{"id":1240,"date":"2017-01-11T16:20:10","date_gmt":"2017-01-11T16:20:10","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1240"},"modified":"2017-01-11T16:20:10","modified_gmt":"2017-01-11T16:20:10","slug":"revised-uk-nice-guidelines-for-hiv-testing-why-local-prevalence-based-targeting-by-gps-and-hospitals-makes-sense","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2017\/01\/11\/revised-uk-nice-guidelines-for-hiv-testing-why-local-prevalence-based-targeting-by-gps-and-hospitals-makes-sense\/","title":{"rendered":"Revised UK NICE Guidelines for HIV testing: why local prevalence based targeting by GPs and hospitals makes sense"},"content":{"rendered":"<p>November 2016 saw the publication of revised UK <a href=\"https:\/\/www.nice.org.uk\/guidance\/NG60\/chapter\/recommendations\">NICE Guidelines<\/a> for HIV testing (last updated 2011) \u2013 only a few weeks before the appearance of the annual Public Health England Report: <a href=\"https:\/\/www.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/574667\/HIV_in_the_UK_2016.pdf\">HIV in the UK\/2016<\/a>.\u00a0 The latter highlights the estimated level of still undiagnosed HIV in the UK (which, at 13,500\/101,000, places us 3% short of the UNAIDS 90:90:90 target) and the proportion of late diagnoses (approx. two\/five thousand).\u00a0 It also draws attention to the \u2018diversity\u2019 of the epidemic, and the relatively poor levels of diagnosis amongst the 16,500 infected <em>non-black African<\/em> heterosexuals (approx. 1\/4, as opposed to 1\/7 for MSM or 1\/8.5 for black African heterosexuals).<\/p>\n<p>In the light of these findings, we can appreciate the move in the <a href=\"https:\/\/www.nice.org.uk\/guidance\/NG60\/chapter\/recommendations\">NICE Guidelines<\/a>, regarding opportunistic testing in primary and secondary care, towards an approach that, first, makes absolutely clear its basis in regional prevalence rather than any other factor, and, second, is more specific \u2013 and more demanding \u2013 about the occasions when testing is recommended. \u00a0We find a new distinction of two levels of high local risk: high (0.2-0.5%) and extremely high (&gt;0.5%).\u00a0 This determines whether testing should be offered on specified occasions, namely, in primary care, at registration and the performance of any blood test, and, in secondary care, at admission and performance of a blood test (\u2018high\u2019 prevalence areas); or whether there should be universal opportunistic testing (\u2018extremely high\u2019 prevalence areas).\u00a0 As compared with the 2011 guidelines, an insistence on local prevalence as the determining factor replaces the specification of multiple high-risk groups (e.g. MSM or black Africans).<\/p>\n<p>The danger with routine HIV testing is well illustrated by a 2011 study of screening in 29 Paris emergency departments: <a href=\"https:\/\/blogs.bmj.com\/sti\/2011\/11\/28\/non-targeted-hiv-testing-in-health-settings-worthwhile\/\">Wilson d&#8217;Almeida &amp; Cremieux\/STIs\/blogs<\/a>. \u00a0This trial seems to have spectacularly failed to pick up any HIV infections that would not have been detected even without the intervention.\u00a0 By contrast, what is proposed by the <a href=\"https:\/\/www.nice.org.uk\/guidance\/NG60\/chapter\/recommendations\">NICE Guidelines<\/a> is routine testing <em>in areas of extremely high prevalence<\/em>.\u00a0 Of course, patients may still refuse testing (<a href=\"http:\/\/sti.bmj.com\/content\/92\/7\/557.extract?sid=6e0976ad-44e7-472a-ba51-faf77a14a904\">Dhairyawan &amp; Orking\/STIs<\/a>) \u2013 and appear to do so all the more frequently where they belong to groups, like non-African heterosexuals, that the authors of the 2016 guidelines are so anxious to include (<a href=\"http:\/\/sti.bmj.com\/content\/early\/2016\/09\/26\/sextrans-2016-052737.abstract?sid=6e0976ad-44e7-472a-ba51-faf77a14a904\">Mohammed &amp; Hughes\/STIs<\/a>).\u00a0 Nevertheless, the 2014 HINTS study (<strong>HI<\/strong>v testing in <strong>N<\/strong>on-<strong>T<\/strong>raditional <strong>S<\/strong>ettings) of the acceptability of routine HIV testing has demonstrated encouraging levels of uptake (c.65%) in UK Emergency Departments, Acute Care Units, Primary Care Centres, and dermatology outpatients (<a href=\"http:\/\/journals.plos.org\/plosone\/article?id=10.1371\/journal.pone.0039530\">Rayment &amp; Sullivan<\/a>; see also <a href=\"http:\/\/sti.bmj.com\/content\/early\/2016\/09\/26\/sextrans-2016-052737.abstract?sid=6e0976ad-44e7-472a-ba51-faf77a14a904\">Mohammed &amp; Hughes\/STIs<\/a>).\u00a0 Conversely, there is evidence, where primary care is concerned, that practitioners may be capable of <strong>missing<\/strong> opportunities for testing even where their patients present with indicator conditions for HIV infection (<a href=\"http:\/\/sti.bmj.com\/content\/early\/2016\/02\/17\/sextrans-2015-052328?papetoc\">Agusti &amp; Casabona\/STIs<\/a>).<\/p>\n<p>Responding to the new NICE guidelines, <a href=\"http:\/\/www.rcgp.org.uk\/news\/2016\/november\/gps-need-support-to-increase-hiv-testing-in-primary-care.aspx\">a GPs&#8217; representative<\/a> stresses the existing workload of GPs and the sensitivity of sexual health issues, but broadly welcomes the new emphasis.