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HIV testing and prevention
This pathway covers recommendations for the NHS, local authorities and the wider public, voluntary, community and private sectors on how to prevent the spread of HIV by increasing the uptake of HIV testing services. In particular, the recommendations aim to increase the uptake of HIV testing among men who have sex with men and black Africans living in England who are, or who have been, sexually active.
The recommendations may benefit the wider community through the universal offer of an HIV test and reduced transmission of HIV as a result of testing and treatment.
The NICE guidance that was used to create the pathway.
Increasing the uptake of HIV testing among men who have sex with men. NICE public health guidance 34 (2011)
Increasing the uptake of HIV testing among black Africans in England. NICE public health guidance 33 (2011)
Effective interventions library
Successful effective interventions library details
These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.
Education and learning
NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.
Service improvement and audit
These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.
Current UK guidelinesBritish HIV Association, British Association of Sexual Health and HIV, British Infection Society (2008) UK national guidelines for HIV testing 2008. London: British HIV Association. aim to 'normalise' and increase HIV testing in all healthcare settings to reduce the levels of undiagnosed HIV infection. They recommend that an HIV test should be offered to everyone in some settings (for example, for antenatal or TB patients) and only to people at risk in other settings (for example, general practice). In areas where more than 2 in 1000 people in the general population have diagnosed HIV, the guidelines recommend an HIV test is considered for everyone at GP registration and hospital admission.
The ability to offer and recommend an HIV test should be within the range of competencies required for many health professionals. A lack of specific training should not be a barrier to carrying out HIV tests. For example, many health professionals should already be trained to take blood and carry out a range of other tests. In addition, they should already be trained in giving bad news (including the results of tests for life-threatening conditions). They should have the information and confidence to use these skills in relation to HIV.
It is assumed that HIV tests are delivered according to current best practice. They should be accompanied by pre- and post-test discussions according to locally agreed procedures. Further information can be found in the UK national guidelines for HIV testing which are currently the national standard.
All frontline healthcare staff, including non-clinical staff, should be trained in diversity issues and be able to challenge the stigma of, and dispel the myths surrounding, HIV and HIV testing.
Point-of-care testing (POCT) should be delivered in accordance with the British Association of Sexual Health and HIV guidance on the use of HIV POCTBritish Association of Sexual Health and HIV (2006) Guidance on the appropriate use of HIV point of care tests. .
The offer of an HIV test should:
- be suited to a person's age, culture, gender and sexuality
- take into account potential barriers to HIV testing, such as stigma or lack of access to services
- be delivered in a non-judgemental way.
Updates to this pathway
24 January 2014 Minor maintenance updates.
11 June 2013 Minor maintenance updates.
14 December 2012 Minor maintenance updates.
6 December 2011 Minor maintenance updates.
25 October 2011 Minor maintenance updates.
The term 'black African' is used to describe anyone who identifies themselves as black African, whether they are migrants from Africa, African descendants or African nationals.
Black African communities encompass diverse population groups including people:
- from a range of cultural, ethnic and faith backgrounds
- who may be heterosexual, bisexual or homosexual
- who may have physical or learning disabilities
- whose knowledge or understanding of English may be limited.
The CE mark is a declaration by the manufacturer that the product meets all of the appropriate requirements of the In Vitro Diagnostic (IVD) Medical Device Directive (98/79/EC). It is illegal to place on the market or supply in the EU any IVD that is not CE marked.
Men who have sex with men may be any age and may include males under the age of 16. They come from any cultural, ethnic or faith background and include those who:
- identify as gay or bisexual
- may identify themselves as heterosexual (and may be having sex with both men and women)
- are involved in the commercial gay scene (such as bars and clubs)
- use public sex environments (such as public toilets and cruising areas)
- opportunistically have sex with men by other means, for example by using Internet sites where men meet for sex
- may have physical or learning disabilities
- may have a limited knowledge or understanding of English.
Point-of-care testing (POCT) is diagnostic testing at, or near, the site of patient care. The aim of POCT is to bring the test to the patient, so that they receive the result immediately (within a few minutes).
Primary care is healthcare delivered outside hospitals. It includes a range of services provided by GPs, nurses, health visitors, midwives and other healthcare professionals and allied health professionals such as dentists, pharmacists and opticians. It includes community clinics, health centres and walk-in centres.
Secondary care is healthcare provided in hospitals. It includes accident and emergency departments, outpatient departments, antenatal services, genitourinary medicine and sexual health clinics.
The window period is the time between infection and when antibodies to the virus are detectable by a test. Depending on the type of test it can take up to 3 months, although fourth generation testing can detect the virus much sooner.
HIV testing and prevention
HIV testing and prevention
Strategy, policy and commissioningView the 'Strategy, policy and commissioning on HIV testing and prevention' path
Increasing uptake of HIV testingView the 'Increasing the uptake of HIV testing' path
Needle and syringe programmesView the 'Needle and syringe programmes overview' path
Preventing STIs and under18 conceptionsView the 'Preventing sexually transmitted infections and under-18 conceptions overview' path
Patient experience in adult NHS services pathwayView the 'Patient experience in adult NHS services overview' path
Paths in this pathway
- Strategy, policy and commissioning on HIV testing and prevention
- Increasing the uptake of HIV testing
- Offering and providing HIV tests
Pathway created: August 2011 Last updated: January 2014
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