Main Category: HIV / AIDS
Also Included In: Men's health;��Sexual Health / STDs
Article Date: 23 Mar 2011 - 3:00 PDT
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New NICE guidance aims to increase HIV testing to help reduce undiagnosed infection and prevent transmission among men who have sex with men by recommending healthcare professionals offer regular, routine testing to all men in high prevalence areas.
In 2009 in the UK, there were 6,630 people diagnosed with HIV. Over 40% of these new diagnoses are among men who have sex with men. There are approximately 30,800 men who have sex with men living with HIV in the UK and of these it is estimated that nearly 9,000 are unaware that they are infected[1].
HIV can be successfully managed with antiretroviral therapies. However, if someone is diagnosed late it's more likely that the virus will have already seriously damaged their immune system. Late diagnosis is one of the biggest contributing factors to illness and death for people with HIV. Almost a third of people in the UK who are diagnosed as HIV positive are diagnosed late[2].
Professor Mike Kelly, Director of the Centre for Public Health Excellence at NICE said: "HIV is still a serious problem in this country, with a large proportion of people unaware they are infected. This new guidance from NICE makes a number of practical recommendations which aim to increase HIV testing by encouraging healthcare professionals to offer it routinely to people in areas where there are a high number of people living with HIV.
"For the individual, there are obvious health benefits to being diagnosed quickly - they can start treatment if they need to and look after their own health, but HIV testing and treatment can also help reduce transmission of the virus."
Recommendations include:
Promoting HIV testing among men who have sex with men
- Ensure interventions to increase the uptake of HIV testing are hosted by, or advertised at, venues that encourage or facilitate sex between men. This is in addition to general, community-based HIV health promotion (for example, locations such as bars could be involved, as well as GP practices).
Primary and secondary care: offering and recommending an HIV test
- Primary care providers should offer and recommend HIV testing to all men who have not previously been diagnosed HIV positive and who fit into one of the following categories (full list available below*): registered with a practice in an area with a large community of men who have sex with men, or registered with a practice in an area with a high HIV prevalence (more than two diagnosed cases per 1000 people), or disclose that they have sex with other men.
- Secondary and emergency care providers should offer and recommend HIV testing to all men admitted to hospital who have previously tested negative for HIV, or have never been tested, and who: are admitted in areas with a high prevalence of HIV, or disclose that they have sex with other men, or have symptoms that may indicate HIV or HIV is part of the differential diagnosis.
Outreach: providing rapid point-of-care tests- Offer tests via outreach in venues where there is high-risk sexual behaviour or in venues sited in areas where there is high local prevalence of HIV. This could include community or voluntary sector premises, public sex environments (such as saunas or cruising areas) or other venues identified during the planning exercise. Tests should be undertaken in a secluded or private area, in line with British HIV Association (BHIVA), et al. guidelines[3].
Dr Matt Kearney General Practitioner, Runcorn; Primary Care Adviser, Department of Health: "This new guidance offers clear guidance to help healthcare professionals, including GPs, offer testing and ensure that those who test positive are offered the treatment they need as soon as possible. For those whose results are negative, testing can also provide an opportunity to identify people who are most likely to be infected and help them remain infection free."
Professor Jane Anderson Consultant Physician, Homerton University Hospital NHS Foundation Trust: "These recommendations encourage healthcare professionals to be more proactive in offering HIV testing. For people with HIV to get the best from the available treatments they need to be aware of their infection and get into care in time. It's also very important that people who not infected know that they are HIV negative. Making regular HIV testing a routine is crucial to achieve these outcomes."
Scott Ellis Health promotion specialist in sexual health and HIV and lecturer in sexual health at University of East London: "The new NICE guidance on HIV testing is a much-needed step forward for men who have sex with men. HIV is still very much a part of our community but is not often talked about except when someone receives a positive test result. We need to be more aware of the virus, of how and where we can test for it and more importantly, that we should be testing regularly for it. The guidance issued today will help us with all of these points and I hope that HIV testing becomes a more routine part of our healthcare as a result."
