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London hospitals first in the UK to offer HIV tests to A&E patients

08 June 2011

Two London hospitals are the first in the UK to offer routine HIV tests to A&E patients—this groundbreaking trial aims to save lives by reducing the number of cases of undiagnosed HIV.

Two London hospitals are the first in the UK to offer routine HIV tests to A&E patients—this groundbreaking trial aims to save lives by reducing the number of cases of undiagnosed HIV.

All patients aged 16–65 attending the A&E department at Chelsea and Westminster Hospital are being offered the 30-second test—more than 450 patients have been tested since the trial started earlier this year. Testing is due to start in the A&E department at St Mary’s Hospital, Paddington, on 20 June.

Currently the NHS routinely offers HIV tests only to pregnant women in antenatal clinics and patients in sexual health clinics.

The Health Protection Agency estimates that 86,500 people are living with HIV in the UK—26% of whom are unaware of their condition—and the number of people in London diagnosed with HIV acquired in the UK has doubled in the last 10 years.

In London 28,000 people are living with HIV and the virus is a particular threat in the gay community—one in 10 gay men in London has HIV, while one in seven gay men on the London gay scene has the virus.

National guidelines published in 2008 by the British HIV Association (BHIVA), British Association for Sexual Health and HIV (BASHH) and the British Infection Society (BIS) recommend extending routine HIV testing by offering an HIV test to all patients registering with a GP or being admitted to hospital in areas where the HIV rate is more than 2 in 1,000 of 15-59 year olds—Chelsea and Westminster and St Mary’s hospitals are in areas of London with some of the highest HIV rates in the country.

The new trial follows a pilot study at Chelsea and Westminster Hospital in 2009, funded by the Department of Health and the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Northwest London, during which more than 2,100 A&E patients had an HIV test—four new HIV diagnoses were made.

Dr Ann Sullivan, Consultant Physician at Chelsea and Westminster Hospital, says: “People whose HIV is undiagnosed are not only more likely to die from the virus but also infect other people while they are unaware of their condition. If diagnosed early, HIV can be successfully treated and people with HIV live to near-normal life expectancies. Successful treatment has also been shown to reduce the risk of HIV transmission.

“Our pilot study demonstrated that routine HIV tests in A&E not only detect undiagnosed cases but also are seen as acceptable by the vast majority of patients. The impact of routine HIV testing in antenatal clinics shows the potential benefits of extending routine tests to A&E. Since its introduction in 1999, 95% of pregnant women take the test and the proportion of newborn babies at risk of infection from HIV has decreased.”

A campaign known as ‘Halve It’, launched this year by a coalition of national experts, aims to reduce the current rate of undiagnosed HIV by 50% by 2015. It includes the All-Party Parliamentary Group on AIDS, the Royal College of GPs, Terrence Higgins Trust, BASHH and BHIVA—the campaign is funded and supported by BHIVA and Gilead Sciences which is funding the HIV testing in A&E project at Chelsea and Westminster and St Mary’s hospitals through its Fellowship Programme.

Former Health Secretary Lord Fowler is chairing an ad hoc committee of the House of Lords to review the success of efforts to prevent and treat HIV/AIDS in the UK and look at efforts to get people diagnosed early.

Sir Nick Partridge, Chief Executive of HIV and sexual health charity Terrence Higgins Trust, says: “We welcome anything which increases testing for HIV and offers it in a way that’s safe and reliable. Thousands of people are still undiagnosed in the UK and the later people are diagnosed the more likely they are to get seriously ill and pass the infection onto others, so it’s vital we encourage people to come forward for HIV tests.”

BASHH President Dr Keith Radcliffe adds: “Treatment costs are approximately double for people diagnosed with late HIV infection and early treatment dramatically reduces the risks of sexual transmission—so the public health benefits of routine HIV testing are clear for all to see. We hope that this initiative encourages all clinicians working in high prevalence areas across the country to recognise that increased HIV testing saves lives, is cost effective and reduces the burden of HIV on our society.”