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HIV testing and prevention

About

What is covered

This interactive flowchart covers how to prevent the spread of HIV by increasing the uptake of HIV testing in primary and secondary care, specialist sexual health services and the community. It describes how to plan and deliver services that are tailored to the local prevalence of HIV, how to promote awareness of HIV testing and how to increase opportunities to offer testing to people who may have undiagnosed HIV.
It includes recommendations on:
  • offering and recommending HIV testing in different settings
  • increasing opportunities for HIV testing
  • promoting awareness and uptake of HIV testing
  • reducing barriers to HIV testing.

Who is it for?

  • Local authority and NHS commissioners of HIV testing services
  • Providers of HIV testing services
  • Practitioners working in services that offer HIV testing
  • The general public
The recommendations are based on NICE guideline NG60 (2016), which updates and replaces NICE guidelines PH33 and PH34 (2011). NICE worked with Public Health England to develop NG60.

Updates

Updates to this interactive flowchart

4 February 2019 Sexual health (NICE quality standard 178) added.
6 September 2017 HIV testing: encouraging uptake (NICE quality standard 157) added.
30 November 2016 Interactive flowchart updated with recommendations from HIV testing: increasing uptake among people who may have undiagnosed HIV (NICE guideline NG60).

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Short Text

Everything NICE has said on HIV testing and prevention in an interactive flowchart

What is covered

This interactive flowchart covers how to prevent the spread of HIV by increasing the uptake of HIV testing in primary and secondary care, specialist sexual health services and the community. It describes how to plan and deliver services that are tailored to the local prevalence of HIV, how to promote awareness of HIV testing and how to increase opportunities to offer testing to people who may have undiagnosed HIV.
It includes recommendations on:
  • offering and recommending HIV testing in different settings
  • increasing opportunities for HIV testing
  • promoting awareness and uptake of HIV testing
  • reducing barriers to HIV testing.

Who is it for?

  • Local authority and NHS commissioners of HIV testing services
  • Providers of HIV testing services
  • Practitioners working in services that offer HIV testing
  • The general public
The recommendations are based on NICE guideline NG60 (2016), which updates and replaces NICE guidelines PH33 and PH34 (2011). NICE worked with Public Health England to develop NG60.

Updates

Updates to this interactive flowchart

4 February 2019 Sexual health (NICE quality standard 178) added.
6 September 2017 HIV testing: encouraging uptake (NICE quality standard 157) added.
30 November 2016 Interactive flowchart updated with recommendations from HIV testing: increasing uptake among people who may have undiagnosed HIV (NICE guideline NG60).

Sources

NICE guidance and other sources used to create this interactive flowchart.
Sexual health (2019) NICE quality standard 178
HIV testing: encouraging uptake (2017) NICE quality standard 157

Quality standards

HIV testing: encouraging uptake

These quality statements are taken from the HIV testing: encouraging uptake quality standard. The quality standard defines best practice for encouraging uptake of HIV testing and should be read in full.

Quality statements

Hospitals in areas of high and extremely high HIV prevalence

This quality statement is taken from the HIV testing: encouraging uptake quality standard. The quality standard defines clinical best practice for encouraging the uptake of HIV testing and should be read in full.

Quality statement

Young people and adults are offered an HIV test when admitted to hospital or attending an emergency department in areas of extremely high HIV prevalence, or when having a blood test when admitted to hospital or attending an emergency department in areas of high HIV prevalence.

Rationale

Increasing the uptake of HIV testing among people living in areas of high or extremely high HIV prevalence is important to reduce late diagnosis. Early diagnosis improves treatment outcomes and reduces the risk of transmission. Offering HIV testing more routinely in hospitals in areas of high or extremely high HIV prevalence will help to ensure that an HIV test is regarded as routine practice. This will help to reduce the stigma that can be associated with HIV testing.

Quality measures

Structure
a) Evidence of local processes to offer an HIV test to all young people and adults who are admitted to hospital or attend an emergency department in areas of extremely high HIV prevalence.
Data source: Local data collection, for example, service protocol.
b) Evidence of local processes to offer an HIV test to all young people and adults having a blood test when admitted to hospital or attending an emergency department in areas of high HIV prevalence.
Data source: Local data collection, for example, service protocol.
Process
a) Proportion of young people and adults admitted to hospital or attending an emergency department, in an area of extremely high HIV prevalence, who receive an HIV test.
Numerator – the number in the denominator who receive an HIV test.
Denominator – the number of young people and adults admitted to hospital or attending an emergency department in an area of extremely high HIV prevalence.
Data source: Local data collection, for example, an audit of patient health records.
b) Proportion of young people and adults having a blood test when admitted to hospital or attending an emergency department in an area of high HIV prevalence who receive an HIV test.
Numerator – the number in the denominator who receive an HIV test.
Denominator – the number of young people and adults having a blood test when admitted to hospital or attending an emergency department in an area of high HIV prevalence.
Data source: Local data collection, for example, an audit of patient health records.
Outcome
a) Number of new HIV diagnoses in areas of high and extremely high prevalence.
Data source: Local data collection for Public Health England’s HIV and AIDS reporting system.
b) Number of new HIV diagnoses made at a late stage of infection in areas of high and extremely high prevalence.
Data source: Local data collection for Public Health England’s HIV and AIDS reporting system. Late stage of infection is defined as a CD4 count less than 350 cells per mm3.

What the quality statement means for different audiences

Service providers (hospital services such as emergency departments and medical admissions units) in areas of extremely high HIV prevalence offer and recommend an HIV test to all young people and adults admitted to hospital or attending an emergency department. In areas of high HIV prevalence providers offer and recommend an HIV test to young people and adults having a blood test when admitted to hospital or attending an emergency department. Providers could offer an HIV test by an opt-out testing system.
Healthcare professionals (such as doctors and nurses) in hospitals in areas of extremely high HIV prevalence offer and recommend an HIV test to all young people and adults admitted to hospital or attending an emergency department. In hospitals in areas of high HIV prevalence healthcare professionals offer and recommend an HIV test to all young people and adults having a blood test when admitted to hospital or attending an emergency department. Healthcare professionals should emphasise that having an HIV test is a routine procedure but if the test is declined, they should provide information on how to access other local HIV testing services.
Commissioners (such as local authorities and clinical commissioning groups) include HIV testing in the service specification for hospitals, including emergency departments, in areas of extremely high or high HIV prevalence. Commissioners should work collaboratively to ensure that hospitals offer and recommend an HIV test to all young people and adults admitted to hospital or attending an emergency department in areas of extremely high HIV prevalence and to those having a blood test when admitted to hospital or attending an emergency department in areas of high prevalence.
Young people and adults admitted to hospital or seen in the emergency department (A&E) are offered an HIV test if the hospital is in an area that has a very high level of HIV. They are also offered an HIV test if they are already having a blood test and the hospital is in an area that has a high level of HIV. This will help to ensure that people with HIV are diagnosed and treated as early as possible.

