One of our strategic goals is to achieve early diagnosis of HIV through ethical, accessible and appropriate testing.
Commissioning HIV Testing Services in England
From the 1 April, a new set of NHS commissioning arrangements for HIV testing services have come into place. This presents a vital opportunity to bring a fresh approach to HIV testing in England where late HIV diagnosis remains too high. Local councils will for the first time take on the role of commissioning HIV testing services alongside other bodies such as the Clinical Commissioning Groups (CCGS) and the NHS Commissioning Board. In light of this, NAT has developed a detailed guide: 'Commissioning HIV Testing Services in England: A practical guide for Commissioners'. This resource has been developed in partnership with an expert group of Commissioners as well as members of the 'Halve It' coalition.
The resource will be a valuable tool to help commissioning bodies develop HIV testing and reduce late diagnosis rates. It provides an invaluable checklist of questions against which commissioning plans can be assessed as well as a range of best practice guidance. There is also an Appendix to the guide. This gives further details on case studies of best practice for HIV testing.
Priorities for HIV testing in the UK
HIV testing rates amongst the groups most at risk are still far too low. Nearly half of black African men and women in the UK have never had an HIV test, while around 15% of gay and bisexual men have never tested. Although overall rates of testing among gay and bisexual men have improved, frequency of testing is still inadequate – over half (54%) of men who have sex with men (MSM) in a recent survey said that they had not tested in the last year.
In 2010, half of those newly diagnosed with HIV were diagnosed late, after the point at which they should have begun treatment. Late diagnosis reduces life expectancy and dramatically increases the likelihood of an early death. It also makes it more likely that that individual has passed HIV on to others. Improved HIV testing is therefore vital to both individual and public health.
That’s why NAT want to see a change in testing culture in the UK. ‘At least annual’ testing must become the norm both for gay and bisexual men and African men and women. We also want to see the rate of African men and women who report ever having an HIV test increased to at least 80%.
It is vital that the recommendations of the UK National Guidelines for HIV Testing, as well as NICE public health guidance (on MSM and black Africans), are fully implemented. A key component of this is the roll-out of HIV testing in a wide range of healthcare settings, including the offer of a test to all general medical admissions and new GP registrants in high prevalence areas.
All of this will require sustained funding for initiatives to reduce undiagnosed HIV.
NAT’s 2012 HIV Testing Action Plan
In early 2012 NAT developed its HIV Testing Action Plan to increase uptake of HIV testing and reduce late diagnosis across the UK. This provides an overview of NAT’s thinking on current HIV testing strategies in the UK and updates our 2009 Action Plan in light of new guidance and forthcoming changes to Health and Social Care in England. It identifies priority activities to increase political will, commitment and resources from a wide range of stakeholders.
Repeat testing for MSM
UK National Guidelines and NICE recommend that all men who have sex with men (MSM) test at least annually. This message needs to be consistent and delivered within prevention programs with sustained funding across the country. In addition, there is work to do to build consensus on when MSM should test more frequently than once a year - the HPA’s recent proposal that the working definition should be every six months for “anyone having unprotected anal intercourse with casual and new sexual partners” should be taken as a starting point. NAT, in partnership with GMFA and BASHH and with support from the Health Protection Agency, have also produced a leaflet to explain to gay men why having regular HIV tests is important and to explain how they can have a test.
Repeat testing in African communities
Late HIV diagnosis and undiagnosed HIV remains especially acute among African communities in the UK. Therefore, NAT supports the development of an annual testing recommendations for sexually active Africans. NICE should introduce this as part of their review of testing guidance for African communities, while the national HIV prevention programme should promote annual testing amongst sexually active Africans.
For more information, read NAT’s special position paper on testing among African communities in England.
Awareness of primary HIV infection
In 2011 NAT released a report, Primary HIV Infection: knowledge amongst gay men, highlighting the poor state of awareness among gay men about primary HIV infection. This followed our initial 2008 report, Primary HIV Infection.
Primary HIV infection refers to first few months after transmission. Symptoms occur in around 70-90% of people recently infected: the most common are the combination of a fever, sore throat and a rash. These signs usually come and go within 2-3 weeks, after which no further symptoms are experienced until several years later - at which point the patient may be very ill, with an extremely damaged immune system and reduced life expectancy. It is thought that up to 50% of HIV transmissions are from people who are themselves recently infected, due to the extremely high viral load at this stage of the infection.
Prevention interventions among gay and African communities need urgently to incorporate information on primary infection and the benefits of early diagnosis.
NAT’s two reports on primary HIV infection and HIV Testing Action Plan contain detailed recommendations on how to increase awareness of this issue.
Types of HIV test
NAT has put together a fact sheet on the different types of HIV test.
Self-testing kits for HIV could also have an important role to play in reaching often vulnerable people who are unable or unwilling to test in GUM or healthcare settings. At the moment, self-testing kits are illegal under the HIV Testing Kits and Services Act (1999). The Government must amend this regulation to permit proper, quality-controlled and regulated self-testing for HIV. NAT’s report on HIV Home Testing sets out the arguments for the legalisation of home self-testing kits.
HIV partner notification
NAT has recently produced a report on HIV partner notification. Our research found that where conducted thoroughly, partner notification can be a highly effective form of HIV testing and, crucially, prevention. Despite this, however, at present the role of partner notification remains rather neglected. It too often goes under resourced, unperformed or unacknowledged. NAT's report seeks to address this by outlining policy steps necessary to achieve high-quality, consistent HIV partner notification across the UK
Our report builds on the expertise and discussion that arose out our expert seminar on this topic in January 2012. A few of the presentations from this seminar are below:
Other useful links: