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Routine HIV testing could save lives and money

Researchers call for general practice screening in areas with high infection rates

Mark Gould

Monday, 31 July 2017

Researchers say that routine HIV screening should be introduced in 74 areas of England with high rates of infection with the virus.

Writing in The Lancet HIV* they say that offering routine tests to people when they register with new GP surgeries in high-risk areas is cost-effective and could save lives.

An estimated 13,500 people in the UK do not know they are HIV+, meaning they miss out on treatment and pose an infection risk to others.

Dr Werner Leber, from Queen Mary University of London, led the study, which involved more than 86,000 people registered at 40 GP surgeries in Hackney, east London. He 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 authorities’ public health budgets, mean that the costs of HIV testing are under intense scrutiny, and in some areas, investment in testing has fallen.”

The scientists conducted a trial which tested the effectiveness of rapid finger-prick HIV testing as part of the standard health check carried out during GP registration. They found it led to a fourfold increase in the HIV diagnosis rate.

They used a mathematical model to show that primary care HIV screening in high-prevalence areas became cost-effective after 33 years. But factoring in the higher costs of care for people diagnosed late showed that screening could become cost-effective far sooner. The annual cost of offering HIV screening to all 74 high-prevalence authorities was estimated at £4 million.

Dr Clare Highton, from the City and Hackney Clinical Commissioning Group (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.”

Dr Michael Brady, medical director of the HIV/Aids charity the Terrence Higgins Trust, said the research was important and showed the approach to be cost-effective and possibly cost-saving.

Dr Brady said the UK’s national HIV testing guidance had been recommending testing in general practices in high-prevalence areas since 2008, with NICE guidelines also recommending the same.

“I hope that policymakers, commissioners and healthcare providers act on these findings and invest in HIV testing in primary care,” he said.

“We have the tools to end HIV transmission in the UK but we won’t achieve that without scaling up testing in general practice and other community settings.”

* Baggaley RF, Irvine MA, Leber W, et al. Cost-effectiveness of screening for HIV in primary care: a health economics modelling analysis. The Lancet HIV, 30 July 2017. DOI: 10.1016/S2352-3018(17)30123-6

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