Template documents
Slide sets
Permission to use pack materials
Evaluation form

Notes on the template documents

A Protocol for HIV testing of adults outside the HIV specialist setting (Word, Pdf)
Intended for use by clinicians, this provides standardised guidance on when HIV testing is indicated, how to perform the test and how to give the result.

B Essential elements of the pre-test discussion (Word, Pdf)
This is a handy aide-memoire that summarises the essential points to cover in a pre-test discussion and can be put up in consulting rooms for staff to check.

C Useful contacts sheet for help with HIV testing (Word, Pdf)
A summary sheet for staff to complete with the contact details of the HIV team and others who can offer advice and assistance with HIV testing.

D Frequently asked questions about HIV testing (Word, Pdf)
A set of answers to questions that patients often ask about HIV testing. It can be used by staff as a 'crib sheet' and also given to the patient as it stands to take away. It contains a fill-in section for useful contact telephone numbers.

E Patient information about testing for blood-borne viruses (BBVs) (Word, Pdf)
This paragraph can be inserted into existing patient information leaflets about routine tests performed in outpatient departments. It covers testing for hepatitis B and C as well as HIV.

F HIV testing poster for use in patient waiting areas (Word, Pdf)
To normalise HIV testing among patients it is important that it is seen as routine and unexceptional. This poster advises patients that HIV testing is a routine investigation in the department and asks them to discuss any concerns they may have with staff.

G Letter to medical director (Word, Pdf)
HIV leads, or other 'HIV champions' might like to consider taking up the issue of routine HIV testing with the medical director. This document is a prepared version of a letter giving a summary of the evidence and asking for help with developing a hospital-wide policy on HIV testing.

Notes on the slide sets

Sets A-D Information on HIV testing
Set A Introduction to the UK national guidelines for HIV testing 2008
Set B The case for increasing HIV testing in all medical settings
Set C Barriers to HIV testing outside the HIV-specialist setting
Set D Key messages, acknowledgements and generic slides

Cases 1-13 Case study presentations illustrating missed opportunities to diagnose HIV infection
These cases have been contributed by leading specialists in their fields and are all composites of patients they have seen. Care has been taken to anonymise the cases to ensure that patients cannot be identified. Contributors are not identified in the individual cases to remove the possibility of identification by location, but all those who contributed are listed in the acknowledgements section of this pack. Any resemblance to persons living or dead is therefore entirely coincidental and no inference should be made about the HIV status of any individual, living or dead, from the case studies.

Case 1 Gastroenterology, Respiratory Medicine
Concerns a patient apparently at low risk of HIV infection who had presented to various healthcare settings with clinical indicators of HIV infection over an eight-year period and who was diagnosed with an AIDS-defining condition. It highlights the expense of late HIV diagnosis to the healthcare system. Useful for those in General and Acute Medicine working in Emergency and Admissions Teams.

Case 2 Dermatology, Gastroenterology, Hepatology, ENT, Oncology
Concerns a patient apparently at low risk of HIV infection who was referred to several outpatient settings with clinical indicators of HIV infection over a five-year period and who was diagnosed with an AIDS-defining condition.

Case 3 Gastroenterology, Infectious Diseases, Respiratory Medicine
Concerns a patient who was apparently considered 'low risk' for HIV for much of her medical history and whose very late diagnosis resulted in death. Useful for those in General and Acute Medicine working in Emergency and Admissions Teams.

Case 4 Emergency Medicine (primary HIV infection with onward transmission)
Involves two patients presenting to the same Emergency Department with probable primary HIV infection (PHI) where it was not recognised and who were later found to be linked as sexual partners. Highlights the potential for onward transmission of HIV during PHI.

Case 5 Dermatology, Gynaecology
Concerns a patient who was referred to several outpatient settings and was diagnosed with an AIDS-defining condition. Illustrates the importance of routine HIV testing in any healthcare setting for people from groups at higher risk of HIV infection in PCTs of high local HIV prevalence.

Case 6 Gastroenterology, Haematology
Concerns a patient apparently at low risk of HIV infection who was referred to two outpatient settings over a year. He was diagnosed with HIV before any serious opportunistic infections had set in, but still late with a CD4 count of under 200. This case illustrates how stigma can prevent patients from disclosing risk factors for HIV.

Case 7 Respiratory Medicine
Concerns a patient apparently at low risk of HIV infection who was referred to two outpatient settings over a year. She was diagnosed with HIV before any serious opportunistic infections had set in, but still late with a CD4 cell count of under 200. This case illustrates how stigma can prevent patients from disclosing risk factors for HIV.

Case 8 Infectious Diseases, General Medicine
Concerns a patient who was diagnosed with HIV in General Practice at a late stage of infection, having been admitted with several clinical indicators of HIV infection two years previously. It illustrates the importance of routine HIV testing in any healthcare setting for people from groups at higher risk of HIV infection and also for patients registering with General Practice in PCTs of high local HIV prevalence.

Case 9 Respiratory Medicine, Gastroenterology
Concerns a patient from a group at high risk of HIV infection living in a PCT of high local HIV prevalence who was investigated for malignancy, having been seen for respiratory problems five years earlier. She was diagnosed with an AIDS-defining condition. It illustrates how 'straight-to-test' protocols for malignancy may delay consideration of HIV as an alternative explanation for gastroenterological problems.

Case 10 Dermatology, Gastroenterology, Respiratory Medicine
Concerns a patient apparently at low risk of HIV infection who had presented with several clinical indicators of HIV infection over a three-year period. He did not disclose behavioural risk factors for HIV on routine questioning. The case illustrates how stigma can prevent patients from disclosing risk factors for HIV. It also highlights how late HIV diagnosis causes emotional stress to patients and financial stress to the healthcare system.

Case 11 General and Emergency Medicine
Also useful for specialists in Haematology, Neurology and Ophthalmology, this case concerns a patient from a group at high risk of HIV infection who went undiagnosed despite numerous contacts with medical services over a 6 year period, presenting with conditions that were clearly HIV-related. He presented with an AIDS-defining condition and died before being discharged.

Case 12 Respiratory Medicine, Dermatology
Concerns a patient apparently at low risk of HIV infection who was admitted following presentation to the Emergency Department and was also seen in Respiratory Outpatient Department with clinical indicators of HIV infection. She was later seen in Dermatology Outpatient Department with a cryptic presentation where the previous pattern was spotted and the HIV test performed.

Case 13 General and Emergency Medicine
This case is particularly useful for General and Acute Medicine, and Emergency and Admissions Teams. It concerns a patient who appeared to be at low-risk of HIV infection and who lived in a high prevalence PCT. He went undiagnosed despite numerous contacts with medical services over a 7 year period, presenting with conditions that were clearly HIV-related. He presented with an AIDS-defining condition and died before being discharged. It illustrates how stigma can prevent patients from disclosing risk factors for HIV.

The templates and slide sets in this pack are copyright MedFASH 2009 but may be freely reproduced for the purpose of ensuring quality of care.

Comments about this resource pack are welcome and will inform any updated versions of the resources. You can download the evaluation form by clicking here. If you use the materials please complete the form and send it to MedFASH at the following address:

Medical Foundation for AIDS & Sexual Health
BMA House
Tavistock Square
London WC1H 9JP
United Kingdom

Alternatively, you can complete it electronically and email it to enquiries@medfash.bma.org.uk