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GPs should offer HIV tests in routine appointments

GPs concerned about workload, funding – and difficult conversations in 10-minute consultations

Louise Prime

Thursday, 01 December 2016

GPs and hospital doctors in areas where HIV infection is relatively common should offer millions of patients HIV testing when they attend for unrelated or routine appointments, the National Institute for Health and Care Excellence (NICE) has recommended this morning. In new guidance that focuses on strategies to reduce barriers to HIV testing to increase uptake, NICE said that, in areas of high HIV prevalence, people should be recommended to have an HIV test when they register with a GP practice or when they have a blood test for a different reason, unless they have already been diagnosed with HIV – but GPs are concerned about lack of resources and funding, as well as the difficulty of raising the subject of HIV testing in an unrelated consultation.

NICE said there are 20 local authority areas with ‘extremely high’ HIV prevalence (i.e. five or more diagnosed infections per 1,000 people aged 15-59 years), including Manchester, Brighton and Hove as well as 18 London boroughs, with an estimated total population of about 3.7 million; and 54 local authority areas with high’ HIV prevalence (two to five diagnosed infections per 1,000), including Leeds, Birmingham and Newcastle, with a total population of about 7.9 million.

NICE said, depending on prevalence, HIV testing should be offered and recommended in hospitals, A&E departments and GP practices. Its recommendations include:

  • In areas of high and extremely high prevalence, offer and recommend HIV testing to everyone who has not previously been diagnosed with HIV and who registers with a GP practice or who has a blood test.
  • In extremely high prevalence areas, offer and recommend HIV testing on admission to hospital, including A&E, to everyone who has not previously been diagnosed with HIV, regardless of whether they are having blood tests.
  • Offer point-of-care testing in situations in which it would be difficult to give people their results, for example if they are unwilling to leave contact details.
  • Consider providing self-sampling kits to people in groups and communities with a high rate of HIV as this strategy “shows great promise, especially as a way to engage people less likely to visit services”.

NICE deputy chief executive Professor Gillian Leng said: “We want to normalise HIV testing so it isn’t viewed any differently from any other blood test … 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.”

Consultant physician in HIV/GUM Dr Ann Sullivan, a member of the guideline development group, commented: “Adding in an HIV test for people in high and extremely high prevalence areas when they’re already having blood taken is a win-win situation and will cost next to nothing.”

GPs have welcomed NICE’s emphasis on using “appropriate” opportunities to offer HIV testing, with additional approaches in areas of highest prevalence, but are concerned about implications for training, workload and funding, as well as potential difficulties in raising the subject in unrelated consultations. The Royal College of GPs clinical lead for HIV, sexual and reproductive health, Dr Philippa Matthews, said funding for wide-scale HIV testing is decided by local councils, with no national uniformity. She said: “There is also the issue of effective implementation – including training and support for practices to adopt these schemes. GPs and our teams are already under immense resource and workforce pressures, making it incredibly difficult to implement any new programme.”

She added: “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.”

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