Barriers to testing for Human Immunodeficiency Virus infection in the United Kingdom

Abstract

In recent years there has been an increased focus on biomedical interventions as a means of Human immunodeficiency Virus (HIV) prevention and the use of antiretroviral therapy (ART) has been a particularly successful tool in prevention efforts, with evidence for treatment in reducing HIV transmission. This is dependent on several factors including the early identification of those infected with HIV. In this thesis I will explore current challenges to testing for HIV in the UK by systematically reviewing current national levels of testing and investigating demographic characteristics associated with timing of diagnosis, testing practices and routes to diagnosis among those recently diagnosed with HIV in West London in order to identify barriers to increased and repeat testing for HIV in the UK. My findings show that guideline recommended testing levels are poor in most clinical settings and this is reflected in overall low HIV test coverage in the UK. HIV diagnosis at an earlier point in infection remains significantly associated with men who have sex with men (MSM) and White ethnicity and both patient and provider barriers act as ongoing challenges in earlier identification of HIV in all groups. Current testing practices are not enough to achieve equitable access to early diagnosis for HIV. Testing practices of clinicians, along with system challenges play an important role in HIV testing and changing these may be the most effective method of increasing earlier identification of HIV positive individuals in the UK.