HIV testing in primary care - groups for routine HIV tests in general practice

Indications for HIV testing in Primary care:

• in all areas, offer and recommend HIV testing to everyone who has not previously been diagnosed with HIV and who:
  
  
  • has symptoms that may indicate HIV or HIV is part of the differential diagnosis (for example, infectious mononucleosis-like syndrome), in line with HIV in Europe's HIV indicator conditions - see linked item
    
    
  • is known to be from a country or group with a high rate of HIV infection
    
    
  • if male, discloses that they have sex with men, or is known to have sex with men, and has not had an HIV test in the previous year
    
    
  • is a trans woman who has sex with men and has not had an HIV test in the previous year
    
    
  • reports sexual contact (either abroad or in the UK) with someone from a country with a high rate of HIV
    
    
  • discloses high-risk sexual practices, for example the practice known as 'chemsex'
    
    
  • is diagnosed with, or requests testing for, a sexually transmitted infection
    
    
  • reports a history of injecting drug use
    
    
  • discloses that they are the sexual partner of someone known to be HIV positive, or of someone at high risk of HIV (for example, female sexual contacts of men who have sex with men)
    
    
• in areas of high and extremely high prevalence, also offer and recommend HIV testing to everyone who has not previously been diagnosed with HIV and who:
  • registers with the practice or
  • is undergoing blood tests for another reason and has not had an HIV test in the previous year
  • additionally, in areas of extremely high prevalence, consider HIV testing opportunistically at each consultation (whether bloods are being taken for another reason or not), based on clinical judgement (1)
    
    
• offer and recommend repeat testing to the people in recommendations above if:
  • in groups or communities with a high rate of HIV, and more frequently if they are at high risk of exposure (in line with Public Health England's HIV in the UK: situation report 2015). For example:
    • men who have sex with men should have HIV and sexually transmitted infection tests at least annually, and every 3 months if they are having unprotected sex with new or casual partners
    • black African men and women should have an HIV test and regular HIV and sexually transmitted infection tests if having unprotected sex with new or casual partners

Notes:

• in 2014, an estimated 103,700 people (69,200 men and 34,400 women) in the UK were living with HIV. The overall HIV prevalence was 1.9 per 1,000 people aged 15 and over (HIV in the UK Public Health England).
  • although there are significant pockets of HIV in other populations and communities, the most significant burden of HIV continues to be borne by men who have sex with men and by black Africans
  • an estimated 45,000 men living with HIV in the UK in 2014 had acquired their infection through sex with other men, an increase from 43,000 in 2013
    • 1 in 20 men aged 15 to 44 who have sex with men is estimated to be living with HIV
• almost 1 in 1,000 heterosexual people aged 15 to 44 in the UK is estimated to be living with HIV
  • prevalence is higher in black African heterosexual women (1 in 22) and men (1 in 56), who together form the second largest group affected by HIV
  • late diagnosis remains a significant problem in heterosexual people: in 2014, 55% were newly diagnosed at a late stage of infection (just over half of whom were black African)
• overall, 17% of people estimated to have HIV are unaware they are infected and so are at risk of passing it on. More people living outside London are unaware of their HIV infection (24%) compared with those in London (12%) ('HIV in the UK')

Reference:

• NICE (December 2016). HIV testing: increasing uptake among people who may have undiagnosed HIV