Source guidance

HIV testing: increasing uptake among people who may have undiagnosed HIV (2016) NICE guideline NG60, recommendations 1.1.6 and 1.1.7

Definitions of terms used in this quality statement

Young people and adults
Young people are aged 16 and 17 years. Adults are aged 18 years and over.
[Expert opinion]
High/extremely high HIV prevalence
Local authorities with a diagnosed HIV prevalence of between 2 and 5 per 1,000 people aged 15 to 59 years have a high HIV prevalence. Those with a diagnosed HIV prevalence of 5 or more per 1,000 people aged 15 to 59 years have an extremely high HIV prevalence (based on modelling of diagnosed HIV prevalence distribution in local authorities in England; see Public Health England's sexual and reproductive health profiles for interactive maps, charts and tables).
[NICE’s guideline on HIV testing]

General practice in areas of high and extremely high HIV prevalence

This quality statement is taken from the HIV testing: encouraging uptake quality standard. The quality standard defines clinical best practice for encouraging the uptake of HIV testing and should be read in full.

Quality statement

Young people and adults in areas of high or extremely high HIV prevalence are offered an HIV test by their GP practice when registering or when having a blood test if they have not had an HIV test in the past 12 months.

Rationale

Increasing the uptake of HIV testing among people living in areas of high or extremely high HIV prevalence is important to reduce late diagnosis. Early diagnosis improves treatment outcomes and reduces the risk of transmission to other people. Offering HIV testing routinely in GP practices in areas of high or extremely high prevalence will help to ensure that having an HIV test is regarded as routine practice. This will help to reduce the stigma that can be associated with HIV testing. As the decision to offer an HIV test will be based on clinical judgement the expected level of achievement against the process measures may vary.

Quality measures

Structure
a) Evidence of local processes to offer an HIV test to young people and adults registering with a GP in areas of high or extremely high HIV prevalence.
Data source: Local data collection, for example, service protocol.
b) Evidence of local processes to offer an HIV test to young people and adults having a blood test at their GP practice in areas of high or extremely high HIV prevalence if they have not had an HIV test in the past 12 months.
Data source: Local data collection, for example, service protocol.
Process
a) Proportion of young people and adults newly registered with a GP in an area of high or extremely high HIV prevalence who receive an HIV test within 3 months of registration.
Numerator – the number in the denominator who receive an HIV test within 3 months of registration.
Denominator – the number of young people and adults newly registered with a GP in an area of high or extremely high HIV prevalence.
Data source: Local data collection, for example, an audit of patient health records. Following consultation, a 3-month timescale was suggested for measurement purposes.
b) Proportion of young people and adults who have not had an HIV test in the past 12 months having a blood test at their GP practice in an area of high or extremely high HIV prevalence who receive an HIV test.
Numerator – the number in the denominator who receive an HIV test.
Denominator – the number of young people and adults who have not had an HIV test in the past 12 months having a blood test at their GP practice in an area of high or extremely high HIV prevalence.
Data source: Local data collection, for example, an audit of patient health records. Given that the decision to offer an HIV test will be based on clinical judgement, GP practices may wish to determine the expected level of achievement on the basis of local patient profile.
Outcome
a) HIV testing rate per 1,000 registered patients in GP practices in areas of high and extremely high HIV prevalence.
Data source: Local data collection from GP practices.
b) Number of new HIV diagnoses in areas of high and extremely high HIV prevalence.
Data source: Local data collection for Public Health England’s HIV and AIDS reporting system.
c) Number of new HIV diagnoses made at a late stage of infection in areas of high and extremely high HIV prevalence.
Data source: Local data collection for Public Health England’s HIV and AIDS reporting system. Late stage of infection is defined as a CD4 count less than 350 cells per mm3.

What the quality statement means for different audiences

Service providers (general practices) in areas of high or extremely high HIV prevalence ensure that staff offer and recommend an HIV test to young people and adults when they register or when they are having a blood test if they have not had an HIV test in the past 12 months. Providers could offer an HIV test by an opt-out testing system.
Healthcare professionals (such as GPs, practice nurses and healthcare assistants) in areas of high or extremely high HIV prevalence offer and recommend an HIV test to young people and adults when they register with the practice or when they are having a blood test if they have not had an HIV test in the past 12 months. Healthcare professionals emphasise that having an HIV test is a routine procedure, but if the test is declined, they should provide information on how to access other local HIV testing services.
Commissioners (such as local authorities, clinical commissioning groups and NHS England) work collaboratively to commission general practice services in areas of high or extremely high HIV prevalence that offer and recommend an HIV test to young people and adults at registration or when they are having a blood test if they have not had an HIV test in the past 12 months. Commissioners ensure that general practices are aware of local HIV prevalence and that training and resources are available to support general practices to implement increased HIV testing.
Young people and adults in areas with a high risk of HIV are offered an HIV test when they register with a GP or when they are having a blood test at their GP practice if they have not had an HIV test in the past 12 months. This will help to ensure that people with HIV are diagnosed and treated as early as possible.

Source guidance

HIV testing: increasing uptake among people who may have undiagnosed HIV (2016) NICE guideline NG60, recommendation 1.1.9

Definitions of terms used in this quality statement

Young people and adults
Young people are aged 16 and 17 years. Adults are aged 18 years and over.
[Expert opinion]
High/extremely high HIV prevalence
Local authorities with a diagnosed HIV prevalence of between 2 and 5 per 1,000 people aged 15 to 59 years have a high HIV prevalence. Those with a diagnosed prevalence of 5 or more per 1,000 people aged 15 to 59 years have an extremely high HIV prevalence (based on modelling of diagnosed HIV prevalence distribution in local authorities in England; see Public Health England's sexual and reproductive health profiles for interactive maps, charts and tables).
[NICE’s guideline on HIV testing]

HIV indicator conditions

This quality statement is taken from the HIV testing: encouraging uptake quality standard. The quality standard defines clinical best practice for encouraging the uptake of HIV testing and should be read in full.

