Approximately a quarter of people with HIV in the UK are undiagnosed. People who are diagnosed late (with a CD4 cell count below 350 cell/mm3 – the threshold for starting HIV treatment in the UK) have an increased risk of developing AIDS and death. Reducing the rate of undiagnosed HIV is also a public health priority. Most people have HIV tests in specialist settings such as genitourinary medicine (GUM) and sexual health clinics, or in antenatal settings. In 2008, guidelines were issued to increase levels of HIV testing in non-specialist settings. The guidelines recommend that all patients presenting with a disease indicating possible HIV infection – for example TB or glandular fever – should be offered an HIV test. The guidelines also state that all adult patients registering with a GP in areas with a local HIV prevalence above 2 per 1000 should be offered testing. Similarly, hospital doctors in high-prevalence areas should offer testing to new patients.
Investigators have assessed adherence to these guidelines. Overall, 27% of eligible patients were tested for HIV. But testing levels varied considerably between studies, ranging from just 0.5% to a high of 83%. Only 22% of patients with indicator diseases were tested for HIV. “Testing in this group is a long-standing recommendation of guidelines prior to 2008, so these results are disappointing,” write the authors. “The lack of adherence to guidelines in this group…is likely to be hindering timely identification of HIV greatly.” The overall testing rate for patients in high-prevalence settings was only marginally higher at 30%.
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