New figures published in the journal HIV Medicine show that the proportion of HIV diagnoses made outside sexual health clinics (SHCs) has increased during the past decade, in line with evolving HIV testing guidelines.
The analysis of national HIV surveillance data shows that between 2005 and 2014, 63,599 adults were newly diagnosed with HIV infection in England, Wales and Northern Ireland. Most people were diagnosed in a SHC (69%), with the remainder being diagnosed in medical admissions/emergency departments (8.6%), general practice (6.4%), antenatal services (5.5%), out-patient services (3.6%), infectious disease units (2.7%) and other settings (4.0%).
The proportion of people diagnosed outside SHCs increased from 27% in 2005 to 32% in 2014. Among men who have sex with men, 14% of HIV diagnoses were made outside SHCs in 2005 compared with 21% in 2014. The proportions increased from 25% to 37% among black African men and from 39% to 52% in women (all trend P<.001).
Median CD4 was highest in patients diagnosed in SHCs and was lowest in those diagnosed during medical admissions or accident and emergency (A&E) attendance (94 cells/μL). “The continued appreciable number of people diagnosed in medical admissions/A&E with low CD4 counts at diagnosis represents evidence of missed opportunities for testing in particular,” the authors say.
They conclude that universal offer and recommendation of an HIV test in primary and secondary healthcare settings is feasible and effective in diagnosing persons who are not regular attendees at SHCs and those who do not feel they are at risk for HIV infection.
Future research will explore the effect of the 2016/2017 UK HIV testing guidelines and determine the contribution of community testing, self-testing and self-sampling strategies.