UK guidelines

UK guidelines for HIV testing, published in September 2008, urge healthcare workers of all specialities to consider HIV testing in a wide range of situations and settings, in order to reduce the number of late and undiagnosed HIV infections.¹ In local areas where HIV prevalence is high, testing is recommended for all adults in all healthcare services.

The guidelines are jointly produced by the British HIV Association (BHIVA), the British Association of Sexual Health and HIV (BASHH) and the British Infection Society (BIS).

The guidelines were supplemented and supported in 2011 by guidance from the National Institute for Health and Clinical Excellence (NICE). The health watchdog issued public health guidance on increasing the uptake of HIV testing in two key communities – men who have sex with men and black African communities.^{2, 3}

While the 2001 National Strategy for Sexual Health and HIV highlighted a role for GPs in providing HIV testing and other sexual health services, development of that role has been limited. The strategy also recommended that all patients at genitourinary medicine (GUM) clinics be offered an HIV test on their first visit, and the 2006 BASHH guidelines recommended that all GUM patients should be offered HIV tests on an ‘opt-out’ basis. Opt-out means that a test is recommended to the patient and carried out unless he or she specifically refuses.

In 2007, the Chief Medical Officer and the Chief Nursing Officer issued a letter⁴ urging general practitioners and non-HIV clinicians to "be alert to the circumstances in which it is appropriate to offer and recommend an HIV test", because of risk factors or signs of HIV infection.

Similarly, the 2008 guidelines envisage that HIV testing is not only offered as part of a sexual health screen, but during a wide range of other potential encounters with health services. The guidelines aspire to put an end to the ‘AIDS exceptionalism’ which suggested that HIV testing could not be handled by mainstream health services, and that specialised pre- and post-test counselling was required. The guidelines state that: “It should be within the competence of any doctor, midwife, nurse or trained healthcare worker to obtain consent for and conduct an HIV test.”

It is recommended that a pre-test discussion concentrate on the benefits of testing and how the results will be given. Positive results should be given face to face, and the patient should normally be seen by a specialist HIV service within 48 hours of receiving the result. The guidelines recommend that detailed post-test discussions are handled by the specialist HIV team.

The guidelines provide an overlapping set of criteria for when opt-out tests should be proposed, based on healthcare setting, local prevalence, other diagnoses, and the lifestyle and demographic characteristics of the patient.