Quality statement

Young people and adults newly diagnosed with an HIV indicator condition are offered an HIV test.

Rationale

Increasing the uptake of HIV testing among people who may have been infected is important to reduce late diagnosis. Early diagnosis improves treatment outcomes and reduces the risk of transmission to other people. Offering HIV testing in primary and secondary care to people newly diagnosed with conditions that may indicate HIV infection could mean that potentially serious consequences of HIV infection are avoided. It may also improve response to treatment for the indicator condition.

Quality measures

Structure
a) Evidence of local systems that alert healthcare professionals to the need to offer an HIV test when an indicator condition is diagnosed.
Data source: Local data collection, for example, system specification.
b) Evidence of local processes to offer an HIV test to young people and adults newly diagnosed with an indicator condition.
Data source: Local data collection, for example, service protocol.
Process
Proportion of young people and adults newly diagnosed with an indicator condition who receive an HIV test.
Numerator – the number in the denominator who receive an HIV test.
Denominator – the number of young people and adults newly diagnosed with an indicator condition.
Data source: Local data collection, for example, an audit of patient health records.
Outcome
a) Number of new HIV diagnoses.
Data source: Local data collection for Public Health England’s HIV and AIDS reporting system.
b) Number of new HIV diagnoses made at a late stage of infection.
Data source: Local data collection for Public Health England’s HIV and AIDS reporting system. Late stage of infection is defined as a CD4 count less than 350 cells per mm3.

What the quality statement means for different audiences

Service providers (such as hospitals including outpatient departments, general practices and sexual health services) ensure that staff are trained to offer and recommend an HIV test to young people and adults who are newly diagnosed with an indicator condition. Providers ensure that systems are in place to alert healthcare professionals to the need to offer and recommend an HIV test when a relevant diagnosis is made. Providers could offer an HIV test by an opt-out testing system.
Healthcare professionals (such as clinicians, GPs and nurses) offer and recommend an HIV test to young people and adults with HIV who are newly diagnosed with an indicator condition. If the test is declined, healthcare professionals should provide information on how to access other local HIV testing services.
Commissioners (such as local authorities, clinical commissioning groups and NHS England) include HIV testing in the service specification for hospitals and GP practices. Commissioners ensure that providers have processes in place to offer and recommend an HIV test to all young people and adults who are newly diagnosed with an indicator condition.
Young people and adults with a health condition that may suggest they have HIV are offered an HIV test. This is so that they can be diagnosed and treated as early as possible if they are infected.

Source guidance

HIV testing: increasing uptake among people who may have undiagnosed HIV (2016) NICE guideline NG60, recommendations 1.1.5 and 1.1.8

Definitions of terms used in this quality statement

Young people and adults
Young people are aged 16 and 17 years. Adults are aged 18 years and over.
[Expert opinion]
HIV indicator conditions
HIV testing is recommended as identified in HIV in Europe’s guidance on HIV indicator conditions. Service providers may wish to focus on the following priorities:
Conditions in which the prevalence of undiagnosed HIV is more than 0.1%
  • Sexually transmitted infections
  • Malignant lymphoma
  • Herpes zoster
  • Hepatitis B or C (acute or chronic)
  • Unexplained lymphadenopathy
  • Mononucleosis-like illness
  • Community-acquired pneumonia
  • Unexplained leukocytopenia/thrombocytopenia lasting more than 4 weeks
  • Seborrheic dermatitis/exanthema
Conditions likely to have an undiagnosed prevalence of HIV of more than 0.1%
  • Subcortical dementia
  • Peripheral neuropathy
  • Unexplained weight loss
  • Unexplained chronic diarrhoea
Potentially AIDS-defining conditions
Neoplasms
  • Cervical cancer
  • Non-Hodgkin’s lymphoma
  • Kaposi’s sarcoma
Bacterial infections
  • Mycobacterium tuberculosis, pulmonary or extrapulmonary
  • Mycobacterium avium complex or Mycobacterium kansasii, disseminated or extrapulmonary
  • Mycobacterium, other species or unidentified species, disseminated or extrapulmonary
  • Pneumonia, recurrent (2 or more episodes in 12 months)
  • Salmonella septicaemia, recurrent
Viral infections
  • Cytomegalovirus retinitis
  • Cytomegalovirus, other (except liver, spleen, glands)
  • Herpes simplex, ulcer(s) for more than 1 month/bronchitis/pneumonitis
  • Progressive multifocal leucoencephalopathy
Parasitic infections
  • Cerebral toxoplasmosis
  • Cryptosporidiosis diarrhoea for more than 1 month
  • Isosporiasis for more than 1 month
  • Atypical disseminated leishmaniasis
  • Reactivation of American trypanosomiasis (meningoencephalitis or myocarditis)
Fungal infections
  • Pneumocystis carinii pneumonia
  • Candidiasis, oesophageal
  • Candidiasis, bronchial/tracheal/lungs
  • Cryptococcosis, extrapulmonary
  • Histoplasmosis, disseminated/extrapulmonary
  • Coccidiodomycosis, disseminated/extrapulmonary
  • Penicilliosis, disseminated
[HIV in indicator conditions HIV in Europe and expert consensus]

Regular HIV testing

This quality statement is taken from the HIV testing: encouraging uptake quality standard. The quality standard defines clinical best practice for encouraging the uptake of HIV testing and should be read in full.

Quality statement

Young people and adults in at-risk groups who test negative for HIV are advised that the test should be repeated at least annually.

Rationale

Regular HIV testing for people in groups or communities at risk of HIV exposure is important to reduce late diagnosis. People who test negative for HIV may continue to be at risk and regular testing will ensure early diagnosis. Early diagnosis will improve treatment outcomes and reduce the risk of transmission to other people. People who have unprotected sex with new or casual partners are at high risk of exposure and should be advised to have an HIV test more often than once a year.

