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Test all new registrants for HIV in high-risk areas, GPs told

GPs in areas with high rates of HIV infection should offer an HIV test to all new registrants to help improve early diagnosis and treatment of the disease, according to London’s GP sexual health leader.

Dr Richard Ma, GP and London sexual and reproductive health GP champion, said HIV testing high-risk groups in general practice is a ‘no-brainer’ from a cost-effectiveness perspective because detecting and managing HIV at an early stage results in huge savings to the NHS.

But he acknowledged that GPs could find offering certain patients a HIV test difficult - because of the stigma involved - and backed an approach where the test was offered to all new registrants in areas with a high prevalence of HIV.

The Government recently announced a drive to offer more HIV testing in general practice to high-risk groups such as gay and bisexual men and African communities. The message was reinforced by the recent publication of the Department of Health’s new Sexual Health Framework, for which a key ambition is better access and uptake of HIV tests in primary care.

Dr Ma told Pulse: ‘As far as cost-effectiveness is concerned it’s a no-brainer because for every patient you diagnose and treat you reduce the lifetime cost of HIV treatment from a third to a quarter of a million pounds. So it’s a really cost-effective intervention.’

He added: ‘Of course a key question is how you identify men who have sex with men and black African men who need testing, without sounding judgemental. And some of the key developments in HIV testing in the last few years [have shown that] in areas where there is a high prevalence of HIV infection, with a prevalence of more than two per 1,000, it is cost-effective to offer HIV testing to all new GP registrants.’

Dr Ma explained that research in GP practices in south-east London and in Brighton has shown the approach is feasible and that the majority of patients actually accept the test.

‘It’s a very practical thing to do in general practice because you  have new patients coming in, most of whom need some sort of testing, so why not include the HIV test?’

The Health Protection Agency last year published the evidence from pilot studies on the costs and acceptability of testing new registrants in general practice, along with resources to support commissioners.

Dr Anthony Nardone, head of sexual health promotion at Public Health England, commented: ‘The Public Health Outcomes Framework sets an indicator for reducing late HIV diagnosis, and every effort must now be made to reduce health service barriers to HIV testing. All local authorities and NHS bodies can use their Joint Strategic Needs Assessment to prioritise and inform the provision of appropriate HIV testing services.

‘In areas with a diagnosed HIV prevalence greater than two per 1,000 population of 15-59 year olds, routine HIV testing for all general medical admissions as well as new registrants in primary care should be commissioned. Individual GPs should also take every opportunity to offer and recommend HIV testing to those with HIV indicator conditions and/or known to be at higher risk of HIV infection.’

Readers' comments (1)

  • It will not be enough to simply offer the test, for those who test positive, rapid, robust, culturally appropriate pathways will need to be in place for those who test positive so that they can access quality post test counselling and referral to specialist treatment centres.
    GP Practices must do a more in terms of HIV awareness and confidentiality, particularly for non clinical staff and especially where they are the 'family' doctor. 'Disclosure' has to remain a matter for the patient and not for anyone else. At the moment, this is all very problematic in many areas, though there are some areas of excellence.

    GP's also need to work much more closely with specialist treatment centres, rely on their 'expert patients' to help develop their own skills and knowledge without expecting all of their HIV+ patients to be either willing or able to engage and finally, they need to be very aware of drug interactions and the impact of the side effects of antiretroviral medication.

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