The catch for low prevalence areas is that HIV is less likely to be thought of as a cause for symptoms, and so HIV is more likely to be diagnosed at a late stage. This can be life-threatening. There is evidence for this here
to find out how your area is doing on late diagnosis of HIV. (Select the indicator HIV late diagnosis (%) (PHOF Indicator 3:04)
)What might a guideline HIV testing rate be for my area?
‘Aware’ practices in low prevalence areas, adopting a safety-first approach to patients with symptoms and with good use of risk assessment might have testing rates of 2-3/1000 registered patients per year.
You should certainly be concerned if you are not doing any HIV tests (excluding any testing for insurance reasons or antenatal testing). The differential diagnosis list for HIV is so broad; it will need to be excluded in at least some patients.If your testing rate is high:
• consider whether this is thanks to the whole team, or could be skewed by one or two individuals
• give positive feedback and congratulations where they are due!
If you think your testing rate might usefully be increased, then use the HIV TIPs assessments and resources to help change practice in your team.If you are re-auditing, and still find a low testing rate:
• consider re-use of some of the assessments and interventions on TIPs
• do you have new staff members, or staff who missed the training, who you should work with?As you consider what your practice might need to do to increase testing rates, think through the different kinds of HIV testing in turn:
• Diagnostic testing of those with symptoms
• Opportunistic testing of those found to be at risk
• HIV screening
• Patient request HIV tests
TIPs will help you address any possible area of weakness.
Even in a low prevalence area, there is possibility of protecting health – or even saving a life with HIV testing.Will you measure your practice HIV testing rate again in 3 months? Or 6 months? Set your reminder now!