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Increasing the uptake of HIV testing in black African communities in England and among men who have sex with men

Increasing the uptake of HIV testing in black African communities in England and among men who have sex with men. Commissioning sexual health services . 2011. NICE public health guidance 33 and 34. What this presentation covers.

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Increasing the uptake of HIV testing in black African communities in England and among men who have sex with men

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  1. Increasing the uptake of HIV testing in black African communities in England and among men who have sex with men Commissioning sexual health services 2011 NICE public health guidance 33 and 34

  2. What this presentation covers • BackgroundScopeOverview of recommendations:commissioning sexual health servicesCosts and savings DiscussionFind out more

  3. Adding value • NICE recommendations: • are based on a systematic review of the evidence base • reinforce the approach within existing BHIVA and BASHH national guidelines • provide an opportunity to raise the issue of increasing access to HIV testing Early HIV testing reduces cases of onward transmission of the virus, saving costs in the long term

  4. Background • In 2009 an estimated 86,500 people in England were living with HIV • 26% of HIV positive men who have sex with men are unaware of their HIV status • More than 40% of new diagnoses among black Africans in the UK are late, which can lead to poorer outcomes • Late or non-diagnosis of HIV increases onward transmission of the virus

  5. Scope • Interventions to increase the uptake of HIV testing to reduce undiagnosed HIV infection among black African communities and among men who have sex with men living in England

  6. Key recommendations • Community engagement and involvement with black African communities • Planning services • Promoting HIV testing • Offering and recommending an HIV test • in specialist sexual health services • in primary and secondary care • Outreach: point-of-care tests (men who have sex with men) • Repeat testing for men who have sex with men • HIV referral pathways • Competencies and supporting core skills forHIV testing in general healthcare settings

  7. Community engagement and involvement: black African communities • Engage local community leads in planning, design and coordination of activities • Work with those running existing community activities to promote HIV testing and the benefits of early diagnosis and treatment • Recruit and train members of the local community as champions to encourage peers to take an HIV test

  8. Planning services: assessing need • Collect local HIV prevalence and incidence data for both black African communities and men who have sex with men and establish community compositions • Establish the concerns and needs regarding HIV testing within these populations • Collect HIV testing service information, including variations in accessibility and waiting times and collate client demographic information • Collect data on current HIV diagnoses, includinglate diagnoses

  9. Planning services: developing local strategy • Ensure a local strategy developed in consultation with relevant local communities encourages: • both groups to undergo HIV testing • professionals to offer and recommend HIV testing • Ensure HIV testing is available in a range of healthcare and community settings • Consider existing strategic frameworks, such as ‘Making it count’ (men who have sex with men)

  10. Promoting HIV testing in black African communities Develop tailored materials that: • explain infection and transmission, the benefits of HIV testing, and outline treatment availability • dispel misconceptions and emphasise early diagnosis as a route into treatment • detail how and where to access local testing services Promote HIV testing through work with community organisations and in community venues

  11. Promoting HIV testing among men who have sex with men Advertise or host interventions at relevant venues such as saunas or websites Run HIV health promotion in GP surgeries and in community locations such as bars Promote HIV testing during sexual health promotion Promotional materials about HIV testing should: - encourage annual tests - present it as empowering and a route into treatment - include availability of point-of-care testing - highlight the reduced ‘window period’ of 4th generation tests

  12. Offering HIV testing in sexual health services All men should be offered and recommended an HIV test Ideally, clinics should be able to offer both fourth generation and point-of-care testing Ensure practitioners are trained to: • routinely offer and recommend an HIV test • provide information on testing and why it is recommended • conduct post-test discussions • recognise symptoms that may signify primaryHIV infection or co-existing illnesses • assess knowledge and refer if necessary

  13. Black African communities: offering an HIV test

  14. Black African communities: HIV testing in primary and secondary care • In areas with a high prevalence of HIV – where diagnosed cases are over 2 in 1000 of the population - offer and recommend an HIV test: • when registering and admitting new patients (primary care and general medical admissions) • to anyone who has a blood test

  15. Men who have sex with men: HIV testing in primary care • Ensure annual HIV testing is part of integrated healthcare offered to men who are known to have sex with men

  16. Men who have sex with men: HIV testing in secondary care Offer and recommend HIV testing during hospital admittance for men who: • are admitted in areas with a high prevalence of HIV • disclose that they have sex with men • have symptoms that may indicate HIV, or HIV is part of the differential diagnosis

  17. Outreach: providing rapid point-of-care tests For men who have sex with men: • Offer tests at venues with high-risk sexual behaviour or in areas with high local prevalence of HIV • Offer rapid point-of-care tests to men who previously tested negative for HIV, or have never been tested • Provide men who don’t test with information on other local testing services • Ensure non-clinical practitioners are trained to test, assess knowledge and provide health promotion

  18. Repeat testing for men who have sex with men • Recommend: • annual testing to all • more frequent testing for those at high risk of exposure • repeat testing after the ‘window period’ for those who tested negative, but have possibly been exposed to the virus

  19. HIV referral pathways • For everyone: provide information on behavioural or health promotion interventions • Positive test: seen by an HIV specialist, preferably within 48 hours; given information about diagnosis and local support • Negative test: encourage repeat testing if at risk • Test declined: ensure they know how to access testing services

  20. Professional competencies Ensure staff feel able to routinely offer and recommend an HIV test. They should: • provide information on testing, discuss why it is recommended and emphasise confidentiality • be able to discuss symptoms, and the implications of a positive or a negative test • be familiar with referral pathways • recognise symptoms that may signify primaryHIV infection or co-existing illnesses

  21. Resources: supporting core skills for HIV testing Offering and recommending a HIV test should bewithin the existing competencies of health professionals. Resources that may help when applying these coreskills to HIV testing include: Tackling HIV Testing: increasing detection and diagnosis (MedFASH) HIV in primary care (MedFASH) • HIV for non-HIV specialists; diagnosing the undiagnosed (MedFASH)

  22. Costs and savingsper 100,000 population Increased costs of around £87k may be incurred through: an increased volume of testing; health promotion and outreach activities; treatment costs for cases of HIV diagnosed as a result of increased testing Savings can be made in year 1 through: earlier diagnosis of cases £3k per 100,000 onward transmission cases avoided £12k per 100,000Reducing onward transmission will lead to large costsavings that increase year on year

  23. Discussion • How can we ensure that community engagement is a key component of our strategic planning for HIV services? • How can we improve the information exchange about local HIV prevalence with primary and secondary care leads? • What CPD opportunities are there within local general healthcare where best practice on offering and recommending an HIV test could be incorporated?

  24. Find out more • Visit www.nice.org.uk/guidance/PH33 and www.nice.org.uk/guidance/PH34 for: • the guidance • the quick reference guides • costing report and template • slide set: primary and secondary care settings • self assessment tools • BMJ Learning module

  25. Feedback • Did this slide set meet your requirements, and will it help you to put the NICE guidance into practice? • We value your opinion and are looking for ways to improve our tools. Please complete thisshort evaluation form • This feedback survey can be accessed by right clicking your mouseover the hyperlink, and then selecting open hyperlink from the menu options

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