Quality measures

Structure
a) Evidence of local processes to identify if young people and adults who test negative for HIV are in at-risk groups.
Data source: Local data collection, for example, service protocol.
b) Evidence of local processes to advise young people and adults in at-risk groups who test negative for HIV that the test should be repeated at least annually.
Data source: Local data collection, for example, service protocol.
Process
Proportion of young people and adults in at-risk groups who test negative for HIV who are advised that the test should be repeated at least annually.
Numerator – the number in the denominator who are advised that the test should be repeated at least annually.
Denominator – the number of young people and adults in at-risk groups who test negative for HIV.
Data source: Local data collection, for example, an audit of patient health records or report from recall system.
Outcome
a) Proportion of young people and adults in at-risk groups who had an HIV test in the past 12 months.
Numerator – the number in the denominator who had an HIV test in the past 12 months.
Denominator – the number of young people and adults in at-risk groups.
Data source: Local data collection, for example, an audit of patient health records. Data on timing of most recent HIV test is available from Public Health England’s Genitourinary medicine clinic activity dataset.
b) Number of new HIV diagnoses in at-risk groups.
Data source: Local data collection for Public Health England’s HIV and AIDS reporting system.
c) Number of new HIV diagnoses made at a late stage of infection in at-risk groups.
Data source: Local data collection for Public Health England’s HIV and AIDS reporting system. Late stage of infection is defined as a CD4 count less than 350 cells per mm3.

What the quality statement means for different audiences

Service providers (such as sexual health clinics, hospitals, general practices and community HIV testing services) ensure that processes are in place to identify young people and adults in at-risk groups who test negative for HIV and to advise them that the test should be repeated at least annually and more often if they are at high risk of exposure.
Healthcare practitioners (such as sexual health advisers, doctors and nurses and lay testers) identify young people and adults in at-risk groups who test negative for HIV and advise them that the test should be repeated at least annually and more often if they are at high risk of exposure. If people are reluctant to have an HIV test at least annually, healthcare professionals should provide information on how to access other local HIV testing services, including those that offer less invasive forms of specimen collection and self-sampling.
Commissioners (local authorities, clinical commissioning groups and NHS England) commission services that identify young people and adults in at-risk groups who test negative for HIV and advise them that the test should be repeated at least annually.
Young people and adults who have a negative HIV test but who may still be at risk of exposure are advised that the HIV test should be repeated at least annually. This is so that they can be diagnosed and treated as early as possible if they become infected.

Source guidance

HIV testing: increasing uptake among people who may have undiagnosed HIV (2016) NICE guideline NG60, recommendation 1.2.6

Definitions of terms used in this quality statement

Young people and adults
Young people are aged 16 and 17 years. Adults are aged 18 years and over.
[Expert opinion]
At-risk groups
HIV testing should be recommended to people in the following groups:
  • people from a country or group with a high rate of HIV infection
  • men who have sex with men
  • trans women who have sex with men
  • people who have had sexual contact with someone from a country with a high rate of HIV or someone with a high risk of HIV (for example, female sexual contacts of men who have sex with men)
  • people who participate in high-risk sexual practices such as ‘chemsex’
  • people who are diagnosed with or tested for a sexually transmitted infection
  • drug users who inject.
[Adapted from NICE’s guideline on HIV testing, recommendations 1.1.5 and 1.1.8 and expert opinion]

People who may have been exposed to HIV

This quality statement is taken from the HIV testing: encouraging uptake quality standard. The quality standard defines clinical best practice for encouraging the uptake of HIV testing and should be read in full.

Quality statement

People who may have been exposed to HIV by a person newly diagnosed with HIV are offered an HIV test.

Rationale

People who may have been exposed to HIV by a person newly diagnosed with HIV are at high risk of being infected. Identifying and contacting these people will enable them to be offered an HIV test as soon as possible. Early diagnosis of HIV improves treatment outcomes and reduces the risk of transmission to other people.

Quality measures

Structure
Evidence of local arrangements to ensure that notification procedures are in place to identify people who may have been exposed to HIV by a person newly diagnosed with HIV. These arrangements may include referral pathways to specialist sexual health services.
Data source: Local data collection, for example, service protocol and referral pathways.
Process
Proportion of contactable people who may have been exposed to HIV by a person newly diagnosed with HIV who are tested within 3 months.
Numerator – the number in the denominator who are tested for HIV within 3 months.
Denominator – the number of contactable people who may have been exposed to HIV by a person newly diagnosed with HIV.
Data source: Local data collection, for example, an audit of patient health records.
Outcome
a) Number of people tested per total number of index cases.
Data source: Local data collection, for example, an audit of patient health records.
b) Number of new HIV diagnoses.
Data source: Local data collection for Public Health England’s HIV and AIDS reporting system.
c) Number of new HIV diagnoses made at a late stage of infection.
Data source: Local data collection for Public Health England’s HIV and AIDS reporting system. Late stage of infection is defined as a CD4 count less than 350 cells per mm3.

What the quality statement means for different audiences

Service providers (such as sexual health clinics) have processes in place to ensure that people who may have been exposed to HIV by a person newly diagnosed with HIV are identified and offered an HIV test.
Healthcare professionals (such as sexual health advisers) help people who test positive for HIV to identify people who they may have exposed to HIV using standard notification procedures. Once people who may have been exposed to HIV are identified, healthcare professionals make contact with them to offer an HIV test.
Commissioners (such as local authorities) commission services that ensure that people who may have been exposed to HIV by a person newly diagnosed with HIV are identified and offered an HIV test.
People who may have been exposed to HIV by a person newly diagnosed with HIV are contacted and offered an HIV test. This will ensure that, if they also have HIV, they are diagnosed and treated as early as possible.

Source guidance

Definitions of terms used in this quality statement

People who may have been exposed to HIV by a person newly diagnosed with HIV
Potential routes of HIV exposure include sexual, injecting drug use and other (including blood/blood product transfusion, organ and skin transplantation, semen donation, and needlestick and other injury). It does not include vertical transmission of HIV from mother to baby that is identified by universal antenatal screening.

