Resources for “HIV testing in TB Clinics”

Human immunodeficiency virus (HIV) infection poses one of the greatest challenges to tuberculosis control, with recent UK data suggesting an increase in the proportion of tuberculosis cases co-infected with HIV (Ahmed AB. Thorax 2007). New United Kingdom guidelines for HIV testing were published by the British HIV Association, the British Association for Sexual Health and HIV and the British Infection Society in September 2008. These guidelines recommended more widespread HIV testing in clinical services such as TB clinics.

Infection with HIV affects the way that TB is treated. In the UK, up to one third of people infected with HIV are unaware of their status. Universal HIV testing means that all individuals attending TB clinics are offered and recommended a HIV test as part of their routine care. This is applicable to all patients irrespective of their age, and the offer of the HIV test is not based on individual risk factors.

Information resources have been developed to support the implementation of this guidance in collaboration with representatives of Primary Care Trusts, Respiratory Medicine Clinics, HIV services and voluntary organisations - TB Alert and National African HIV Prevention. The resources developed include:

•  TB information cards (‘i-cards’) to provide information on the tests which will be conducted in the clinic. The TB i-cards are available in 12 languages, including English.
• Standardised flip charts to be placed in the TB clinics, informing patients they will routinely be offered HIV testing in the clinic. The TB flip charts are available in 12 languages, including English.
• Leaflets for healthcare workers informing them about the latest guidelines and helping them to normalise HIV testing in TB clinics.

In order to support the implementation of these guidelines, the National Knowledge Service -TB has trialled the impact of the implementation of the ‘opt out’ HIV testing policy along with evaluation of the resources developed by the NKS – TB amongst 25 London TB clinics from 10th September 2009 – 10th March 2010.  All patients newly diagnosed with TB were tested for their HIV status unless they specifically refused their consent (opt out), in line with the 2008 guidance. Patients who refused testing were supplied with resources developed by the  NKS – TB information resources to consider and further opportunities to be tested offered at their subsequent clinic visits.

Ahmed AB, Abubakar I, Delpech V, Lipman M, Boccia D, Forde J, Antoine D, Watson JM. The growing impact of HIV infection on the epidemiology of tuberculosis in England and Wales: 1999 2003.Thorax. 2007 Aug; 62(8):672-6. Epub 2007 Feb 20.

Last reviewed: 21 July 2010