National HIV Testing Guidelines Research Articles

Improving detection of undiagnosed HIV through routine screening in a central London emergency department

HIV is a global public health issue. Routine testing for HIV should be performed on all 16–59 years old attending emergency departments (EDs) in high-prevalence areas in the UK.In August...

High HIV prevalence among decedents received by two high-volume mortuaries in Kisumu, western Kenya, 2019.

BackgroundAccurate data on HIV-related mortality are necessary to evaluate the impact of HIV interventions. In low- and middle-income countries (LMIC), mortality data obtained through civil registration are often of poor quality. Though not commonly conducted, mortuary surveillance is a potential complementary source of data on HIV-associated mortality.MethodsDuring April-July 2019, we assessed HIV prevalence, the attributable fraction among the exposed, and the population attributable fraction among decedents received by two high-volume mortuaries in Kisumu County, Kenya, where HIV prevalence in the adult population was estimated at 18% in 2019 with high ART coverage (76%). Stillbirths were excluded. The two mortuaries receive 70% of deaths notified to the Kisumu East civil death registry; this registry captures 45% of deaths notified in Kisumu County. We conducted hospital chart reviews to determine the HIV status of decedents. Decedents without documented HIV status, including those dead on arrival, were tested using HIV antibody tests or polymerase chain reaction (PCR) consistent with national HIV testing guidelines. Decedents aged less than 15 years were defined as children. We estimated annual county deaths by applying weights that incorporated the study period, coverage of deaths, and mortality rates observed in the study.ResultsThe two mortuaries received a total of 1,004 decedents during the study period, of which 95.1% (955/1004) were available for study; 89.1% (851/955) of available decedents were enrolled of whom 99.4% (846/851) had their HIV status available from medical records and post-mortem testing. The overall population-based, age- and sex-adjusted mortality rate was 12.4 per 1,000 population. The unadjusted HIV prevalence among decedents was 28.5% (95% confidence interval (CI): 25.5–31.6). The age- and sex-adjusted mortality rate in the HIV-infected population (40.7/1000 population) was four times higher than in the HIV-uninfected population (10.2/1000 population). Overall, the attributable fraction among the HIV-exposed was 0.71 (95% CI: 0.66–0.76) while the HIV population attributable fraction was 0.17 (95% CI: 0.14–0.20). In children the attributable fraction among the exposed and population attributable fraction were 0.92 (95% CI: 0.89–0.94) and 0.11 (95% CI: 0.08–0.15), respectively.ConclusionsOver one quarter (28.5%) of decedents received by high-volume mortuaries in western Kenya were HIV-positive; overall, HIV was considered the cause of death in 17% of the population (19% of adults and 11% of children). Despite substantial scale-up of HIV services, HIV disease remains a leading cause of death in western Kenya. Despite progress, increased efforts remain necessary to prevent and treat HIV infection and disease.

From research to international scale-up: stakeholder engagement essential in successful design, evaluation and implementation of paediatric HIV testing intervention.

Stakeholder engagement between researchers, policymakers and practitioners is critical for the successful translation of research into policy and practice. The Counseling and Testing for Children at Home (CATCH) study evaluated a paediatric index case testing model, targeting the children of HIV-infected adults in care in Kenya. Researchers collaborated with stakeholders in the planning, execution and evaluation, and dissemination phases of CATCH. They included a community advisory board, the national HIV programme, County health departments, institutional ethics review bodies, a paediatric bioethics group, facility heads and frontline healthcare workers . Stakeholder analysis considered the power and interest of each stakeholder in the study. All stakeholders had some power to influence the success of the project in the different phases. However, support from institutions with higher hierarchical power increased acceptance of the study by stakeholders lower in the hierarchy. During the planning, execution and evaluation, and dissemination phases, the study benefitted from deliberate stakeholder engagement. Through engagement, changes were made in the approach to recruitment to ensure high external validity, placing recruitment optimally within existing clinic flow patterns. Choices in staffing home visits were made to include the appropriate cadre of staff. Adaptations were made to the consenting process that balanced the child's evolving autonomy and risks of HIV disclosure. Dissemination involved delivering site-specific results in each HIV clinic, local and international conferences and sharing of study tools, resulting in the study approach being scaled up nationally. The deliberate engagement of stakeholders early in intervention development optimized study validity and accelerated adoption of the CATCH approach in nationwide HIV testing campaigns by the Ministry of Health and inclusion of paediatric index-case testing in national HIV testing guidelines. Involving policymakers and frontline healthcare workers throughout the study cycle builds capacity in the implementing team for quick adoption and scale-up of the evidence-based practice.