Asking people about their sexual history

This quality statement is taken from the sexual health quality standard. The quality standard defines clinical best practice for sexual health and should be read in full.

Quality statement

People are asked about their sexual history at key points of contact.

Rationale

Asking people about their sexual history enables healthcare professionals to identify if they are at risk of sexually transmitted infections (STIs) and ensures that they can be given information and support to prevent infection. It can also help local services to understand the needs of their populations.

Quality measures

Structure
a) Evidence of local agreement on the key points of contact when people will be asked about their sexual history.
Data source: Local data collection, such as service protocols.
b) Evidence of local processes to ensure that people are asked about their sexual history at key points of contact.
Data source: Local data collection, such as service protocols.
Process
Proportion of people who have a discussion about their sexual history at key points of contact.
Numerator – the number in the denominator who have a discussion about their sexual history.
Denominator – the number of people attending a key point of contact.
Data source: Local data collection. Documenting that a discussion has taken place could form part of an electronic health record.
Outcome
Coverage of testing for STIs: proportion of people attending the service who are tested for STIs.
Data source: Local data collection, for example, the proportion of young people screened for chlamydia and HIV testing coverage is collected as part of Public Health England’s Sexual and reproductive health profiles.

What the quality statement means for different audiences

Service providers (such as primary care services, contraceptive services, genitourinary medicine clinics, abortion services, community sexual health services, and voluntary and community organisations) ensure processes are in place and staff are trained to ask people about their sexual history in a sensitive and supportive way at key points of contact. Service providers can help staff to ensure sexual history taking becomes routine by providing tools such as self-completion checklists.
Healthcare professionals (such as GPs, midwives, nurses, doctors, and drug and alcohol workers) ask people about their sexual history at key points of contact. Healthcare professionals ensure that they discuss sexual history in a sensitive and supportive way.
Commissioners (clinical commissioning groups, local authorities and NHS England) ensure that they commission services that identify people who are at risk of STIs by asking them about their sexual history at key points of contact. Commissioners agree key points of contact when people should be asked about their sexual history with service providers. Commissioners ensure that services that engage with people who are less likely to attend primary care or sexual health services are included.
People using healthcare services are asked about their sexual history, for example, the gender of their last partner and their use of condoms, when they attend relevant appointments. This will ensure that they are given the support they need if they are at risk of getting an STI.

Source guidance

Definitions of terms used in this quality statement

Key points of contact
Key points of contact could be consultations:
  • with newly registered patients
  • about contraception, pregnancy (including planning a pregnancy), abortion, alcohol or substance misuse
  • when carrying out a cervical smear test, offering an STI test, or providing travel immunisation.
Asking about sexual history
Services may take a brief core sexual history to establish whether someone is at any risk of STIs and then take a more detailed history if the screen is positive. A more detailed sexual history should include:
  • the gender of sexual partner(s)
  • the type of sexual contact/sites of exposure (oral, vaginal, anal)
  • condom use/barrier use (and whether properly used)
  • relationship with the partner (for example, live-in, regular or casual partner), duration of the relationship and whether the partner could be contacted
  • the time interval since the last sexual contact
  • any symptoms or any risk factors for blood-borne viruses in the partner including known or suspected STIs, injecting drug use, previous homosexual sex (for male partners) and any other risk of sexual infection.
[Adapted from the British Association of Sexual Health and HIV’s UK national guideline for consultations requiring sexual history taking, recommendation 3.3.1]

Equality and diversity considerations

When asking people about their sexual history, be aware that they may have additional needs such as physical, sensory or learning disabilities, and that they may not speak or read English, or may have reduced literacy skills. People should have access to an interpreter or advocate if needed.
Healthcare professionals should ensure that older people are asked about their sexual history in order to identify if they are at risk of STIs. Healthcare professionals should also be trained to identify and respond to the specific needs of lesbian, gay, bisexual, and transgender people when asking about their sexual history.
Safeguarding links should be in place with all services that may engage with young people and vulnerable adults about their sexual health. Services should be clear what action should be taken if concerns are raised about child sexual exploitation or abuse, female genital mutilation, human trafficking or modern slavery.

Discussing prevention and testing with people who are at risk of sexually transmitted infections

This quality statement is taken from the sexual health quality standard. The quality standard defines clinical best practice for sexual health and should be read in full.

Quality statement

People identified as being at risk of sexually transmitted infections have a discussion about prevention and testing.

Rationale

Discussing how to prevent and be tested for sexually transmitted infections (STIs) can increase opportunities for testing and harm reduction. A structured discussion can help identify and reduce behaviours that put a person at risk of STIs.

Quality measures

Structure
a) Evidence of local arrangements to ensure that trained healthcare professionals are available to discuss behaviour change with people identified as being at risk of STIs.
Data source: Local data collection, such as training records and staff rotas.
b) Evidence of local processes to ensure that people identified as being at risk of STIs have a discussion about prevention and testing.
Data source: Local data collection, such as service protocols.
Process
Proportion of people identified as being at risk of STIs who have a discussion about prevention and testing.
Numerator – the number in the denominator who have a discussion about prevention and testing.
Denominator – the number of people identified as being at risk of STIs.
Data source: Local data collection. Documenting that a discussion has taken place could form part of an electronic health record.
Outcome
a) Coverage of testing for STIs: proportion of people attending the service who are tested for STIs.
Data source: Local data collection, for example, the proportion of young people screened for chlamydia and HIV testing coverage are collected as part of Public Health England’s Sexual and reproductive health profiles.
b) New STI diagnoses (excluding chlamydia in people aged under 25) per 100,000 people aged 15 to 64.
Data source: These data are collected as part of Public Health England’s Sexual and reproductive health profiles.
c) Chlamydia detection rate per 100,000 people aged 15 to 24.
Data source: These data are collected as part of Public Health England’s Sexual and reproductive health profiles.

