All genitourinary medicine clinics in the United Kingdom have received a firm recommendation to introduce 'opt-out' testing for HIV for all patients, regardless of risk factors for infection, in guidelines published by the British Association of Sexual Health and HIV this month.
The guidelines also recommend that in-depth discussion prior to testing is necessary only for those patients who have been at high risk of infection, or those who present with a particular concern about an HIV infection risk. “Provision of a leaflet about HIV testing can provide much of the information needed prior to obtaining consent”, the guidelines state.
The move to standardise `opt-out` testing in the UK’s sexual health clinics follows on from the recommendation in the 2004 National Strategy for Sexual Health and HIV, which set the following HIV testing targets for all genitourinary medicine clinics:
- to offer HIV testing to all GUM clinic attendees by the end of 2004 with a view to increasing the uptake to those offered it to 40% by the end of 2004 and to 60% by the end of 2007.
- By the end of 2007 it is hoped that the number of previously undiagnosed HIV positive people attending clinics is reduced by 50%.
'Opt-out' testing has already been introduced by many clinics in London, along with same-day testing services targeted at high-risk individuals, especially gay men. A number of clinics have also begun to work with Terrence Higgins Trust to offer one hour testing in London, Birmingham, Brighton, Bristol and Leeds at sites outside sexual health clinics in order to increase uptake of HIV testing. The Royal Free Hospital in London is also offering one hour testing.
Recommendations on the window period
One of the biggest causes of confusion and anxiety for people seeking HIV antibody testing is the 'window period' of three months during which people may have a 'false negative' result due to the slow emergence of HIV antibodies.
Any reduction in the waiting period prior to testing as a result of the introduction of newer antibody tests is discouraged in the new guidelines; the guidelines say that the three month delay between the last risky exposure and testing (during which antibodies to HIV emerge) has proven reliable over the last ten years in determing whether people are truly HIV-negative. Although data suggest that 50% of people will test positive within one month, clinics should continue to recommend a three month wait as standard policy.
Arrangements for giving results are also addressed by the guidelines. Clinics should only give results over the phone or by text message to patients at low risk of HIV infection, and all patients should be told at the time of testing how results will be communicated. Face to face provision of results is strongly encouraged for highly anxious patients, regardless of their degree of risk, those for whom English is a second language and for patients likely to test HIV-positive.
The guidelines are available for download at:
http://www.bashh.org/guidelines.asp
For information on same day testing services, click here.
To search for your nearest HIV testing centre in the UK, click here.