PT - JOURNAL ARTICLE AU - Rahma Elmahdi AU - Sarah M Gerver AU - Gabriela Gomez Guillen AU - Sarah Fidler AU - Graham Cooke AU - Helen Ward TI - Low levels of HIV test coverage in clinical settings in the UK: a systematic review of adherence to 2008 guidelines AID - 10.1136/sextrans-2013-051312 DP - 2014 Mar 01 TA - Sexually Transmitted Infections PG - 119--124 VI - 90 IP - 2 4099 - http://sti.bmj.com/content/90/2/119.short 4100 - http://sti.bmj.com/content/90/2/119.full SO - Sex Transm Infect2014 Mar 01; 90 AB - 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.