A decade on from the publication of the British HIV Association's National HIV Testing Guidelines: are opportunities to increase the uptake of HIV testing still being missed?

Background: Guidelines recommend HIV testing in indicator conditions in which the prevalence of undiagnosed HIV exceeds 0.1%. We assessed adherence to national recommendations on HIV testing within the acute medical unit in NHS Fife. Secondly, we performed a look-back exercise to identify missed opportunities for HIV diagnosis in individuals who presented at a late stage of infection. Methods: Data were collected on admissions over a 24-hour-period during four consecutive weeks in 2018. Case records were reviewed and diagnoses were screened against a list of indicators. Additionally, data were obtained from HPS on late HIV diagnoses within NHS Fife from 2013-2018. Records were interrogated for presentations to healthcare services within the 5 years prior to HIV diagnosis. Results: In total, 226 patients were admitted during the study period. All patients were white, with median age 68yrs. 101 indicator conditions were identified, relating to 83 patients (36.7%). Bacterial pneumonia was the most frequently identified indicator (n=40). Only 3 patients were offered HIV testing (3.6%). From 2013-2018, 23 patients were diagnosed with HIV at late stage. The median age at diagnosis was 41yrs and the median CD4 count was 161 cells/mm3. Fifteen patients (65.2%) had presented to hospital in the 5 years preceding diagnosis with an indicator. The most frequently missed indicator was chronic diarrhoea (n=6). Three patients (13%) have died since diagnosis. Conclusions: * Opportunities to increase uptake of HIV testing among people who may have undiagnosed HIV are being missed * Further educational initiatives and review of local HIV testing protocols are indicated

Profile of Clients of HIV Testing and Counseling in a Tertiary Care Center and Need of Testing in Tuberculosis

Introduction: Sexually transmitted infection is public health issue that amplifies HIV burden globally. At National Center of AIDS and STD Control, annual reported STI are rising steeply recently. Incidence of HIV is 0.03% while prevalence in adult population is less than 1%. National HIV testing guidelines 2017 recommends HIV tests should be performed in tuberculosis and medical conditions. However, it is not routinely done in Nepal.
 Objective: To assess profile of STI and HIV among patients attending HIV testing and counseling center of tertiary hospital, and to assess fraction of tuberculosis patients undergoing HIV testing.
 Materials and Methods: All patients attending HIV testing and counseling center were tested for HIV. Tests for STI were done based on patient symptoms. Data collected were analyzed with SPSS.
 Results: Suspected STI (41.1%) was commonest cause of HIV testing. Among STI, gram positive diplococcic were noted in 11.5% and 3.4% had PCR positive Chlamydia. Only 19.4% (7 out of 36) of total tuberculosis patients in hospital were screened for HIV, among which, 57.14% (4 out of 7) were seropositive for HIV, which is noteworthy.
 Conclusion: Our study shows patterns of STI, and that gonorrhea and chlamydia could be underdiagnosed in Nepal. Every patient with tuberculosis should routinely be screened for HIV. But only small fraction of tuberculosis patients underwent HIV screening, out of which HIV positivity was high, reflecting the gap and need for routine HIV screening in TB patients.

