UK News

Doctors against HIV testing in A&E

The British HIV Association (BHIVA) conference in October hosted a fascinating debate about the pros and cons of HIV testing in Accident and Emergency (A&E) departments.

Dr Duncan Churchill, of the Royal Sussex County Hospital in Brighton, said that a third of the estimated 65,000 plus people with HIV in the UK are undiagnosed and don’t know they have the disease. People diagnosed late (‘late presenters’) have 10 times more chance of early death than those diagnosed early enough for treatments to be effective.

The experience of antenatal HIV testing of nearly all pregnant mothers in Britain showed that ‘opt out’ testing clearly works, he said. This has meant that the number of babies now born with the disease in this country has gone down to just a few each year.

But we need to test men at risk of the disease, both straight and gay, who do not come forward for testing and are reluctant to access health services.

A significant majority of people who come to GUM departments for testing or treatment for other sexually transmitted infections (STIs) leave the clinic without receiving HIV testing.

And GPs don’t want to do HIV testing because they argue they are not paid to do it and they say they don’t have the time or facilities.
‘Opt out’ testing would, “change the culture of HIV testing” in the UK, he said.

The cost of each HIV test in A&E would be as low as £3, Dr Churchill said, making it extremely cost effective.

Lisa Power, head of policy at the Terrence Higgins Trust, said that THT was in favour of targeted testing rather than blanket testing.
There are very limited resources in the NHS and there was also very little evidence that opt out testing in A&E was cost effective or practical.

HIV prevalence is much higher in London than the rest of the country, she said, and there should be intensive and targeted community HIV testing aimed at high risk groups, such as gay men and Africans.

Even at £3 a test, the cost of HIV testing in A&E could be more than £44 million each year at least and the money could be better spent testing elsewhere.

“Waiting for HIV test results is a considerable strain for the patient,” Power said: “There is a serious lack of understanding and prejudice against HIV in the rest of the medical profession.”

There would also be serious problems of confidentiality and follow up at A&E and the money would be better spent educating all medical staff about HIV.

Dr Churchill retorted that each new HIV infection costs as much as half a million pounds in NHS costs during the life time of the patient and HIV testing in A&E would save a lot of money in the long run.
At the end of the debate there was a vote amongst the 600 BHIVA delegates and there was a majority against the motion advocating routing HIV testing in A&E.