usually visiting the GP for reasons not connected with HIV; a conversation that is  difficult within the frustrating constraints of the standard 10-minute consultation.

‘Despite this, many doctors and nurses in high prevalence areas are doing an incredible job at integrating HIV testing into relevant routine care.’

Professor Gillian Leng, deputy chief executive of NICE, said: ‘This important new guideline, which draws together and updates two previous guidelines, makes a number of important recommendations to increase the awareness and uptake of HIV testing.

‘We want to normalise HIV testing so it isn’t viewed any differently from any other blood test. There are now highly effective treatments for HIV and it should no longer be seen with fear or stigma.

‘Today, on World Aids Day, we would like all NHS and community services to think about HIV testing and see what they can do to ensure their organisation can put in place the comprehensive HIV testing we recommend in our new guideline.’

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