HIV testing in persons diagnosed with hepatitis B and C

In the UK, an estimated 101 200 people are living with HIV, 13% of whom are unaware of their infection 1. The first national guidelines for HIV testing published in 2008 recommended the universal offer of an HIV test in health care services for persons diagnosed with hepatitis B and C 2. The latest National Institute for Health and Care Excellence (NICE) testing guidelines (released in December 2016) continue to recommend offering HIV tests to people with HIV indicator conditions, which include hepatitis B and hepatitis C, and in services treating people for hepatitis B and hepatitis C 3. Using the Sentinel Surveillance of Blood Borne Virus Testing (SSBBV), linked to the national HIV and AIDS Reporting System (HARS), we investigated the extent to which the guidelines are being followed. HIV testing information was extracted from the SSBBV for all adults (≥ 15 years old) with a first positive test between 2010 and 2014 for hepatitis C virus (HCV) antibodies, indicative of being ever infected, or for hepatitis B virus (HBV) surface antigen. Persons tested within the SSBBV were matched, using deterministic and probabilistic methodologies, to the HARS, and persons identified as diagnosed with HIV infection prior to their hepatitis diagnosis were excluded. Persons testing HBV positive in antenatal services were also excluded, as women are routinely tested for HIV and HBV as part of the antenatal screening programme. Among persons who tested positive for HCV (32 114), 38.7% (12 429) were tested for HIV on the same day as their HCV test, 6.7% (2158) were tested in the following 6 months, and 54.6% (17 527) had no record of an HIV test during the 6-month period following their positive HCV test (Table 1). Among persons who tested positive for HBV (16 086), the corresponding figures were 34.8% (5593), 10.7% (1722) and 54.5% (8771). In persons who were HCV positive, HIV testing was less likely in older persons [adjusted odds ratio (aOR) per 10-year increase 0.88; 95% confidence interval (CI) 0.86–0.90] and in persons diagnosed in primary care (aOR: 0.6; 95% CI: 0.6–0.7) when compared with secondary care. In persons who were HBV positive, HIV testing was less likely in older persons (aOR per 10-year increase 0.94; 95% CI: 0.92–0.97), but more likely in men (aOR: 1.2; 95% CI: 1.1–1.3) and in those diagnosed in primary care (aOR: 1.2; 95% CI: 1.1–1.3) and sexual health services (aOR: 1.9; 95% CI: 1.7–2.0) when compared with secondary care. The HIV positivity rate in persons tested for HIV within 6 months was 1.9% among persons who were HCV positive and 2.4% among persons who were HBV positive. Of those with no record of an HIV test within 6 months (HCV: 17 527; HBV: 8771), 13 (0.1%) and 10 (0.1%) persons were diagnosed with HIV infection after the 6-month period, respectively, 77% and 60% of whom were diagnosed within 2 years. Although some persons may have received an HIV test in a service not covered by the SSBBV or were lost to follow-up once diagnosed with hepatitis, these data suggest that HIV testing following a positive test for hepatitis is suboptimal in England, regardless of clinical setting. Opportunities have been missed to diagnose persons coinfected with HIV and to offer education on HIV risk reduction strategies. HIV testing rates were higher in sexual health services, but < 20% of individuals with hepatitis are diagnosed within this setting, and greater awareness and implementation of the most recent NICE HIV testing guidelines are needed among all health professionals.

P101 How soon are patients testing outside gum receiving a positive HIV result?

Introduction UK national guidelines for HIV testing 2008, recommend that any individual testing positive for HIV should see a specialist preferably within 48 h and certainly two weeks of receiving the result. Methods All HIV positive test results performed outside the GUM clinic between January 2013 and December 2014 were obtained from the microbiology database at Frimley Park Hospital. 35 patients were identified. 20 were excluded because they were previously known to have HIV, had a “non-specific” or “weakly reactive” result. Results Of the 15 new diagnosis, 8/15 were inpatients, 4/15 outpatients and 3/15 GP diagnosis. Two-thirds were male, 53% White British and 73% heterosexual. The average age was 46 (31–65) years. All the patients had a fourth generation HIV test and a confirmatory test. The majority (87%) were late diagnosis with symptomatic HIV/AIDS and an average CD4 count of 50 cells/mm³. One inpatient diagnosis was missed for 5 weeks until the patient re-presented with PCP. The rest were all seen by a specialist (HIV consultant or health advisor) within 2 weeks of receiving their diagnosis with 64% seen within 24–48 h. Discussion/conclusion The majority were late, symptomatic patients with AIDS. All but one result which was initially missed were seen by a specialist within the recommended 2 to 14 days after diagnosis. The recommendation now is that all positive results are phoned to the named consultant/GP responsible for the patient as well as the HIV/GUM team.

