Time to move towards opt-out testing for HIV in the UK

Hamill, Matthew M; Burgoine, Kathy; Farrell, Francis; Hemelaar, Joris; Patel, Gira B.; Welchew, David; Jaffe, Harold W.

doi:10.1136/bmj.39218.404201.94

Cited by 41 publications

(29 citation statements)

References 10 publications

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“…The same may hold for other countries in Europe and North America, where the median CD4 at start of ART is low [28]. In view of the marked differences in mortality when comparing late-presenting individuals to those presenting earlier, our results argue in favour of expanded HIV testing [29][30][31]. These arguments are complemented by our results, which demonstrate that in individuals with timely HIV diagnosis ART is initiated promptly before a further drop of CD4 T-cells.…”

Section: Discussionsupporting

confidence: 73%

Delayed diagnosis of HIV infection and late initiation of antiretroviral therapy in the Swiss HIV Cohort Study

Wolbers¹,

Bucher²,

Furrer³

et al. 2008

HIV Medicine

110

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Objectives To investigate delayed HIV diagnosis and late initiation of antiretroviral therapy (ART) in the Swiss HIV Cohort Study. Methods Two sub‐populations were included: 1915 patients with HIV diagnosis from 1998 to 2007 and within 3 months of cohort registration (group A), and 1730 treatment‐naïve patients with CD4≥200 cells/μL before their second cohort visit (group B). In group A, predictors for low initial CD4 cell counts were examined with a median regression. In group B, we studied predictors for CD4<200 cells/μL without ART despite cohort follow‐up. Results Median initial CD4 cell count in group A was 331 cells/μL; 31% and 10% were <200 and <50 cells/μL, respectively. Risk factors for low CD4 count were age and non‐White race. Homosexual transmission, intravenous drug use and living alone were protective. In group B, 30% initiated ART with CD4≥200 cells/μL; 18% and 2% dropped to CD4 <200 and <50 cells/μL without ART, respectively. Sub‐Saharan origin was associated with lower probability of CD4 <200 cells/μL without ART during follow‐up. Median CD4 count at ART initiation was 207 and 253 cells/μL in groups A and B, respectively. Conclusions CD4<200 cells/μL and, particularly, CD4<50 cells/μL before starting ART are predominantly caused by late presentation. Earlier HIV diagnosis is paramount.

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Section: Discussionsupporting

confidence: 73%

Delayed diagnosis of HIV infection and late initiation of antiretroviral therapy in the Swiss HIV Cohort Study

Wolbers¹,

Bucher²,

Furrer³

et al. 2008

HIV Medicine

110

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“…Specific benefits associated with rapid testing include immediate communication of test results (in standard tests between 25% and 33% of those tested do not return to receive their results), and advantages in immediate medical staff awareness of HIV status so as to limit the potential for HIV transmission during medical procedures (Kane, 1999;Branson, 2000a). Rapid tests modified to use oral fluid samples obviate the need for either venepuncture or finger prick blood analysis (Hamill et al, 2007). Oral fluid HIV tests offer additional advantages due to their non-invasive nature, can be performed anywhere, do not require specialist phlebotomy training or equipment, and reduce biohazardous risk (Delaney et al, 2006).…”

Section: Rapid Testing and Saliva Testingmentioning

confidence: 99%

“…Finally, prevention counselling should not be required with HIV diagnostic testing or as part of HIV screening programmes in healthcare settings . Although one-third of people with HIV infection in the UK remain undiagnosed, current UK guidelines recommend opt-out testing only for pregnant women and people attending genitourinary clinics (Hamill et al, 2007).…”

Section: Testing For Hivmentioning

confidence: 99%

Saliva Testing as a Practical Tool for Rapid HIV Screening

Blake¹,

Leighton²,

Sharma³

2011

HIV and AIDS - Updates on Biology, Immunology, Epidemiology and Treatment Strategies

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“…Previous work in antenatal clinics demonstrated a change in policy from a selective ''opt-in'' to a ''universal opt-out'' HIV test [13]. The provision of supporting information and training to healthcare professionals has led to an increase in the uptake of HIV testing [14].…”

mentioning

confidence: 99%

Universal HIV testing in London tuberculosis clinics: a cluster randomised controlled trial

Roy¹,

Anaraki

Hardelid

et al. 2012

Eur Respir J

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We assessed whether implementation of a combination of interventions in London tuberculosis clinics raised the levels of HIV test offers, acceptance and coverage.A stepped-wedge cluster randomised controlled trial was conducted across 24 clinics. Interventions were training of clinical staff and provision of tailor-made information resources with or without a change in clinic policy from selective to universal HIV testing. The primary outcome was HIV test acceptance amongst those offered a test, before and after the intervention; the secondary outcome was an offer of HIV testing. Additionally, the number and proportion of HIV tests among all clinic attendees (coverage) was assessed.1,315 patients were seen in 24 clinics. The offer and coverage of testing rose significantly in clinics without (p50.002 and p50.004, respectively) and with an existing policy of universal testing (p50.02 and p50.04, respectively). However, the level of HIV test acceptance did not increase in 18 clinics without routine universal testing (p50.76) or the six clinics with existing universal testing (p50.40).The intervention significantly increased the number of HIV tests offered and proportion of participants tested, although acceptance did not change significantly. However, the magnitude of increase is modest due to the high baseline coverage.

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Time to move towards opt-out testing for HIV in the UK

Abstract: M Hamill and colleagues believe the UK could do more to ensure people know their HIV status

Cited by 41 publications

References 10 publications

Delayed diagnosis of HIV infection and late initiation of antiretroviral therapy in the Swiss HIV Cohort Study

Delayed diagnosis of HIV infection and late initiation of antiretroviral therapy in the Swiss HIV Cohort Study

Saliva Testing as a Practical Tool for Rapid HIV Screening

Universal HIV testing in London tuberculosis clinics: a cluster randomised controlled trial

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