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>November 2016 saw the publication of revised UK NICE Guidelines for HIV testing (last updated 2011) \u2013 only a few weeks before the appearance of the annual Public Health England Report: HIV in the UK\/2016.\u00a0 The latter highlights the estimated level of still undiagnosed HIV in the UK (which, at 13,500\/101,000, places us 3% short [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/sti\/2017\/01\/11\/revised-uk-nice-guidelines-for-hiv-testing-why-local-prevalence-based-targeting-by-gps-and-hospitals-makes-sense\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[264,1642,16495],"tags":[],"class_list":["post-1240","post","type-post","status-publish","format-standard","hentry","category-health-policy","category-hiv-testing","category-uk-guidelines"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Revised UK NICE Guidelines for HIV testing: why local prevalence based targeting by GPs and hospitals makes sense - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2017\/01\/11\/revised-uk-nice-guidelines-for-hiv-testing-why-local-prevalence-based-targeting-by-gps-and-hospitals-makes-sense\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Revised UK NICE Guidelines for HIV testing: why local prevalence based targeting by GPs and hospitals makes sense - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"November 2016 saw the publication of revised UK NICE Guidelines for HIV testing (last updated 2011) \u2013 only a few weeks before the appearance of the annual Public Health England Report: HIV in the UK\/2016.\u00a0 The latter highlights the estimated level of still undiagnosed HIV in the UK (which, at 13,500\/101,000, places us 3% short [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/sti\/2017\/01\/11\/revised-uk-nice-guidelines-for-hiv-testing-why-local-prevalence-based-targeting-by-gps-and-hospitals-makes-sense\/\" \/>\n<meta property=\"og:site_name\" content=\"Sexually Transmitted Infections\" \/>\n<meta property=\"article:published_time\" content=\"2017-01-11T16:20:10+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2017\\\/01\\\/11\\\/revised-uk-nice-guidelines-for-hiv-testing-why-local-prevalence-based-targeting-by-gps-and-hospitals-makes-sense\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2017\\\/01\\\/11\\\/revised-uk-nice-guidelines-for-hiv-testing-why-local-prevalence-based-targeting-by-gps-and-hospitals-makes-sense\\\/\"},\"author\":{\"name\":\"\",\"@id\":\"\"},\"headline\":\"Revised UK NICE Guidelines for HIV testing: why local prevalence based targeting by GPs and hospitals makes sense\",\"datePublished\":\"2017-01-11T16:20:10+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2017\\\/01\\\/11\\\/revised-uk-nice-guidelines-for-hiv-testing-why-local-prevalence-based-targeting-by-gps-and-hospitals-makes-sense\\\/\"},\"wordCount\":486,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#organization\"},\"articleSection\":[\"health policy\",\"HIV testing\",\"UK guidelines\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2017\\\/01\\\/11\\\/revised-uk-nice-guidelines-for-hiv-testing-why-local-prevalence-based-targeting-by-gps-and-hospitals-makes-sense\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2017\\\/01\\\/11\\\/revised-uk-nice-guidelines-for-hiv-testing-why-local-prevalence-based-targeting-by-gps-and-hospitals-makes-sense\\\/\",\"name\":\"Revised UK NICE Guidelines for HIV testing: why local prevalence based targeting by GPs and hospitals makes sense - Sexually Transmitted Infections\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#website\"},\"datePublished\":\"2017-01-11T16:20:10+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2017\\\/01\\\/11\\\/revised-uk-nice-guidelines-for-hiv-testing-why-local-prevalence-based-targeting-by-gps-and-hospitals-makes-sense\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2017\\\/01\\\/11\\\/revised-uk-nice-guidelines-for-hiv-testing-why-local-prevalence-based-targeting-by-gps-and-hospitals-makes-sense\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2017\\\/01\\\/11\\\/revised-uk-nice-guidelines-for-hiv-testing-why-local-prevalence-based-targeting-by-gps-and-hospitals-makes-sense\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Revised UK NICE Guidelines for HIV testing: why local prevalence based targeting by GPs and hospitals makes sense\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/\",\"name\":\"Sexually Transmitted Infections\",\"description\":\"Discussion and suggestion space for readers of STIs\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#organization\",\"name\":\"Sexually Transmitted Infections\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/files\\\/2017\\\/10\\\/blog-logo-sti.png\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/files\\\/2017\\\/10\\\/blog-logo-sti.png\",\"width\":378,\"height\":34,\"caption\":\"Sexually Transmitted Infections\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#\\\/schema\\\/logo\\\/image\\\/\"}},{\"@type\":\"Person\",\"@id\":\"\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/author\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Revised