Investigating barriers in HIV-testing oncology patients. The IBITOP study: phase I.

BackgroundSince the advent of combined antiretroviral therapy (ART), the incidence of non-AIDS-defining cancers (non-ADCs) among HIV-positive patients is rising. We previously described HIV testing rates of <5% in our oncology centre, against a local HIV prevalence of 0.4% [1]. We have since worked with the Service of Oncology to identify, how HIV testing can be optimized, we have conducted a study on investigating barriers in HIV-testing oncology patients (IBITOP) among treating oncologists and their patients.MethodsAfter an initial two-month pilot study to examine feasibility [2], we conducted the first phase of the IBITOP study between 1st July and 31st October 2013. Patients of unknown HIV status, newly diagnosed with solid-organ non-AIDS-defining cancer, and treated at Lausanne University Hospital were invited to participate. Patients were offered HIV testing as a part of their initial oncology work-up. Oncologist testing proposals and patient acceptance were the primary endpoints.ResultsOf 235 patients with a new oncology diagnosis, 10 were excluded (7 with ADCs and 3 of known HIV-positive status). Mean age was 62 years; 48% were men and 71% were Swiss. Of 225 patients, 75 (33%) were offered HIV testing. Of these, 56 (75%) accepted, of whom 52 (93%) were tested. A further ten patients were tested (without documentation of being offered a test), which gave a total testing rate of 28% (62/225). Among the 19 patients who declined testing, reasons cited included self-perceived absence of HIV risk, previous testing and palliative care. Of the 140 patients not offered HIV testing and not tested, reasons were documented for 35 (25%), the most common being previous testing and follow-up elsewhere. None of the 62 patients HIV tested had a reactive test.ConclusionsIn this study, one third of patients seen were offered testing and the HIV testing rate was fivefold higher than that of previously observed in this service. Most patients accepted testing when offered. As HIV-positive status impacts on the medical management of cancer patients, we recommend that HIV screening should be performed in settings, where HIV prevalence is >0.1%. Phase II of the IBITOP study is now underway to explore barriers to HIV screening among oncologists and patients following the updated national HIV testing guidelines which recommend testing in non-ADC patients undergoing chemotherapy.

G398(P) Acceptability of HIV testing of children in Paediatricians in Greater Manchester

AimsIt is recommended that clinicians have a high index of suspicion for children who could be at risk of HIV infection, to facilitate early detection, appropriate initiation of treatment and...

G397(P) Awareness of National HIV Testing Guidelines amongst Paediatricians

AimsThis project aimed to evaluate the awareness of several UK National Guidelines for HIV Testing amongst paediatricians. The importance of early detection of HIV infection is to prevent the presentation...

HIV testing in Lanarkshire.

The 2008 UK National Guidelines for HIV testing were designed in order to decrease the proportion of people living with undiagnosed HIV infection. Two audits were conducted. The aim of Audit 1 was to determine the proportion of current medical inpatients with an indicator condition that had been tested for HIV. Audit 2 aimed to identify missed opportunities for testing prior to diagnosis among newly diagnosed individuals with HIV. Audit 1 involved a case note review looking for indicator conditions and HIV testing of all inpatients. Audit 2 analysed the hospital case notes of all new Lanarkshire HIV patients in 2010 for previous missed diagnostic opportunities. In Audit 1, 36% (63/174) of medical inpatients had a current indicator condition. Of the total population, 1.7% (3/174) had what would be an AIDS-defining condition if they had a positive HIV test. However, only 11% (7/63) of individuals were appropriately HIV tested. For Audit 2, 64% (9/14) of newly diagnosed individuals had previous missed opportunities for diagnosis. Increased education of clinical staff around testing guidelines is needed, as we have demonstrated that the 2008 guidelines are not being adhered to.

P2.042 An Audit of HIV Testing Rates in Patients Admitted with Pneumonia Pre- and Post- Implementation of Opt-Out HIV Testing For Acute Medical Admissions

BackgroundUK National Guidelines for HIV Testing recommend that an HIV test should be considered in all general medical admissions where diagnosed HIV prevalence in the local population exceeds two in...

