Guides for More HIV Testing

posted: 04/04/2011

The number of people who got infected with HIV within the UK in the last 10 years has almost doubled. New infections that happened in the UK (rather than abroad) rose from 1,950 in 2001 to 3,780 in 2010.

In response the National Institute for Clinical Excellence (NICE, the body that tells the NHS what healthcare works and is good value for money) has issued new guidance for the testing of the two groups most at risk of getting HIV in the UK, gay/bi men and African people.

HIV testing helps people keep good health

Testing and treating people with HIV helps the person with HIV stay healthy and to live a near-normal life, helps avoid passing on HIV to others, and can save the NHS a lot of money.
 

The NICE guidance aims to increase the numbers taking HIV tests to reduce the number of people who do not know they have HIV and so help prevent HIV being passed on by Africans living in the UK and gay men.

Gay and bisexual men remain the group most at risk of becoming infected with HIV in the UK with 70 per cent more men being diagnosed with HIV in the past 10 years (from 1,810 in 2001 to 3,080 in 2010).
 

‘NAT welcomes the new NICE guidance on increasing testing among African communities and gay men. Not only is the number of people being diagnosed with HIV still too high, late diagnosis is an extremely important problem as it means a person is likely to have had HIV for a number of years – with a high risk of transmission to sexual partners – and it can also reduce the effectiveness of treatment,” commented Deborah Jack, Chief Executive of NAT (National AIDS Trust).

‘It is crucial that HIV testing becomes ‘normalised’ in our society, not just among gay men and African communities, but also amongst health professionals. Many people with HIV attend NHS services for years without being offered an HIV test and this neglect needs to be addressed and stopped.’

'The importance of HIV testing should now be reflected in Government plans as they reorganise the NHS and public health. In particular, it is essential that HIV late diagnosis remain a key outcome indicator to assess progress in public health at the local level. It is also vital that the extensive reorganisation of the NHS does not undermine recent momentum in HIV testing.’
 

‘Public Health England must ensure that the vision for HIV testing amongst gay men and African communities set out in the NICE Guidance is consistently implemented across the whole of the NHS and public health system.’
 

NICE HIV testing guidance for gay/bi men

NICE testing guidance for Africans living in the UK

Source – HPA press release

Image

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
 

Source

5M Still Waiting for Treatment

posted: 01/10/2009

Although four million people are now receiving antiretroviral treatment in low and middle-income countries, another five million adults and children lack access to treatment, according to figures released today by United Nations agencies.

The report Towards universal access: scaling up priority HIV/AIDS interventions in the health sector is published by the World Health Organization, UNAIDS and UNICEF, and is the third annual review of international progress towards the goal of universal access to treatment and prevention by 2010.

Although more than a million people are estimated to have been enrolled into treatment programmes during 2008 alone, the biggest annual increase since treatment scale-up began, only 42% of those in need of treatment in low and middle-income countries are currently being reached.

Mothers and babies

The report also reveals major gaps in two priority areas, the prevention of mother to child transmission and treatment of children.

The report estimates that 21% of pregnant women received an HIV test in 2008, and 45% received drugs to prevent mother to child transmission, of whom around one-third received only single-dose nevirapine, the least effective form of preventive treatment. Only one-third of those who tested positive were assessed for eligibility for antiretroviral treatment for their own health.

Although 38% of children with HIV in low- and middle-income countries in need of treatment received it, infant diagnosis continues to lag behind. In 41 reporting low- and middle-income countries only 15% of children born to HIV-infected mothers were tested for HIV within the first two months of life.

Background to universal access
In 2001 the convening of The United Nations Special Session on HIV/AIDS marked an historic beginning. For the first time a global set of targets was agreed in response to the crisis. In 2006 at the second United Nations General Assembly High Level Meeting on HIV/AIDS, countries agreed to work towards the goal of “universal access to comprehensive prevention programmes, treatment, care and support” by 2010. The G8 Final declaration in L’Aquila, Italy in July 2009 claimed “We will implement further efforts towards universal access to HIV/AIDS prevention, treatment, care and support by 2010”

WHO, UNICEF and UNAIDS in collaboration with other international monitoring and reporting mechanisms have been monitoring progress, nationally, regionally and globally, of the health sector’s response to HIV. The report presented today is the third in a series of annual progress reports towards universal access that includes HIV services for women and children.

