Introduction

These guidelines are intended to facilitate an increase in HIV testing in all healthcare settings as recommended by the UK’s Chief Medical Officers and Chief Nursing Officers [1–4] in order to reduce the proportion of individuals with undiagnosed HIV infection, with the aim of benefiting both individual and public health. Misconceptions remain regarding HIV testing that hinder increased testing. In particular, many clinicians believe that lengthy pre-test counselling is required prior to testing. These guidelines provide the information needed to enable any clinician to perform an HIV test within good clinical practice and encourage ’normalisation‘ of HIV testing.

For this change in approach to be beneficial and ethically acceptable, it is imperative that following a positive HIV diagnosis, a newly diagnosed individual is immediately linked into appropriate HIV treatment and care.

This guidance refers to both diagnostic testing of individuals presenting with ‘clinical indicator diseases’ (i.e. where HIV infection enters the differential diagnosis) and opportunistic screening of populations where this is indicated on the basis of prevalence data. We also include an appendix on the provision of community-based HIV testing (Appendix 3).

It must be emphasised that in the UK, HIV testing remains voluntary and confidential. This is entirely possible within any healthcare setting if these guidelines are followed.

Executive Summary

• HIV is now a treatable medical condition and the majority of those living with the virus remain fit and well on treatment.
• Despite this a significant number of people in the United Kingdom are unaware of their HIV infection and remain at risk to their own health and of passing their virus unwittingly on to others.
• Late diagnosis is the most important factor associated with HIV-related morbidity and mortality in the UK.
• Patients should therefore be offered and encouraged to accept HIV testing in a wider range of settings than is currently the case.
• Patients with specific indicator conditions should be routinely recommended to have an HIV test.
• All doctors, nurses and midwives should be able to obtain informed consent for an HIV test in the same way that they currently do for any other medical investigation.

Downloads

UK National Guidelines for HIV Testing 2008

Table 1 (Clinical indicator diseases for adult HIV infection) and Table 2 (Clinical indicator diseases for paediatric HIV infection)
Letter from Dr Mary Armitage, Immediate Past Clinical Vice President, Royal College of Physicians (RCP)
Press Release for the UK National Guidelines for HIV Testing 2008
Consultation comments on the UK National Guidelines for HIV Testing 2008

Writing Group

• British HIV Association (BHIVA): Martin Fisher
• British Infection Society (BIS): Ed Ong
• British Association for Sexual Health and HIV (BASHH): Adrian Palfreeman
• Royal College of Emergency Medicine: James Wardrope
• Royal College of General Practitioners: Ewen Stewart
• Royal College of Nursing: Enrique Castro-Sanchez
• Royal College of Physicians: Tim Peto
• Royal College of Paediatrics and Child Health: Karen Rogstad
• British Medical Association: Julian Sheather
• Dept. of Health Expert Advisory Group on AIDS: Brian Gazzard, Deenan Pillay
• General Medical Council: Jane O’Brien
• Health Protection Agency: Valerie Delpech
• Medical Foundation for AIDS and Sexual Health: Ruth Lowbury, Russell Fleet
• National AIDS Trust: Yusuf Azad
• Children’s HIV Association (CHIVA): Hermione Lyall
• Society of Health Advisors: James Hardie
• UK-CAB: Godwin Adegbite
• BASHH Clinical Effectiveness Group: Guy Rooney
• Lay representative: Richard Whitehead