More HIV Testing Urged
posted: 08/10/2010
The NHS health advice body NICE has produced its first HIV guidance, about HIV testing. The draft HIV testing guidance recommends that mainstream health services offer much more HIV testing to the two communities most affected by HIV in England, black African people and to men who have sex with men. The guidelines also call for more testing to be offered in places such as bars and saunas, using rapid point-of-care tests.
NICE HIV testing: open for comments
The National Institute for Health and Clinical Excellence (NICE) tells the NHS which are the best and most cost-effective treatments and public health interventions. NHS bodies are legally required to fund the medicines and treatments recommended by NICE.
Making HIV testing guidelines work
Other organisations have produced HIV testing guidelines before, notably the British HIV Association (BHIVA) and the British Association for Sexual Health and HIV (BASHH). But these were not backed by the UK National Screening Committee, nor by NICE, and many parts of the NHS simply ignored them.
The most recent BHIVA and BASHH testing guidelines recommended that HIV testing should be offered in a wide range of healthcare settings, including GP surgeries and most hospital departments. Little was done about this.
NICE will force more testing action
To increase testing, the Department of Health asked NICE to produce public health guidance to increase HIV testing both among men who have sex with men and among black African communities. The new NICE guidance supports most of the BHIVA and BASHH testing recommendations, and goes further with some recommendations.
There are two guidelines - one to increase testing in men who ave sex with men, and a the other for increasing testing among black African people.
Local strategies needed
For both men who have sex with men and for black Africans in England, NICE recommends preparing local strategies to increase HIV testing, developed in consultation with community organisations and the people affected. These strategies should focus on sections of the community who are less likely to use services. Community engagement and involvement is particularly important for black African communities.
Africans - involve people as champions and leaders
NICE recommends that black Africans in England should be recruited and trained to act as ‘health champions’ and ‘role models’. HIV testing work must deal with people’s misunderstandings and ignorance about HIV, testing and treatment, and must promote the benefits of early diagnosis and tackle HIV-related stigma.
The guidance for black African communities includes providing HIV testing outside sexual health clinics. This is because the evidence from the literature is that HIV testing in sexual health clinics is seen by some black Africans as stigmatising, complicated and time-consuming, while HIV testing in other healthcare settings was welcomed.
NICE recommends that general practitioners should routinely offer an HIV test to black Africans who have not tested before or who have had a new sexual partner since the last negative test. In hospitals and other healthcare settings, an opt-out test should be routinely provided to black Africans who are having blood taken for other reasons.
Testing in sex venues to reach gay men
Health promotion interventions promoting testing to men who have sex with men should include venues, such as saunas, clubs and cruising areas, or websites, which facilitate sex between men.
NICE appears more enthusiastic than BHIVA about community testing in sex on the premises venues. In gay venues, NICE says rapid tests (using mouth swabs or finger-prick blood samples) should be provided by trained staff, in a secluded or private area.
NICE’s guidance for men who have sex with men encourages testing in primary care (GPs), but not in secondary care (hospitals). The BHIVA guidelines are different, and recommend that all healthcare settings should offer an HIV test to any man who says he has sex with other men.
NICE recommends that GP surgeries should recommend all males to have HIV tests where the surgery is in an area with a large gay community or theer is a high rate of HIV.
Carl Burnell, of the gay men’s health charity GMFA, questions whether this will is work, because of the many other demands on GP surgery capacity. “The strategy assumes that other services are running like clockwork and have capacity to offer HIV testing,” he said.
Clear path from testing to services
All testing services need clear pathways for people to obtain any necessary confirmation of the HIV test result, HIV treatment services and HIV support groups. People who test negative may need help through counselling and safer sex interventions.
The draft guidance comes before results are published on several Department of Health funded pilot projects evaluating new testing strategies.
NICE’s guidance is open for feedback and comments until late November. The final NICE HIV testing guidance will appear in March 2011.
HIV testing guidelines for MSM
HIV testing guidleines for black Africans in England
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