London hospital says it will continue to offer HIV tests to all accident and emergency patients after trial

BMJ 2011; 342 doi: (Published 13 June 2011) Cite this as: BMJ 2011;342:d3705
  1. Caroline White
  1. 1London

A London hospital has begun offering bloodless HIV tests to every adult patient attending its accident and emergency department, in a bid to curb onward transmission of the infection in the capital, where rates are among the highest in the United Kingdom.

Figures from the Health Protection Agency, published at the end of last year, indicate that a quarter (26%) of the estimated 86 500 people infected with HIV in the UK are unaware that they are infected. By 2012 the number of diagnosed and undiagnosed cases in the UK is expected to reach 100 000.

Since the end of January Chelsea and Westminster Hospital has been routinely offering an HIV test to emergency care patients aged between 16 and 67 who are able to be tested. HIV tests are normally routinely offered in the NHS only to pregnant women in antenatal clinics and patients attending sexual health clinics.

Some 450 emergency care patients have taken the £5 saliva test, which takes less than a minute. At least one person has tested positive. Around 100 000 patients attend the hospital’s emergency care department each year.

London’s St Mary’s Hospital, which sees around 73 000 patients a year in its emergency department, is set to follow suit on 20 June, and Manchester Royal Infirmary began offering routine HIV blood tests in its medical admission units this week.

Both London hospitals are part of a trial looking at whether uptake is influenced by the healthcare professional who offers the test. At Chelsea and Westminster, where acceptance currently runs at 75%, all tests are offered by doctors; at St Mary’s nurses will offer the test.

A spokesman for Chelsea and Westminster Hospital said that it would continue routine testing once the trial funds had run out and that it planned to extend it to other high risk areas, such as acute oncology and medical admissions. Tuberculosis clinics were also being considered, he said.

The trial follows a pilot study at the hospital in 2009. During the pilot more than 2000 emergency care patients had an HIV test. Four new diagnoses were made, and two further cases were identified through contact tracing.

Ann Sullivan, a consultant physician at Chelsea and Westminster Hospital, told the BMJ: “That prevalence is about right for this area, which is about seven diagnosed cases per 1000 people. In order for this test to be cost effective we need to diagnose one per 1000.”

She added: “Infection rates among those not in high risk groups have been increasing. Two of the four newly diagnosed cases did not have typical risk factors, so they would have been missed.”

Figures from the Health Protection Agency show that in London, overall, 5.24 in every 1000 people had a diagnosed HIV infection in 2009. The number of people in London with HIV acquired in the UK has doubled in the past 10 years. Other UK hotspots include Brighton and Hove, with 7.57 per 1000 people, and Manchester, with 5.22 per 1000.

National guidelines published in 2008 by the British HIV Association, the British Association for Sexual Health and HIV, and the British Infection Society recommend extending routine HIV testing to all patients registering with a GP or being admitted to hospital in areas where the HIV rate is more than two in 1000 among 15-59 year olds.

Keith Radcliffe, president of the British Association for Sexual Health and HIV, said, “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.”

Deborah Jack, chief executive of the National AIDS Trust said, “With one in four people with HIV in the UK unaware of their infection and more than half diagnosed late, this is a serious health challenge that needs to be addressed. So the initiatives to increase testing are really positive steps.”


Cite this as: BMJ 2011;342:d3705