Evidence and resources to commission expanded HIV testing in priority medical services in high prevalence areas, April 2012
Health Protection Agency
- The Health Protection Agency (HPA) recommends that routine HIV testing should be commissioned as a priority for all general medical admissions in high prevalence areas.
- HIV testing by general practitioners should be widely promoted, especially in high prevalence areas, although further consideration should be given to the best model of expanding testing in primary care.
- This document aims to provide current and future commissioners with a concise overview of the evidence of acceptability, feasibility, clinical benefit and cost-effectiveness of expanding HIV testing in general medical admissions and new registrants in general practice.
- A late (CD4 count <350/mm3) or very late (CD4<200/mm3) HIV diagnosis is associated with increased morbidity and mortality. Half of the new HIV diagnoses reported in 2010 were after the point at which the diagnosed individual should have commenced treatment. The proportion of late HIV diagnoses has been included as an indicator in the Public Health Outcome Framework.
- National HIV testing guidelines (2008) and National Institute of Health and Clinical Excellence (NICE) guidance (2011) recommend expanding HIV testing in high prevalence areas, defined as those with a diagnosed prevalence of more than two in 1,000. This includes 40 primary care trusts (PCTs) and 54 local authorities in England (see appendices).
- The “Time to Test for HIV” report examined the results of eight Department of Health (DH) pilot projects and concluded that the routine offer of an HIV test in general medical services was:
- Acceptable to patients and feasible to establish in a variety of medical settings
- Effective in detecting previously undiagnosed infection: 50 new HIV diagnoses were made among 11,000 patients tested (positivity of 4/1,000)
- Cost of introducing routine HIV testing into general medical services was an average of £9 per test for general medical admissions and £8 for new registrants in general practice.
- The estimated annual cost of expanding testing into general medical services nationally in areas of high prevalence with coverage of 75% would be £1.3 million: the cost for an average high prevalence PCT would be £19,000 per 100,000 population.
Please visit the HIV Testing landing page for further information.
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Last reviewed: 20 April 2012