What the quality statement means for different audiences

Service providers (such as primary care services, contraceptive services, genitourinary medicine clinics and community sexual health services) ensure that they have healthcare professionals trained in sexual health who discuss the prevention of and testing for STIs with people identified as being at risk. Service providers should ensure that healthcare professionals signpost people at risk to high-quality supporting information and services, including online sexual health services.
Healthcare professionals (such as GPs, midwives, practice nurses and doctors who work in sexual health services) have one-to-one structured discussions with people identified as being at risk of STIs about how they can reduce their risk and how to get tested. Healthcare professionals should signpost people at risk to high-quality supporting information and services, including online sexual health services.
Commissioners (clinical commissioning groups, local authorities and NHS England) work together to ensure that they commission a range of services that provide information on the prevention of and testing for STIs to people identified as being at risk. Commissioners ensure that services that engage with people who are less likely to attend primary care or sexual health services are included.
People who are at risk of getting an STI talk to their healthcare professional about how to prevent STIs. They should also be given information about how to get tested for STIs and where to get further advice.

Source guidance

Definitions of terms used in this quality statement

Discussion about prevention and testing
Discussions should be structured on the basis of behaviour change theories. They should address factors that can help reduce risk taking and improve self-efficacy and motivation. Ideally, each session should last at least 15 to 20 minutes. The number of sessions will depend on individual need.
People at risk of sexually transmitted infections
This includes the following key groups and behaviours:
  • men who have sex with men
  • people who have come from or who have visited areas of high HIV prevalence
  • people who misuse alcohol or substances, or both
  • people who have early onset of sexual activity
  • people who have condomless sex and frequently change or have multiple sexual partners.

Equality and diversity considerations

A discussion about prevention and testing for STIs should be age appropriate and accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English, or who have reduced literacy skills. People should have access to an interpreter or advocate if needed.
Healthcare professionals should be trained to identify and respond to the specific needs of lesbian, gay, bisexual, and transgender people when discussing prevention and testing for STIs.

Condom distribution schemes

This quality statement is taken from the sexual health quality standard. The quality standard defines clinical best practice for sexual health and should be read in full.

Quality statement

Local authorities provide a range of condom distribution schemes tailored to the needs of their populations.

Rationale

Providing a variety of condom distribution schemes ensures that different populations, including those most at risk of sexually transmitted infections (STIs), can access a scheme that will meet their needs. Condom schemes should be provided alongside existing services that are likely to be used by people most at risk of getting an STI. This can increase rates of condom use and reduce STI rates.

Quality measures

Structure
a) Evidence of local arrangements to assess the needs of local populations for condom distribution schemes.
Data source: Local data collection, such as needs assessments based on consultation and STI rates.
b) Evidence of local arrangements to provide a range of condom distribution schemes tailored to the needs of the population.
Data source: Local data collection, such as service specifications for a mix of different types of condom distribution scheme.
c) Evidence of local arrangements to publicise condom distribution schemes to people most at risk of getting an STI.
Data source: Local data collection, such as posters, leaflets and social media campaigns.
Outcome
a) Proportion of people who are at risk of STIs who used a condom at last intercourse.
Data source: Local data collection, such as a survey of young people or other groups at risk of STIs.
b) New STI diagnoses (excluding chlamydia in people aged under 25) per 100,000 people aged 15 to 64.
Data source: These data are collected as part of Public Health England’s Sexual and reproductive health profiles.
c) Chlamydia detection rate per 100,000 people aged 15 to 24.
Data source: These data are collected as part of Public Health England’s Sexual and reproductive health profiles.

What the quality statement means for different audiences

Service providers (voluntary sector services, school health services and primary healthcare services) provide a range of condom distribution schemes tailored to the needs of different local populations. Service providers publicise condom schemes to people most at risk of getting an STI. Service providers also ensure that referral pathways are in place to other services to meet the needs of those using the service.
Healthcare professionals (such as GPs, practice nurses, pharmacists and sexual health consultants) are aware of condom distribution schemes and tell people who are at risk of getting an STI how to access them.
Commissioners (local authorities) ensure that they commission a mix of different types of condom distribution schemes tailored to the needs of the population, including multicomponent schemes, single-component schemes (free condoms) and cost-price sales schemes. Commissioners should commission tailored multicomponent condom schemes in preference to other types of condom scheme for young people aged under 16. Commissioners ensure there are links between condom schemes and local sexual and reproductive health services.
People at risk of getting an STI are made aware of where they can get condoms.

Source guidance

Sexually transmitted infections: condom distribution schemes (2017) NICE guideline NG68, recommendation 1.1.1

Definitions of terms used in this quality statement

Condom distribution schemes
These are usually referred to as 'condom schemes'. The term refers to all schemes that provide free or cost-price condoms, female condoms and dental dams, with or without lubricant. Schemes also offer advice, information or support. They include:
  • Cost-price sales schemes that provide cost-price condoms and, if appropriate, lubricant. They include community schemes that provide cost-price condoms to sex workers and online services.
  • Multicomponent schemes (such as C-card) that distribute free condoms with or without lubricant, together with training, information or other support.
  • Single-component schemes that provide or distribute free condoms and if appropriate, lubricant. This includes online services for specific groups or areas of the country, and distribution schemes in public places.
[NICE’s guideline on sexually transmitted infections: condom distribution schemes, terms used in this guideline]

Equality and diversity considerations

Condom schemes should be accessible for young people including those who use public transport.
Safeguarding links should be in place with all services that may engage with young people and vulnerable adults about their sexual health. Services should be clear what action should be taken if concerns are raised about child sexual exploitation or abuse, female genital mutilation, human trafficking or modern slavery.

Access to sexual health services

This quality statement is taken from the sexual health quality standard. The quality standard defines clinical best practice for sexual health and should be read in full.

Quality statement

People contacting a sexual health service about a sexually transmitted infection are offered an appointment that is within 2 working days.

Rationale

Prompt access to sexual health services will promote good sexual health and reduce sexual health inequalities. Ensuring people are offered quick and easy access to support can help to reduce the likelihood of onward transmission of sexually transmitted infections (STIs), ensuring that tests and interventions can be provided to reduce health complications. If walk-in clinics are provided there should be reasonable waiting times to encourage people to use the service.

