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.
HIV testing – the
changing balance
Psychological &
social impact
Medical benefits
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
The UK tends to follow the USA’s lead ...
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
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-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 seroconversion 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
deborah.jack@nat.org.uk
See also
‘HIV Testing Action Plan’ - August 2009
‘Home testing for HIV’ - September 2008
‘Primary HIV Infection’ NAT - July 2008
www.nat.org.uk
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.