New guidance published by NICE suggests that doctors located in regions of high HIV prevalence should offer tests to those attending regular appointments.
This would then potentially lead to millions more tests, effectively catching HIV viruses in early stages on more occasions.
It is estimated that over 3.5 million people currently reside in areas of very high HIV prevalence.
And a further 8 million live in areas of high prevalence.
The new guidance was released on World Aids Day, but it has not necessarily found favour with GP groups.
It has been noted that GPs are under no obligation to offer this, as it is not part of the GP contract, however it seems that this will change, according to the new document.
“In areas of high and extremely high prevalence, also offer and recommend HIV testing to everyone who has not previously been diagnosed with HIV and who: registers with the practice or; is undergoing blood tests for another reason and has not had an HIV test in the previous year. Additionally, in areas of extremely high prevalence, consider HIV testing opportunistically at each consultation (whether bloods are being taken for another reason or not), based on clinical judgement,” the new guidance indicates.
Commenting on the issue, Dr Andrew Green, the prescribing lead for the GPC, explained that he understood and “supports efforts to improve the early diagnosis of patients who have been infected with HIV. Early treatment dramatically decreases infectivity and improves survival, and a co-ordinated approach is clearly important”.
But Green believes there are still issues to be addressed before this plan can be put in place.
“However, the challenge now is on commissioners to provide this service, because screening activities are not part of essential GMS contracts and so GPs are not required to undertake this activity personally, whatever NICE may say. Indeed, they should not do so if it would harm the care of other patients. Many of the practices with high prevalence rates will be in inner city areas who will have high list-turnovers and will already be struggling to provide effective care”.
RCGP clinical lead for HIV, sexual and reproductive health, Dr Philippa Matthews, broadly welcomed the new approach, but also believed that implementing it could be problematical.
“As the guidelines acknowledge, there are barriers for GP surgeries to offer wide-scale HIV testing. Funding for such initiatives is currently decided by local councils, and there is no uniformity across the country. There is also the issue of effective implementation – including training and support for practices to adopt these schemes”.
Matthews expanded on this perception, outlining some of the issues for GPs.
“Furthermore, there are sensitivities that GPs need to take into account when offering HIV tests to patients who are usually visiting the GP for reasons not connected with HIV; a conversation that is difficult within the frustrating constraints of the standard 10-minute consultation. Despite this, many doctors and nurses in high prevalence areas are doing an incredible job at integrating HIV testing into relevant routine care”.