Quality measures

Structure
Evidence of local arrangements to ensure that people contacting a sexual health service about an STI are offered an appointment that is within 2 working days.
Data source: Local data collection, such as service protocols. Included in the Department of Health and Social Care’s Integrated sexual health services: a suggested national service specification.
Process
a) Proportion of contacts with a sexual health service about an STI in which an appointment that is within 2 working days, was offered.
Numerator – the number in the denominator in which an appointment that is within 2 working days, was offered.
Denominator – the number of contacts with a sexual health service about an STI.
Data source: Local data collection, such as an audit of patient health records. Included in the Department of Health and Social Care’s Integrated sexual health services: national service specification.
b) Proportion of attendances at a sexual health service walk-in clinic in which the waiting time was less than 2 hours.
Numerator – the number in the denominator in which the waiting time was less than 2 hours.
Denominator – the number of attendances at a sexual health service walk-in clinic.
Data source: Local data collection, such as clinic wait time records. Included in the Department of Health and Social Care’s Integrated sexual health services: national service specification.
Outcome
a) Satisfaction with access to services among people who contact sexual health services about an STI.
Data source: Local data collection, such as a patient survey.
b) Coverage of testing for STIs: proportion of people attending the service who are tested for STIs.
Data source: Local data collection, for example, the proportion of young people screened for chlamydia and HIV testing coverage are collected as part of Public Health England’s Sexual and reproductive health profiles.
c) New STI diagnoses (excluding chlamydia in people aged under 25) per 100,000 people aged 15 to 64.
Data source: These data are collected as part of Public Health England’s Sexual and reproductive health profiles.
d) Chlamydia detection rate per 100,000 people aged 15 to 24.
Data source: These data are collected as part of Public Health England’s Sexual and reproductive health profiles.

What the quality statement means for different audiences

Service providers (sexual health services) ensure that they offer people who contact the service about an STI either an appointment or the option to attend a walk-in clinic, which is within 2 working days. Service providers ensure that walk-in clinics are sufficiently resourced so that waiting times are less than 2 hours. Providers should offer a mix of timed appointments and walk-in clinics to meet the needs of the local population.
Healthcare professionals who work in sexual health services offer people contacting the service about an STI either an appointment or the option to attend a walk-in clinic, which is within 2 working days.
Commissioners (local authorities) commission sexual health services with sufficient capacity to ensure that people contacting the service about an STI are offered either an appointment or the option to attend a walk-in clinic, which is within 2 working days, and monitor waiting times.
People who contact a sexual health service about an STI are offered either an appointment or attendance at a walk-in clinic within 2 working days. If they go to a walk-in clinic they wait no longer than 2 hours.

Source guidance

Definitions of terms used in this quality statement

Sexual health services
Sexual health services include arrangements for the notification, testing, treatment and follow-up of partners of people who have an STI (partner notification).
The service should be delivered in accordance with the level 1, 2 and 3 service model. It does not include self-managed care such as home remote sampling and test kits accessed via online services.
An appointment
A scheduled time at a clinic or the option to attend a walk-in clinic.
[Expert opinion]

Equality and diversity considerations

Services should make reasonable adjustments to ensure that people with additional needs such as physical, sensory or learning disabilities, and people who do not speak or read English, or who have reduced literacy skills, can contact sexual health services to make appointments. People should have access to an interpreter or advocate if needed.
Sexual health services should be accessible for young people including those who use public transport.

Partner notification

This quality statement is taken from the sexual health quality standard. The quality standard defines clinical best practice for sexual health and should be read in full.

Quality statement

People diagnosed with a sexually transmitted infection are supported to notify their partners.

Rationale

Supporting people who have been diagnosed with a sexually transmitted infection (STI) to notify their partners can help to prevent reinfection and reduce the transmission of STIs. It can also ensure that their partners are tested, and if necessary treated, as soon as possible to prevent health complications.

Quality measures

Structure
a) Evidence of local arrangements for partner notification to be discussed with people diagnosed with STIs.
Data source: Local data collection, such as service protocols. Included in the Department of Health and Social Care’s Integrated sexual health services: national service specification.
b) Evidence of local arrangements for partner notification support to be provided to people diagnosed with STIs.
Data source: Local data collection, such as service protocols and referral pathways. Included in the Department of Health and Social Care’s Integrated sexual health services: national service specification.
Process
Proportion of people diagnosed with an STI who have partner notification initiated.
Numerator – the number in the denominator who have partner notification initiated.
Denominator – the number of people diagnosed with an STI.
Data source: Local data collection. Public Health England’s GUMCAD STI surveillance system collects data on partner notification being initiated.
Outcome
a) Coverage of testing for STIs: proportion of people attending the service who are tested for STIs.
Data source: Local data collection, for example, the proportion of young people screened for chlamydia and HIV testing coverage, are collected as part of Public Health England’s Sexual and reproductive health profiles.
b) Number of people presenting as a partner of an index case diagnosed with an STI.
Data source: Local data collection. Public Health England’s GUMCAD STI surveillance system collects data on people presenting as a partner of a person identified as having an index case of chlamydia, gonorrhoea, HIV or non-specific genital infection.

What the quality statement means for different audiences

Service providers (such as primary care services, genitourinary medicine clinics and community health services) ensure that processes are in place for discussions about partner notification to take place when people are diagnosed with an STI. Service providers ensure that they have clear partner notification procedures in place, including referral pathways to specialist providers, so that people can be supported to notify their partners.
Healthcare professionals (such as GPs, practice nurses and sexual health consultants) ensure they are aware of local partner notification procedures and provide support to people diagnosed with an STI to notify their partners. Partner notification may be undertaken by the healthcare professional or the person diagnosed with an STI and may require referral to a specialist service.
Commissioners (clinical commissioning groups, local authorities and NHS England) ensure that they commission services that support people who are diagnosed with an STI to notify their partners. Commissioners ensure that the roles and responsibilities of different services in relation to partner notification are clear and that referral pathways are in place. Commissioners regularly monitor and review the overall effectiveness of local partner notification procedures.
People diagnosed with an STI are given encouragement and support from a healthcare professional to tell their partners about the STI. This will help partners to get tested as soon as possible and to receive treatment if they are also infected.

Source guidance

Definitions of terms used in this quality statement

Support to notify their partners
Partner notification procedures should be in place to provide support to contact, test and treat partners of people diagnosed with an STI. The support provided should be tailored to meet the individual’s needs and if necessary people should be referred to a specialist with responsibility for partner notification. Partner notification may be undertaken by the healthcare professional or the person diagnosed with an STI.

