Low levels of HIV test coverage in clinical settings in the UK: a systematic review of adherence to 2008 guidelines
Open Access
- 9 January 2014
- journal article
- review article
- Published by BMJ in Sexually Transmitted Infections
- Vol. 90 (2), 119-124
- https://doi.org/10.1136/sextrans-2013-051312
Abstract
Objectives To quantify the extent to which guideline recommendations for routine testing for HIV are adhered to outside of genitourinary medicine (GUM), sexual health (SH) and antenatal clinics. Methods A systematic review of published data on testing levels following publication of 2008 guidelines was undertaken. Medline, Embase and conference abstracts were searched according to a predefined protocol. We included studies reporting the number of HIV tests administered in those eligible for guideline recommended testing. We excluded reports of testing in settings with established testing surveillance (GUM/SH and antenatal clinics). A random effects meta-analysis was carried out to summarise level of HIV testing across the studies identified. Results Thirty studies were identified, most of which were retrospective studies or audits of testing practice. Results were heterogeneous. The overall pooled estimate of HIV test coverage was 27.2% (95% CI 22.4% to 32%). Test coverage was marginally higher in patients tested in settings where routine testing is recommended (29.5%) than in those with clinical indicator diseases (22.4%). Provider test offer was found to be lower (40.4%) than patient acceptance of testing (71.5%). Conclusions Adherence to 2008 national guidelines for HIV testing in the UK is poor outside of GUM/SH and antenatal clinics. Low levels of provider test offer appear to be a major contributor to this. Failure to adhere to testing guidelines is likely to be contributing to late diagnosis with implications for poorer clinical outcomes and continued onwards transmission of HIV. Improved surveillance of HIV testing outside of specialist settings may be useful in increasing adherence testing guidelines.This publication has 15 references indexed in Scilit:
- The potential impact of routine testing of individuals with HIV indicator diseases in order to prevent late HIV diagnosisBMC Infectious Diseases, 2013
- Feasibility and Effectiveness of Indicator Condition-Guided Testing for HIV: Results from HIDES I (HIV Indicator Diseases across Europe Study)PLOS ONE, 2013
- HIV Testing in Non-Traditional Settings – The HINTS Study: A Multi-Centre Observational Study of Feasibility and AcceptabilityPLOS ONE, 2012
- Projected life expectancy of people with HIV according to timing of diagnosisAIDS, 2012
- Impact of late diagnosis and treatment on life expectancy in people with HIV-1: UK Collaborative HIV Cohort (UK CHIC) StudyBMJ, 2011
- The impact of new national HIV testing guidelines at a district general hospital in an area of high HIV seroprevalenceJournal of the Royal College of Physicians of Edinburgh, 2011
- Missed opportunities for HIV testing--a costly oversightQJM: An International Journal of Medicine, 2010
- Barriers to HIV testing in Europe: a systematic reviewEuropean Journal of Public Health, 2010
- Why don't physicians test for HIV? A review of the US literatureAIDS, 2007
- The late diagnosis and consequent short-term mortality of HIV-infected heterosexuals (England and Wales, 2000–2004)AIDS, 2006