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Low levels of HIV test coverage in clinical settings in the UK: a systematic review of adherence to 2008 guidelines
  1. Rahma Elmahdi1,
  2. Sarah M Gerver1,
  3. Gabriela Gomez Guillen2,
  4. Sarah Fidler3,
  5. Graham Cooke3,
  6. Helen Ward1
  1. 1Department of Infectious Disease Epidemiology, Imperial College London, London, UK
  2. 2Department of Global Health, Academic Medical Center, University of Amsterdam and Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
  3. 3Department of Communicable Diseases, Department of Medicine, Imperial College London, London, UK
  1. Correspondence to Professor Helen Ward, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK; h.ward{at}imperial.ac.uk

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.

  • HIV TESTING
  • HIV
  • DIAGNOSIS

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