Ben Tunstall, Terrence Higgins Trust's Head of Health Improvement, said: "We welcome the introduction of these new guidelines, the first of their kind, as a vital step forward in encouraging gay men to test and engaging health care professionals in the need to offer increased, more easily accessible testing. We urge anyone having sex with different partners to make regular HIV testing a priority. These guidelines need to be put into practice to combat onward transmission of HIV and reduce the unacceptably high levels of undiagnosed HIV that we're still seeing in the UK."
Dr Keith Radcliffe, President of the British Association for Sexual Health and HIV said: "The later people are diagnosed with HIV, the more difficult and expensive it is to treat them, the poorer their outcome may be, and the more likely they are to have transmitted the infection. With an estimated 9,000 men who have sex with men unaware that they are HIV positive, we are delighted that this guidance, which is based on an overwhelming body of evidence, demonstrates the urgent need to move away from targeted testing, to a system of routine testing for all those at risk of contracting HIV, and we hope that all local health authorities, and all healthcare professionals work hard in implementing this guidance."
Royal College of General Practitioners Chair Dr Clare Gerada said: "HIV can be successfully managed in ways that can improve quality of life and reduce complications and transmission of infection. It is important therefore that all health professionals do everything possible to encourage testing amongst high risk groups. The RCGP welcomes the new NICE guidelines and we are sure that GPs will help patients come forward for testing."
Notes
About the guidance
1. The guidance will be available on the NICE website from 23 March, 2011.
2. The Health Protection Agency will publish data on the number of new HIV diagnoses in the UK on 23 March 2011
3. Men who have sex with men are disproportionately infected with HIV in England which is why the Department of Health asked NICE to produce guidance on how to increase the uptake of testing in this population.
4. This is one of two pieces of complementary NICE guidance on how to increase the uptake of HIV testing. The other guidance focuses on black African communities living in England and is available from the NICE website. People with an interest in increasing the uptake of HIV testing among both groups should refer to both pieces of guidance.
5. * Primary care providers should offer and recommend HIV testing to all men who have not previously been diagnosed HIV positive and who:
- register with a practice in an area with a large community of men who have sex with men, or
- register with a practice in an area with a high HIV prevalence (high prevalence means more than two diagnosed cases per 1000 people), or
- disclose that they have sex with other men, or
- are known to have sex with men and have not had a HIV test in the previous year, or
- are known to have sex with men and disclose that they have changed sexual partner or disclose high risk sexual practices, or
- have symptoms that may indicate HIV or HIV is part of the differential diagnosis (see national guidelines[4] for HIV indicator diseases), or
- are diagnosed with, or request screening for, a sexually transmitted infection, or
- live in a high prevalence area and are undergoing blood tests for another reason.
The BHIVA et al. guidelines[5] also state that an HIV test should be offered to patients attending genitor-urinary medicine or sexual health clinics, antenatal services, termination of pregnancy services, drug dependency programmes, and services for tuberculosis, hepatitis B and C, and lymphoma.
In areas where more than 2 in 1000 people have been diagnosed with HIV, the BHIVA guidelines recommend that professionals should consider offering and recommending an HIV test when registering and admitting new patients.
[1] Health Protection Agency 2010
[2] Late diagnosis is defined as taking place after antiretroviral treatment would typically have begun, or when the person has an AIDS-defining illness.
[3] British HIV Association, British Association of Sexual Health and HIV, British Infection Society (2008) UK national guidelines for HIV testing 2008. London: British HIV Association.
[4] British HIV Association, British Association of Sexual Health and HIV, British Infection Society (2008) UK national guidelines for HIV testing 2008. London: British HIV Association.
[5] British HIV Association, British Association of Sexual Health and HIV, British Infection Society (2008) UK national guidelines for HIV testing 2008. London: British HIV Association.
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