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New care standards for HIV aim to boost quality despite funding pressures

Eight standards cover range of care from diagnosis to end of life

Caroline White

Thursday, 19 April 2018

Treatment advances mean that HIV is becoming more common in people over the age of 50, and services need to better reflect the need for care over the life course, says the British HIV Association today on the issue of its latest set of quality standards for people living with HIV.*

The eight standards, which update earlier versions published in 2007 and 2013, aim to inform commissioning decisions within and outside the NHS to meet the growing need for more efficient and cost-effective services, while better reflecting the changing needs of patients and boosting quality.

They cover the care that any adult living with HIV in the UK should expect to receive and include: testing, diagnosis and prevention; person-centred care; outpatient care and treatment; complex care; sexual and reproductive health; psychological care; HIV across the life course; and developing and maintaining excellent care.

Developed in partnership with care providers, professional associations, commissioners and people living with HIV, they take a holistic and integrated approach, embracing overall health and wellbeing, as well as clinical care.

Each standard presents a rationale, quality statements and measurable and auditable outcomes. Three new sections have been introduced looking at HIV prevention, stigma and wellbeing, and HIV across the life course

Estimates suggest that there are currently around 13,000 people in the UK who do not know they are HIV positive. They can unknowingly infect others, unlike most (96%) of those attending HIV clinics on antiretroviral therapy, of whom most have an undetectable viral load.

And a significant proportion of new diagnoses are made at a late stage, which results in poorer health outcomes and lower life expectancy.

Effective HIV testing strategies should be tailored to local need and maximise the opportunity for testing in both non-clinical and clinical settings, say the standards. That includes self-sampling and self-testing which have emerged as acceptable and convenient methods for accessing an HIV test.

The impact of regular testing is shown in the fall in diagnoses in five London clinics in 2017, where it is thought to have been a key factor.

Despite highly effective treatment, psychological and social problems persist, as does the experience of HIV-related stigma.

Stigma still exists in healthcare services themselves, and the standards call for training for all staff on how to identify its impact and effects, including what it is, how it manifests, the consequences on wellbeing and behaviour, as well as how issues can be addressed practically.

The standards recognise the diverse needs of people living with HIV at different stages of their lives. Young adults and adolescents living with HIV should have care and support that is young-person friendly and at convenient times and locations, it says.

Sexual healthcare and contraception services should be part of an integrated care package, which also includes an awareness of potential risks this age group is particularly vulnerable to, such as sexual exploitation, coercion and sexual assault.

Testing needs to target older age groups, as there has been an increase in the number and proportion of people over 50 diagnosed with HIV, and these are more likely to be late diagnoses.

Effective treatment also means that people with HIV are living longer, leading to other underlying conditions, particularly cardiovascular disease, osteoporosis, menopause and dementia.

“There has been enormous progress in HIV treatment and care in the last five years and we are proud to say that outcomes for people living with HIV in the UK are among the best in the world. They now have a very similar life expectancy to the general population, but this brings with it fresh challenges,” comments BHIVA Chair, Chloe Orkin.  

“On the one hand, we must manage the complex co-morbidities of an ageing HIV population, but on the other we welcome the very positive impact of effective medications on HIV transmission. Increased testing, alongside prevention interventions such as pre-exposure prophylaxis (PrEP), are leading to real breakthroughs in limiting the spread of infection and new diagnoses.”

She added: “We hope that these new standards will provide a framework to inform and support commissioning decisions both within and outside the NHS. In addition to targeting all healthcare professionals, they are also there to inform people living with HIV, and those who advocate for them, about the care they should expect to receive when they access HIV services.”


* Standards of Care for people living with HIV in the UK 2018. British HIV Association, April 2018.

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