Overall HIV Prevalence
The primary objective of the unlinked anonymous prevalence monitoring programme (UAPMP) is to monitor the prevalence of HIV infection in selected adult populations (pregnant women, injecting drug users and genitourinary medicine clinic attendees ). Since the programme began in 1990, approaching ten million samples have been irreversibly unlinked and anonymised from patient identifying information and tested for HIV infection.
Prevalence is defined as the proportion of individuals within a population who are infected at a given time. In the case of HIV, individuals may remain symptom free for long periods of time and therefore their infection remains unrecognised. The UA programme includes those persons who have already been diagnosed with infection as well as persons who are currently undiagnosed and would therefore not be included in other surveillance systems.
Information collected by the programme is used to:
- Monitor prevalence and associated risk factors in the selected populations
- Measure the effectiveness of voluntary confidential HIV testing strategies
- Provide timely and useful information for the targeting of health promotion, the evaluation of preventive measures, and the planning of medical and social services for those affected by HIV
- In combination with other data, to provide estimates of the national total of HIV-infected persons and to assist in estimating future numbers of persons with severe HIV disease who will require care
Methods
The populations covered by the programme are pregnant women, genitourinary medicine clinics attendees and injecting drug users. Samples from these individuals are anonymised and irreversibly unlinked from all patient identifiers. Limited demographic and clinical information is retained and the samples are then tested for presence of HIV infection. The legal and ethical basis for Unlinked Anonymous HIV testing was established before the programme began . Specific methodology differs for each of the populations covered
Ethics
The legal and ethical basis for Unlinked Anonymous HIV testing was established before the programme began – ‘for purposes of public health surveillance, and where samples are anonymised, specific patient consent is not required’[1]. Guidelines from the Medical Research Council [2] also state that it is acceptable to use human material surplus to clinic requirements provided the material is anonymous and unlinked. The procedures used by each of the Unlinked Anonymous surveys are consistent with the Human Tissue Act 2004 and subsequent regulations [3]. Approval has been received from over 150 local ethics committees covering each site where unlinked anonymous surveys are underway. Active local arrangements allow patients the opportunity to be aware of what may happen to their samples and mechanisms are in place for respecting spontaneous objections.
References
1. Heptonstall J, Gill ON. The legal and ethical basis for unlinked anonymous testing. CDR 1989;48:3-6
2. Human tissue and biological samples for use in research: Operational and ethical guidelines, 2001.
http://www.mrc.ac.uk/Utilities/Documentrecord/index.htm?d=MRC002420
3. Human Tissue Act. http://www.dh.gov.uk/en/Policyandguidance/healthandsocialcaretopics/
Tissue/Tissuegeneralinformation/DH_4102169
Unlinked Anonymous Surveys
All Unlinked Anonymous Survey Data Sets (supplementary to annual report 'Testing Times')
The following file contains all the tables and figures from the Unlinked Anonymous Prevalence Monitoring Programme (surveillance update November 2007):
Supplementary data tables of the Unlinked Anonymous Prevalence Monitoring Programme: data to the end of 2006 (PDF, 292 KB)