HIV testing

Question 1

In 2018, what proportion of the 103,800 people living with HIV in the UK were diagnosed?

Answer 1

93%

Question 2

Of those diagnosed with HIV how many are on ART?

Answer 2

97%

Question 3

What proportion of people with a HIV viral load result are undetectable?

Answer 3

97%

Question 4

What prevalence of undiagnosed HIV is considered cost-effective for HIV screening?

Answer 4

1 in 1000 (0.1%)

Question 5

What is the estimated prevalence of undiagnosed HIV in England? Is universal population screening indicated?

Answer 5

0.016%; therefore universal testing not supported

Question 6

People belonging to which groups at increased risk of exposure to HIV (10)?

Answer 6

MSM
Female sexual contacts of MSM
Black Africans
IVDU (past or present)
Sex workers
Prisoners
Trans women
People from a country with high (>1%) DIAGNOSED seroprevalence
Sexual contact from high seroprevalence country
Person whose mother living with HIV

Question 7

In which healthcare settings should HIV opt-out testing be offered (5)?

Answer 7

Sexual health services
Addiction and substance misuse services
Antenatal services
Termination of pregnancy services
Hepatitis B and C, TB and lymphoma services

Question 8

What is the UK prevalence of UNDIAGNOSED HIV in MSM, Black African men and women AND PWID?

Answer 8

MSM 0.68% (6 in 1000)
Black African 0.71 (7 in 1000)
PWID 0.089%

Question 9

Is the undiagnosed prevalence threshold for testing in pregnancy the same as general population?

Answer 9

No, lower
0.0075%
cost-effective

Question 10

How are indicator conditions of HIV categorised?

Answer 10

AIDS defining
or
Non-AIDS defining associated with an undiagnosed IV seroprevalence >1 in 1000

Question 11

Who should have an annual HIV test at minimum?

Answer 11

PWID
sex workers
Sexually active MSM

Question 12

What factors suggest 3 monthly HIV testing for MSM?

Answer 12

Condomless anal sex
Multiple or anonymous sexual partners
> 10 sexual partners in 12 months
Drug use during sex (Grade 1B evidence for meth and poppers)

Question 13

What is the sensitivity and specificity of blood-based self-tests approved in Europe?

Answer 13

> 99%`

Question 14

What generation assay is used for the self-test for HIV?

Answer 14

Second or Third gen

Question 15

Which groups of people may benefit from HIV self-testing?

Answer 15

High prevalence of HIV
Vulnerable populations less likely to access testing
People who test frequently due to ongoing risk

Question 16

What is the benefit of dried blood spot samples over mini tube samples for self-sampling HIV tests?

Answer 16

Better processing rates; 98.8% vs 55.7%; mini-tubs limited by inadequate blood volume

Question 17

What is the window period (99th percentile estimate) for 4th generation HIV serology?

Answer 17

45 days

Question 18

What is the window period (99th percentile estimate) for 3rd generation HIV serology?

Answer 18

60 days

Question 19

What is the window period (99th percentile estimate) for all POCTs for HIV?

Answer 19

90 days

Question 20

Which type of test for HIV should be first line/gold standard?

Answer 20

4th generation venous sampling

Question 21

How might PEP, PrEP or early ART affect the HIV test serology?

Answer 21

Blunt the HIV antibody response

Non-reactive, atypical or non-progressive

Question 22

What are the structural, policy, legal and organisational Barriers to testing HIV?

Answer 22

Access to services
Testing environment
Service capacity
Cost

Question 23

What are Barriers to testing HIV at the healthcare provider level?

Answer 23

Clinicians may lack relevant knowledge/skills
Non-HIV specialist
Lack of relevant communication skills/ability to undertake risk assessment
Lack of skill to use rapid POCT

Question 24

What are Barriers to testing HIV at the individual level?

Answer 24

Lack of awareness or perception of being low risk of IV

Fear of a positive result