Only a minority of primary care trusts in England are following the national guidelines on HIV testing, despite many areas increasing the number of services on offer.
Guidelines endorsed by the National Institute of Clinical Excellence in 2011 recommend that sexual health commissioners extend their offer of testing for HIV beyond sexual health clinics and antenatal services if the prevalence is above an infection rate of two people in every 1000.
They state that there should be universal testing of all patients who register with a GP and new admissions to hospital, as well as outreach programmes targeted towards groups at a higher risk.
Investigators for online journal HIV Medicine found that only four primary care trusts (PCTs) had commissioned expanded testing services in all three areas.
The authors said: “The results of this audit confirm that routine HIV testing in these settings has been commissioned in only a minority of high-prevalence areas. Prioritizing the introduction of routine testing in these settings will be necessary to fully implement national testing guidelines.”
Overall, four out of the five areas that have a high HIV prevalence have expanded their testing, which in most cases was testing in the community (18 PCTs of the 35 that responded), which tended to be aimed at gay and bisexual men, and African groups.
11 of the PCTs offered testing when patients registered with a doctor, whilst only five provided screening for patients who were admitted to hospital, although in both cases there were a greater number who provided testing as an option in both settings.
Areas which had the highest rates of HIV prevalence – with over five people in every 1000 – were more likely to have commissioned extra testing, as were those based in London.
Almost all of the PCTs blamed a lack of resources for extending services, with two-thirds blaming NHS restructuring. However, all trusts expected the rate of testing to remain the same or increase over the next year.