March 2010 Overview of NAT and HIV Testing in the UK Deborah Jack, Chief Executive, NAT.
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March 2010 Overview of NAT and HIV Testing in the UK Deborah Jack, Chief Executive, NAT
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Transcript of March 2010 Overview of NAT and HIV Testing in the UK Deborah Jack, Chief Executive, NAT.
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
70 - 90% 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
USA UK
Routine ante natal testing 1995 1998
Rapid testing in outreach 2003 2006
Shift from pre-test ‘counselling’ to ‘discussion’
2003 2008
New national guidelines 2006 2008
Annual test recommended for high risk groups
2006 2009
The UK tends to follow the USA’s lead ...
New UK national testing guidelines - 2008
More widespread testing recommended
High prevalence areas
Specific healthcare settings
Identified symptoms
Lifestyle or risk group
Opt-in or opt-out testing?
Opt-outOpt-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 2008
www.nat.org.uk
National AIDS Trust is a registered charity, number 2972977 and a company limited by guarantee (registered in England and Wales) number 2175938.Registered office: Target Winters Ltd, 29 Ludgate Hill, London EC4M 7JE
© National AIDS Trust 2010. 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.
www.nat.org.uk