UK NICE Guidelines for HIV testing: why local prevalence based targeting by GPs and hospitals makes sense - Sexually Transmitted Infections","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/sti\/2017\/01\/11\/revised-uk-nice-guidelines-for-hiv-testing-why-local-prevalence-based-targeting-by-gps-and-hospitals-makes-sense\/","og_locale":"en_US","og_type":"article","og_title":"Revised UK NICE Guidelines for HIV testing: why local prevalence based targeting by GPs and hospitals makes sense - Sexually Transmitted Infections","og_description":"November 2016 saw the publication of revised UK NICE Guidelines for HIV testing (last updated 2011) \u2013 only a few weeks before the appearance of the annual Public Health England Report: HIV in the UK\/2016.\u00a0 The latter highlights the estimated level of still undiagnosed HIV in the UK (which, at 13,500\/101,000, places us 3% short [...]Read More...","og_url":"https:\/\/blogs.bmj.com\/sti\/2017\/01\/11\/revised-uk-nice-guidelines-for-hiv-testing-why-local-prevalence-based-targeting-by-gps-and-hospitals-makes-sense\/","og_site_name":"Sexually Transmitted Infections","article_published_time":"2017-01-11T16:20:10+00:00","twitter_card":"summary_large_image","twitter_misc":{"Written by":"","Est. reading time":"2 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/sti\/2017\/01\/11\/revised-uk-nice-guidelines-for-hiv-testing-why-local-prevalence-based-targeting-by-gps-and-hospitals-makes-sense\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/sti\/2017\/01\/11\/revised-uk-nice-guidelines-for-hiv-testing-why-local-prevalence-based-targeting-by-gps-and-hospitals-makes-sense\/"},"author":{"name":"","@id":""},"headline":"Revised UK NICE Guidelines for HIV testing: why local prevalence based targeting by GPs and hospitals makes sense","datePublished":"2017-01-11T16:20:10+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/sti\/2017\/01\/11\/revised-uk-nice-guidelines-for-hiv-testing-why-local-prevalence-based-targeting-by-gps-and-hospitals-makes-sense\/"},"wordCount":486,"publisher":{"@id":"https:\/\/blogs.bmj.com\/sti\/#organization"},"articleSection":["health policy","HIV testing","UK guidelines"],"inLanguage":"en-US"},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/sti\/2017\/01\/11\/revised-uk-nice-guidelines-for-hiv-testing-why-local-prevalence-based-targeting-by-gps-and-hospitals-makes-sense\/","url":"https:\/\/blogs.bmj.com\/sti\/2017\/01\/11\/revised-uk-nice-guidelines-for-hiv-testing-why-local-prevalence-based-targeting-by-gps-and-hospitals-makes-sense\/","name":"Revised UK NICE Guidelines for HIV testing: why local prevalence based targeting by GPs and hospitals makes sense - Sexually Transmitted Infections","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/sti\/#website"},"datePublished":"2017-01-11T16:20:10+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/sti\/2017\/01\/11\/revised-uk-nice-guidelines-for-hiv-testing-why-local-prevalence-based-targeting-by-gps-and-hospitals-makes-sense\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/sti\/2017\/01\/11\/revised-uk-nice-guidelines-for-hiv-testing-why-local-prevalence-based-targeting-by-gps-and-hospitals-makes-sense\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/sti\/2017\/01\/11\/revised-uk-nice-guidelines-for-hiv-testing-why-local-prevalence-based-targeting-by-gps-and-hospitals-makes-sense\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/sti\/"},{"@type":"ListItem","position":2,"name":"Revised UK NICE Guidelines for HIV testing: why local prevalence based targeting by GPs and hospitals makes sense"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/sti\/#website","url":"https:\/\/blogs.bmj.com\/sti\/","name":"Sexually Transmitted Infections","description":"Discussion and suggestion space for readers of STIs","publisher":{"@id":"https:\/\/blogs.bmj.com\/sti\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/sti\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/sti\/#organization","name":"Sexually Transmitted Infections","url":"https:\/\/blogs.bmj.com\/sti\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/sti\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/sti\/files\/2017\/10\/blog-logo-sti.png","contentUrl":"https:\/\/blogs.bmj.com\/sti\/files\/2017\/10\/blog-logo-sti.png","width":378,"height":34,"caption":"Sexually Transmitted Infections"},"image":{"@id":"https:\/\/blogs.bmj.com\/sti\/#\/schema\/logo\/image\/"}},{"@type":"Person","@id":"","url":"https:\/\/blogs.bmj.com\/sti\/author\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/posts\/1240","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/users\/152"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/comments?post=1240"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/posts\/1240\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/media?parent=1240"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/categories?post=1240"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/sti\/wp-json\/wp\/v2\/tags?post=1240"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}