HIV is a key public health issue in the UK. Currently, two in five people diagnosed with HIV are diagnosed late, and one in six people living with HIV are unaware of their infection. Late diagnosis carries significant consequences, with those diagnosed late facing poorer health outcomes and increased risk of death. In fact, those diagnosed late carry a ten-fold increased risk of death in the year after diagnosis compared to those diagnosed earlier. Importantly, by diagnosing people earlier, not only can we can improve health outcomes, we can also help reduce onward transmission. Nowadays, HIV can be managed almost like any other long-term condition, and with early diagnosis and prompt treatment, people living with HIV can lead normal lives.
With one simple blood test, we can make all the difference
Late stage HIV is often picked up in secondary or emergency care settings, and often at the point where the individual’s health status has significantly deteriorated. However, retrospective mapping shows that those diagnosed late have often presented to primary care in the years running up to diagnosis with HIV-related signs or symptoms. This means that crucial opportunities to diagnose HIV in primary care are not only being missed, but that in our role as GPs we have a real opportunity to help reduce the rate of late diagnosed HIV, improve health outcomes, and tackle this important public health issue.
GPs often worry about a patient’s reaction to being offered a test. But in reality most patients are happy to be offered an HIV test in primary care. HIV testing is also relatively straight forward and shouldn’t take up much time. There’s no need to take a sexual history or to conduct any lengthy pre-test counselling – verbal consent is all that is required (as with any other diagnostic test).
By raising awareness of HIV, and routinely including an HIV test when investigating people with signs or symptoms that may be associated with HIV infection (such as shingles, oral thrush, persistent diarrhoea, weight loss, or glandular fever-like symptoms) we can diagnose more HIV in primary care, and ultimately save lives.
We’re currently piloting this new approach to HIV testing across NHS Southwark CCG, using a suite of behaviour change materials developed by GPs, for GPs. The aim is to reduce the rate of late diagnosis in the borough, through raising awareness of the signs and symptoms of HIV and empowering GPs to include HIV testing as part of their differential diagnoses when consulting with patients. The approach has been positively received by our GPs so far, and we aim to recruit more localities to adopt the approach in 2017.
There’s no doubt about the role we can play as GPs in tackling the issue of late diagnosed HIV through more frequent testing as part of our routine consultations. With one simple blood test, we can make all the difference. So I am urging you all to consider HIV when you are unsure of a diagnosis and to include an HIV test more often when you are arranging blood tests. Together we can make a real difference so, don’t think twice, think test.
For more information about HIV testing in primary care and to watch the #ChangeTheFaceOfHIV film, click here.
Dr Jonty Heaversedge is chair of Southwark CCG and a GP in South East London. He is also a member of the HIV Awareness in Primary Care. For more information about the Southwark pilot or to access the materials being piloted, you can email him here.
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