29 Jun 07

Routine opt-out HIV testing is needed in GP surgeries, accident and emergency departments and hospital wards, says an article in this week's British Medical Journal by a group of HIV researchers including Professor Harold Jaffe from Oxford's Department of Public Health and five medical students from Oxford University.

One third of people in the UK with HIV do not know they have the virus, but UK guidelines recommend opt-out testing only for pregnant women and people attending genitourinary (GUM) clinics.

The authors of the article argue that routine opt-out testing would not only give a more accurate picture of how many people have HIV, but would cut infection rates, lessen the stigma surrounding testing and reduce the number of people being diagnosed in the later stages of HIV.

Opt-out testing is an approach in which all patients within a certain age range would be routinely offered HIV testing, with testing carried out unless the patient specifically declines.

The authors point to the USA, where guidelines from the Centres for Disease Control and Prevention now recommend opt-out testing as the standard of care for people aged 13-64 years unless the prevalence of HIV is less than 0.1 per cent of the population.

'Programmes for routine screening have been instituted in emergency departments and urgent care centres at several US hospitals and yielded relatively high rates of previously undiagnosed HIV infection,' they say.

About 20,000 UK residents between the ages of 15 and 59 were living with undiagnosed HIV infection in 2005. Surveys of gay men attending GUM clinics in the same year showed the prevalence of undiagnosed HIV among that group was 3.2 per cent. In women of childbearing age that prevalence was much lower (0.09 per cent), but was highest in women from sub-Saharan Africa (2.4 per cent).

The authors call for surveys to be carried out in patient populations of known increased HIV prevalence and in facilities that are known to serve people at increased risk of infection. This would provide the necessary data to inform a discussion of expanding opt-out HIV testing.

'In view of the clear advantages of early diagnosis of HIV infection for public and individual health, we believe the effectiveness and feasibility of expanded opt-out testing should be seriously assessed,' says Professor Jaffe.

The article is by Professor Harold Jaffe of Oxford's Department of Public Health, Matthew Hamill, a GUM specialist at the Camden Primary Care Trust, London, and five students in their fifth year of a medical degree at Oxford University. The students examined the issue during their public health rotation on their course. Prof Jaffe says: 'I'm particularly pleased by the interest shown by Oxford medical students in this important public health topic.'