Low levels of HIV test coverage in clinical settings in the UK: a systematic review of adherence to 2008 guidelines

Title: Low levels of HIV test coverage in clinical settings in the UK: a systematic review of adherence to 2008 guidelines
Authors: Elmahdi, R
Gerver, SM
Guillen, GG
Fidler, S
Cooke, G
Ward, H
Item Type: Journal Article
Abstract: Objectives: To quantify the extent to which guideline recommendations for routine testing for HIV are adhered to outside of genitourinary medicine (GUM), sexual health (SH) and antenatal clinics. Methods: A systematic review of published data on testing levels following publication of 2008 guidelines was undertaken. Medline, Embase and conference abstracts were searched according to a predefined protocol. We included studies reporting the number of HIV tests administered in those eligible for guideline recommended testing. We excluded reports of testing in settings with established testing surveillance (GUM/SH and antenatal clinics). A random effects meta-analysis was carried out to summarise level of HIV testing across the studies identified. Results: Thirty studies were identified, most of which were retrospective studies or audits of testing practice. Results were heterogeneous. The overall pooled estimate of HIV test coverage was 27.2% (95% CI 22.4% to 32%). Test coverage was marginally higher in patients tested in settings where routine testing is recommended (29.5%) than in those with clinical indicator diseases (22.4%). Provider test offer was found to be lower (40.4%) than patient acceptance of testing (71.5%). Conclusions: Adherence to 2008 national guidelines for HIV testing in the UK is poor outside of GUM/SH and antenatal clinics. Low levels of provider test offer appear to be a major contributor to this. Failure to adhere to testing guidelines is likely to be contributing to late diagnosis with implications for poorer clinical outcomes and continued onwards transmission of HIV. Improved surveillance of HIV testing outside of specialist settings may be useful in increasing adherence testing guidelines.
Issue Date: 10-Jan-2014
Date of Acceptance: 8-Dec-2013
ISSN: 1368-4973
Publisher: BMJ Publishing Group
Start Page: 119
End Page: 124
Journal / Book Title: Sexually Transmitted Infections
Volume: 90
Issue: 2
Copyright Statement: © 2014 The Author(s). Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 3.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:
Sponsor/Funder: Medical Research Council (MRC)
Wellcome Trust
Funder's Grant Number: G0802431
Keywords: Science & Technology
Life Sciences & Biomedicine
Infectious Diseases
Delayed Diagnosis
Guideline Adherence
HIV Seropositivity
Mass Screening
Practice Guidelines as Topic
Retrospective Studies
United Kingdom
1103 Clinical Sciences
1117 Public Health And Health Services
1108 Medical Microbiology
Public Health
Publication Status: Published
Appears in Collections:Department of Medicine
Faculty of Medicine
Epidemiology, Public Health and Primary Care

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