Key messages Antiretroviral therapy (ART) has transformed treatment of HIV infection The benefits of early diagnosis of HIV are well recognised - not offering HIV testing represents a missed opportunity Over 25% of HIV-positive individuals remain undiagnosed, accounting for 54-70% of transmission 39% of HIV-positive heterosexuals are not diagnosed until their CD4 cell count falls below 200 In 2005, 24% of deaths in HIV-positive adults were attributable to late HIV diagnosis In one study, 62% of late diagnoses had been seen in secondary care in the previous 2 years, 26% with an HIV related problem

Key messages UK recommend screening for HIV in adult populations where undiagnosed prevalence is >1/1000 as it has been shown to be cost-effective UK guidelines recommend routine opt-out HIV testing for patients with <insert relevant condition> UK guidelines recommend universal HIV testing for patients from groups at higher risk of HIV infection A perceived lack of risk should not deter you from offering a test when clinically indicated Some patients may not disclose that they have put themselves at risk of HIV infection in the past Bullet 2: see ‘Table 1: Clinical indicator conditions for adult HIV infection’ in the UK National Guidelines for HIV Testing 2008 for a full list.

Tackling HIV Testing Project Advisory Group Dr Mary Armitage (Chair), Immediate Past Clinical Vice-President, Royal College of Physicians, Consultant Physician & Endocrinologist, Royal Bournemouth Hospital Dr Nick Beeching, Clinical Lead, Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital Dr Christine Blanshard, Consultant Physician and Gastroenterologist, Homerton Hospital, London Dr Gary Brook, Consultant in Genitourinary Medicine, Central Middlesex Hospital, London Professor Chris Bunker, Consultant Dermatologist, Chelsea & Westminster and Royal Marsden Hospitals, Imperial College London Professor Jackie Cassell, Chair in Clinical Epidemiology, Brighton and Sussex Medical School Dr Martin Fisher, Consultant in HIV/Genitourinary Medicine, Brighton and Sussex University Hospital Dr Susie Forster, Consultant in Genitourinary Medicine and Clinical Lead for Sexual Health, Cambridgeshire Community Services Professor Margaret Johnson, Professor of HIV Medicine, Royal Free Hospital, London Ms Ruth Lowbury, Chief Executive, MedFASH Professor Rob Miller, Consultant Physician and Reader in Clinical Infection, University College Hospital, London Ms Angelina Namiba, Project Manager, Primary Care Access, Positively Women Mr Charles Oduka, Chair, African HIV Policy Network Dr Ed Ong, Consultant in Infectious Diseases, Newcastle General Hospital Ms Kay Orton, Policy Lead for HIV Services, Department of Health Dr Adrian Palfreeman, Consultant in Genitourinary Medicine, Leicester Royal Infirmary Dr Angela Robinson, Consultant in Genitourinary Medicine, University College Hospital, London Dr Murad Ruf, Assistant Director Health Protection, Consultant in Public Health Medicine, NHS Lambeth Ms Heather Wilson, Senior Health Adviser, Barnet Hospital, London

Tackling HIV Testing Project Contributors MedFASH is grateful to the following colleagues who contributed cases and materials to the project: Dr Rachel Baggaley, Dr Rachel Baggaley, Head of HIV and Health at Christian Aid, Honorary Research Fellow at the London School of Hygiene and Tropical Medicine and working in primary health care in Lambeth PCT Dr Nick Beeching, Clinical Lead, Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital Dr Christine Blanshard, Consultant Physician and Gastroenterologist, Homerton Hospital, London Dr Gary Brook, Consultant in Genitourinary Medicine, Central Middlesex Hospital, London Professor Chris Bunker, Consultant Dermatologist, Chelsea & Westminster and Royal Marsden Hospitals, Imperial College, London Dr Kate Cwynarski, Consultant Haematologist, Royal Free Hospital, London Dr Martin Fisher, Consultant in HIV/Genitourinary Medicine, Brighton and Sussex University Hospital Dr Susie Forster, Consultant in GUM and Clinical Lead for Sexual Health, Cambridgeshire Community Services Professor Rob Miller, Consultant Physician and Reader in Clinical Infection, University College Hospital, London Dr Adrian Palfreeman, Consultant in Genitourinary Medicine, Leicester Royal Infirmary Dr Conal Perrett, Dermatology Department, Chelsea & Westminster Hospital, London Dr Alison Rodger, Department of Infection and Population Health, University College London and HIV Department, Royal Free Hospital, London

Also contains UK National Guidelines for HIV Testing 2008 from BASHH/BHIVA/BIS Available from: enquiries@medfash.bma.org.uk or 020 7383 6345 www.medfash.org.uk

Available from enquiries@medfash.bma.org.uk, www.medfash.org.uk, or 020 7383 6345

Who can test?

Who to test?

Who to test?

Source: Health Protection Agency, www.hpa.org.uk Table: PCTs in England in 2007 with diagnosed HIV prevalence 2/1000 population (adults aged 15-59 years) http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1221722386448 Source: Health Protection Agency, www.hpa.org.uk

Source: Health Protection Agency, www.hpa.org.uk Rates of HIV-infected persons accessing HIV care by area of residence, 2007 Only 6 PCTs in London do not meet the HPA definition of high local HIV prevalence. Full information can be found at http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1201767906579 http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1221722386448 Source: Health Protection Agency, www.hpa.org.uk 11

Who to test?

HIV prevalence (%) in adults (15–49) in Africa, 2007 Countries of higher HIV prevalence HIV prevalence (%) in adults (15–49) in Africa, 2007 2008 Report on the global AIDS epidemic Source: UNAIDS Global Report 2008, www.unaids.org

Countries of higher HIV prevalence 2008 Report on the global AIDS epidemic HIV prevalence (%) in adults (15–49) in Eastern Europe and Central Asia, 2007 Source: UNAIDS Global Report 2008, www.unaids.org

HIV prevalence (%) in adults (15–49) in Asia, 2007 Countries of higher HIV prevalence HIV prevalence (%) in adults (15–49) in Asia, 2007 2008 Report on the global AIDS epidemic Source: UNAIDS Global Report 2008, www.unaids.org

Who to test?

Which test to use?

Q: What should be a reasonable time to receive an HIV test result?