March 2010 Overview of NAT and HIV Testing in the UK Deborah Jack, Chief Executive, NAT

A little bit about NAT (National AIDS Trust) The UK’s leading policy and campaigning charity on HIV with four strategic goals: Effective HIV prevention to halt the spread of HIV Early diagnosis through ethical, accessible and appropriate testing Equitable access to treatment, care and support for people living with HIV Eradication of HIV-related stigma and discrimination.

HIV in the UK – some basic facts There are over 85,000 people living with HIV in the UK % of people experience symptoms about 10 days after infection (sero-conversion) After this there are often no symptoms for many years Treatments and life-expectancy have improved enormously in last 10 years Without treatment people have worse health outcomes and are more likely to infect others.

HIV testing in the UK – some basic facts Over a quarter of HIV infection is undiagnosed Vast majority of HIV tests take place in sexual health or ante-natal clinics In 2008, 55% of people were diagnosed ‘late’ (after treatment should have started) Many people diagnosed late have had symptoms of HIV missed by healthcare professionals Testing technology has improved enormously.

Psychological & social impact Medical benefits HIV testing – the changing balance

Key barriers to HIV testing - for individuals HIV-related stigma Poor awareness of risk of infection Poor understanding of effectiveness of treatment Poor knowledge of where to get a test Fears over loss or breaches of confidentiality.

Barriers to HIV testing - for health professionals Lack of knowledge of HIV – resulting in lack of confidence Concerns about ‘making judgements’ Fear of having to give positive result Lack of incentives to test No formal agreed national target for HIV testing.

HIV testing – a timeline USAUK Routine ante natal testing Rapid testing in outreach Shift from pre-test ‘counselling’ to ‘discussion’ New national guidelines Annual test recommended for high risk groups The UK tends to follow the USA’s lead...

New UK national testing guidelines More widespread testing recommended High prevalence areas Specific healthcare settings Identified symptoms Lifestyle or risk group

Opt-in or opt-out testing? Opt-out Opt-in We normally test all patients for HIV. Tell me if you don’t want to be tested. If you’d like an HIV test, please tell me.

NAT’s Testing Action Plan 2009 – key themes Changing our testing ‘culture’ Reducing late diagnosis Diagnosing HIV ‘early’ Increasing testing outside traditional settings. Using latest testing technologies

NAT’s Testing Action Plan – key recommendations Implement agreed national testing guidelines Get consistent messages around HIV, testing and its benefits (& improve media coverage) Introduce regional and local targets on late diagnosis Make fourth generation assay tests the norm.

NAT’s Testing Action Plan – 10 key recommendations Ensure A&E doctors understand sero- conversion symptoms and train/incentivise GPs Educate ‘gatekeepers’ to these services Introduce HIV training for non-HIV specialists (in settings where HIV testing is recommended) Review/amend home testing regulations and pilot home sampling within NHS

Recent progress National prevention programmes influenced by NAT recommendations (primary infection, regular testing) Number of DH-funded pilots (including community testing and home sampling) Other funding allocated to testing initiatives (e.g. Gilead) NHS Direct agreed to change algorithms to respond to sero-conversion symptoms and progress made on ‘out of hours’ GP services Audit of labs conducted by HPA London has adopted a target to reduce late diagnosis.

Thank you! Deborah Jack See also ‘HIV Testing Action Plan’ - August 2009 ‘Home testing for HIV’ - September 2008 ‘Primary HIV Infection’ NAT - July

National AIDS Trust is a registered charity, number and a company limited by guarantee (registered in England and Wales) number Registered office: Target Winters Ltd, 29 Ludgate Hill, London EC4M 7JE © National AIDS Trust All rights reserved. No part of this publication may be copied or transmitted in any form or by any means without the National AIDS Trust's permission.