Recommendations from NICE

In 2011, NICE (the National Institute for Health and Care Excellence) produced public health guidance on increasing the uptake of HIV testing in two related documents. One concerns interventions for men who have sex with men, the other work with black African communities.^{1, 2}

The document concerning black African communities repeats a number of the key recommendations in the BHIVA/BASHH guidelines. In all healthcare settings (including general practice, outpatient and emergency departments), an HIV test should be routinely offered and recommended to all patients who come from high-prevalence countries, patients who have had sexual contact abroad and patients who have symptoms that may be related to HIV.

In addition, everybody attending a sexual health, antenatal, termination of pregnancy, drug dependency, tuberculosis, hepatitis B, hepatitis C or lymphoma services should be offered an HIV test.

At health services in areas of relatively high HIV prevalence, healthcare workers ‘should consider’ recommending HIV testing when registering and admitting new patients. In addition, an HIV test should be offered and recommended to all patients who are having another blood test anyway.

The wording of the document on testing men who have sex with men is somewhat different, but the implications are similar. In all healthcare settings, male patients who are known to be gay or bisexual should be offered and recommended an HIV test. General practitioners should repeat the offer on an annual basis.

At health services in areas of high HIV prevalence, all male patients (whether they are known to have sex with men or not) should be offered and recommended a test.

For both population groups, NICE recommends that directors of public health and commissioners develop a local strategy for increasing testing rates. The strategy should lead to more health professionals offering HIV testing and more individuals accepting the offer. The strategy should be developed in consultation with local voluntary organisations and community members and should pay particular attention to groups who are less likely to access services.

Community engagement and involvement is seen as particularly important in relation to black African communities. NICE recommends that community members should be recruited and trained to act as champions and role models. Programmes need to address misconceptions about HIV testing and treatment, promote the benefits of early diagnosis and tackle HIV-related stigma.

Health promotion interventions promoting testing to men who have sex with men should be encountered in venues, such as saunas or websites, which facilitate sex between men.

Moreover, the guidance supports outreach testing programmes in high-prevalence areas and also in venues where high-risk sexual behaviour between men occurs. This could include saunas and cruising areas. NICE appears to be more enthusiastic than BHIVA/BASHH about such projects, although they do note that testing will not be appropriate in all such venues. In such settings, rapid tests (using mouth swabs or fingerprick blood samples) should be provided by trained staff, in a secluded or private area.

All testing services (including community testing) need to have clear referral pathways to confirmatory HIV testing, HIV treatment services and support groups. Moreover, people who test negative may need referral to counselling and safer sex interventions, as well as repeat testing (for example, if a risk has been taken during a test’s window period). Men who have sex with men are recommended to test annually, or more frequently if their sexual behaviour suggests that they may be at higher risk.