Equality and diversity considerations

Services to support people to notify their partners about an STI should be accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English, or who have reduced literacy skills. People should have access to an interpreter or advocate if needed.

Repeat testing for sexually transmitted infections

This quality statement is taken from the sexual health quality standard. The quality standard defines clinical best practice for sexual health and should be read in full.

Quality statement

Men who have sex with men have repeat testing every 3 months if they are at increased risk of sexually transmitted infections.

Rationale

Regular repeat testing for sexually transmitted infections (STIs) for men who have sex with men and who are at increased risk of STIs will ensure that diagnosis is made as soon as possible and further transmission of STIs can be avoided.

Quality measures

Structure
a) Evidence of local arrangements to provide STI repeat testing every 3 months for men who have sex with men and are at increased risk of STIs.
Data source: Local data collection, such as service protocols.
b) Evidence of local arrangements to encourage men who have sex with men to have repeat STI tests every 3 months if they are at increased risk of STIs.
Data source: Local data collection, such as health promotion leaflets and materials.
Process
a) Proportion of men who have sex with men and are at increased risk of STIs who were sent a reminder to have repeat testing for STIs within the past 3 months.
Numerator – the number in the denominator who were sent a reminder to have repeat testing for STIs within the past 3 months.
Denominator – the number of men who have sex with men and are at increased risk of STIs.
Data source: Local data collection, such as an audit of patient health records.
b) Proportion of men who have sex with men and are at increased risk of STIs who were tested for STIs within the past 3 months.
Numerator – the number in the denominator who were tested for STIs within the past 3 months.
Denominator – the number of men who have sex with men and are at increased risk of STIs.
Data source: Local data collection, such as an audit of patient health records.
Outcome
a) Coverage of testing for STIs: proportion of people attending the service who are tested for STIs.
Data source: Local data collection, for example, the proportion of young people screened for chlamydia and HIV testing coverage are collected as part of Public Health England’s Sexual and reproductive health profiles.
b) New STI diagnoses (excluding chlamydia in people aged under 25) per 100,000 people aged 15 to 64.
Data source: These data are collected as part of Public Health England’s Sexual and reproductive health profiles.
c) Chlamydia detection rate per 100,000 people aged 15 to 24.
Data source: These data are collected as part of Public Health England’s Sexual and reproductive health profiles.

What the quality statement means for different audiences

Service providers (such as primary care services, genitourinary medicine clinics, community sexual health services and online sexual health services) offer men who have sex with men repeat STI testing every 3 months if they are at increased risk of STIs. Service providers ensure men are signposted to an alternative service for repeat testing if necessary. They ensure that recall reminders are sent every 3 months to improve re-attendance rates.
Healthcare professionals (such as GPs, practice nurses and sexual health consultants) offer men who have sex with men repeat appointments for STI testing every 3 months if they are at increased risk of STIs. If their service does not provide repeat testing, healthcare professionals should signpost the person to an alternative service.
Commissioners (clinical commissioning groups, local authorities and NHS England) ensure that they commission services that arrange repeat appointments for STI testing every 3 months for men who have sex with men and are at increased risk of STIs. This could include online sexual health services.
Men who have sex with men and who have a high risk of getting an STI are offered testing for STIs every 3 months.

Source guidance

British Association of Sexual Health and HIV (2016) United Kingdom national guideline on the sexual health care of men who have sex with men, recommendations on STI and HIV testing.

Definitions of terms used in this quality statement

Men who have sex with men and are at increased risk of sexually transmitted infections
Men who have sex with men, who have:
  • condomless anal intercourse with partner(s) of unknown or serodiscordant HIV status over last 12 months
  • over 10 sexual partners, over last 12 months
  • drug use (such as methamphetamine, mephedrone, inhaled nitrites, gamma-butyrolactone (GBL), ketamine, and other novel psychoactive substances) during sex over last six months
  • multiple or anonymous partners since last tested
  • any condomless sexual contact (oral, genital or anal) with a new partner since last tested.
[Adapted from the British Association of Sexual Health and HIV guideline on United Kingdom national guideline on the sexual health care of men who have sex with men, recommendations on STI and HIV testing]

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Pathway information

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Supporting information

Glossary

commonly used to describe sex between men that occurs under the influence of drugs taken immediately before and/or during the sexual session; the drugs most commonly associated with chemsex are crystal methamphetamine, GHB/GBL, mephedrone and, to a lesser extent, cocaine and ketamine
local authorities with a diagnosed HIV prevalence of 5 or more per 1,000 people aged 15 to 59 years (based on modelling of diagnosed HIV prevalence distribution in local authorities in England; see Public Health England's sexual and reproductive health profiles)
detect HIV antibodies and p24 antigen simultaneously; this means they have the advantage of reducing the time between infection and testing HIV positive to about 1 month
local authorities with a diagnosed HIV prevalence of between 2 and 5 per 1,000 (people aged 15–59 years), based on modelling of diagnosed HIV prevalence distribution in local authorities in England; see Public Health England's sexual and reproductive health profiles)
local authorities with a diagnosed HIV prevalence of between 2 and 5 per 1,000 (people aged 15–59 years), based on modelling of diagnosed HIV prevalence distribution in local authorities in England; see Public Health England's sexual and reproductive health profiles)
non-clinical practitioners who have been trained to carry out HIV tests
point-of-care tests or 'rapid' tests are a common way to test for HIV; they are easy to use when an alternative to venepuncture is preferable, for example outside conventional healthcare settings and where it's important to avoid a delay in obtaining a result. However, they have reduced specificity and sensitivity compared with fourth generation laboratory tests; this means there will be false positives, particularly in areas with lower HIV prevalence, and all positive results need to be confirmed by serological tests
public areas where people go to engage in consensual sexual contact (both same sex and opposite sex)
self-sampling HIV kits allow people to collect their own sample of blood or saliva and send it by post for testing; they usually receive negative results by text message
self-testing kits allow people to perform their own HIV test in a place of their own choosing and get an immediate result (typically within 15–20 minutes)
the time between potential exposure to HIV infection and when a test will give an accurate result; the window period is 1 month for a fourth generation test and 3 months for older tests

Paths in this pathway

Pathway created: August 2011 Last updated: February 2019

© NICE 2019. All rights reserved. Subject to Notice of rights.

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