Reports standardised

WHO together with UNICEF developed a joint reporting tool to request information from national programmes to collect data on the scale-up of health sector interventions in response to HIV. The goal of this process is to facilitate the collection of a standardised set of information.

By the end of 2008 between 3.7 and 4.3 million people were on antiretroviral treatment including an estimated 275,700 children (38% of those in need) under the age of 15 years.

Progress varies by country and region. In sub-Saharan Africa, for example, where two-thirds of all global infections occur, an estimated 2.9 million people were on treatment by the end of 2008, with an approximate increase of 800,000 people during 2008.

edited from aidsmap

Reference
WHO, UNICEF, UNAIDS. Towards universal access: scaling up priority HIV/AIDS interventions in the health sector. September 2009.

Needle Exchanges Give Good Value

posted: 20/02/2009

Providing free needles and syringes to people who inject heroin and cocaine is a cost-effective use of NHS money, the government's medicines watchdog said today. Free needles and syringes help prevent the transmission of HIV and hepatitis.

The National Institute for Health and Clinical Excellence (Nice) issued its first guidance on how harm reduction services for injecting drug users should be run throughout England, suggesting combining non-judgmental needle exchange schemes with treatment to help users come off drugs.

1 in 4 share injecting drug kit

Professor Mike Kelly, director of the institute's public health division, said there are about 200,000 injecting drug users in Britain. He estimated about 25% of users share needles, putting themselves at a greatly increased risk of being infected with Hepatitis C or HIV.

NW England focus

In NW England there are just over 100 people diagnosed with HIV who were infected through sharing drug injection kit. The actual number is probably closer to 140 because many people have not yet been diagnosed with HIV. Whatever the actual number is, only 2 in 100 people with HIV in NW England got HIV through sharing drug kit. Most people become infected with HIV through sex without condoms.

Around 40% of injecting drug users have hepatitis C and then the risk of death is 10 times higher than among the population at large. Having both HIV and hepatitis C is common.

Kelly said: "The cost to the NHS of caring for someone who injects drugs is around £35,000 over their lifetime. From a societal perspective, the average [lifetime] cost rises to an estimated £480,000 when you take into account the high cost of crime including criminal justice costs."

Needle exchanges help people consider treatment 

If needle exchange schemes are run well, they can provide an effective conduit for doctors, nurses and pharmacists to gain direct contact with hard-to-reach groups – the first step towards encouraging them to seek treatment.

Providing injecting drug users with extra years of healthy life was cost-effective for taxpayers, said Nice.

Guidance supports HIV and hepatitis C prevention

Kelly added: "Keeping in check the epidemic of Hepatitis and maintaining HIV at its relatively low levels is an important aim that this guidance will serve."

Needle and syringe exchange schemes have been provided throughout England for more than 20 years. They provide injecting drug users with sterile equipment, needle disposal bins and advice on safer injecting practices. Primary care trusts (PCTs) have had discretion on how to run services to meet local needs.

Guidance for NHS

The Nice guidelines include advice on how PCTs should tailor the service to encourage injectors to seek treatment by offering more accessible opening times and locations.

Dr Mathew Hickman, chair of the Hepatitis C prevention working group at the Advisory Council for the Misuse of Drugs, said: "Needle and syringe programmes are a critical component of public health action to prevent Hepatitis C infections among injecting drug users.

"Evidence suggests that a combination of interventions is most effective. This means that staff need to use the opportunity they have with injectors actively to promote and refer people into treatment, such as opiate substitution programmes."

Dr David Sloan, vice-chair of the Public Health Interventions Advisory Committee, said: "Although HIV rates remain relatively low among injecting drug users in the UK, bad practice, such as the sharing of needles among multiple users, makes these individuals extremely vulnerable to any future outbreak."
 

The NICE guidance is now available for people using drugs, carers and the wider public. This includes professional guidance for healthcare staff, and the background papers and evidence for the new guidelines.

source