HIV testing

• HIV testing can be undertaken by clinicians in any setting and is not a specialised test. 
• Testing requires informed consent but counselling is not needed.
• For opt-out BBV testing in Emergency Departments and in Antenatal clinics, routine testing is done without individual discussion – informed consent is provided through patient information posters supported by staff training. This has been widely implemented across the ED testing programme in England with over 7 million BBV tests performed (2 million individual HIV tests). 
• Guidance on the consent process and associated issues was produced by BHIVA/BASHH/BIA and RCEM in 2024
• Opt-out testing is defined in Europe as “consent based on pre-test information, provided by posters, information leaflets or videos, displayed in waiting rooms that HIV and/or blood-borne virus testing is included in routine blood testing or a medical intervention package, effectively given by allowing someone to draw blood from the arm but without prior specific discussions about which conditions are being tested for and without the requirement for explicit oral or written consent” 

 

Testing in HIV ICs 

• There is nothing apparent in the guidance above, or in GMC guidance, which precludes the application of a similar model to testing in specific conditions. It has been suggested that a similar approach to testing in ICs could be applied, but it is unlikely that any specific endorsement could be secured at national level. 
• Given the higher probability of a positive result in IC presentations (although the absolute risk in most cases remains low), it is recommended that verbal consent is gained, but this is simplified as much as possible by the use of digital/paper posters, patient information and publicity to support understanding of testing in certain conditions. 
• An extended discussion is NOT usually required. A suitable form of words might be ‘In people with this problem/condition, we routinely do an HIV test – is that OK?’
• Remember that even in the presence of an IC, the probability of a negative test result is much greater than a positive result.
• Agree on how the result will be provided. Many patients will be content with being advised that the service will only be in touch if they need to speak about the result, or with getting results through a standard (eg telephone) results service. Those who are more concerned may wish to be contacted with the result. 

HIV Informed is the source for HIV-related information for the Health and Social care workforce and gives a range of information including downloadable resources on HIV Testing in Scotland and short learning modules on stigma, living with HIV and PrEP/PEP. 

For clinicians offering HIV testing, TURAS Learn (requires a log in) has modules on Confident conversations to increase HIV testing and a module which specifically focusses on testing in Indicator Conditions: Recognition and Diagnosis of Human Immunodeficiency Virus (HIV), as well as learning on HIV Stigma.