A survey of HIV care in the UK: results of British HIV Association (BHIVA) National Audit 2010

The aim of the 2010 BHIVA audit was to assess the impact of the 2008 UK HIV testing guidelines on clinical practice. Here, we report one aspect of the audit comprising a survey of local testing policy and practice at centres providing adult HIV services across the UK. Selected recommendations from the 2008 national HIV testing guidelines were assessed as target outcomes and the percentages of sites and subjects meeting these recommendations were calculated. One hundred and thirty-two sites responded to the survey and many are actively promoting HIV testing locally. Sites report HIV testing is routine in genitourinary (GU) medicine and antenatal services but offered selectively in other clinical areas. Encouragingly, 21 (16%) report some local general practitioner practices are offering testing routinely to new patients at registration. However, the time to receive non-urgent HIV test results exceeds 72 hours in 29% of sites. In conclusion, HIV testing needs to continue to expand across clinical settings to reduce the number of patients living with undiagnosed infection. Laboratory turnaround time needs to improve to ensure non-urgent HIV test results are available within 72 hours.

World Aids Day 2012: Are you missing the signs of an HIV infection?

British Journal of Community NursingVol. 17, No. 12 Long-Term ConditionsWorld Aids Day 2012: Are you missing the signs of an HIV infection?Ian PeateIan PeateSearch for more papers by this authorIan PeatePublished Online:16 Aug 2013https://doi.org/10.12968/bjcn.2012.17.12.604AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References British HIV Association (2008) “National Guidelines for HIV Testing”. http://tinyurl.com/yh6uk9f (accessed 6 November 2012) Google ScholarEllis S, Curtis H and Ong E (2012) HIV diagnoses and missed opportunities. Results of the British HIV Association (BHIVA) National Audit 2010. Clinical Medicine 12(5)430–4 Crossref, Medline, Google ScholarHealth Protection Agency (2011) “Migrant Health: Infectious diseases in non-UK born populations in the UK” http://tinyurl.com/br4nup5 (accessed 6 November 2012) Google ScholarHealth Protection Agency (2012) “HIV diagnoses in the UK to end-2011: update using data to mid-2012” http://tinyurl.com/cl2pja4 (accessed 6 November 2012) Google Scholar FiguresReferencesRelatedDetails 1 December 2012Volume 17Issue 12ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Published online 16 August 2013 Published in print 1 December 2012 Information© MA Healthcare LimitedPDF download

HIV testing for acute medical admissions: evaluation of a pilot study in Leicester, England

ObjectivesThe 2008 UK National Guidelines for HIV testing recommended HIV testing should be offered to all general medical admissions aged 16–60 years in high prevalence areas, and that this should...

HIV testing in black Africans living in England

We examined the uptake of HIV testing in black Africans living in England before the introduction of national testing guidelines. Analyses were conducted using data from an anonymous self-completed questionnaire linked to oral fluid samples to establish HIV status in black Africans attending community venues in England in 2004. Of 946 participants, 44% had ever been tested for HIV and 29% had been tested in the previous 24 months. Of those with undiagnosed HIV, 45% had previously had a negative HIV test. Almost a third of people tested in the UK had been at general practice. Uptake of HIV testing was not associated with perceived risk of HIV. These findings highlight the need for the implementation of national HIV testing guidelines in the UK, including the promotion of testing in general practice. Regular testing in black Africans living in the UK should be promoted regardless of their HIV test history.

HIV dementia: a diagnosis to keep in mind

British Journal of Hospital MedicineVol. 73, No. 7 Case ReportHIV dementia: a diagnosis to keep in mindChristine M Kelly, Alastair RO Miller, Baba Aji, Tom SolomonChristine M KellySearch for more papers by this author, Alastair RO MillerSearch for more papers by this author, Baba AjiSearch for more papers by this author, Tom SolomonSearch for more papers by this authorChristine M Kelly; Alastair RO Miller; Baba Aji; Tom SolomonPublished Online:16 Aug 2013https://doi.org/10.12968/hmed.2012.73.7.410AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Antinori A, Arendt G, Becker JTet al. (2007) Updated research nosology for HIV associated neurocognitive disorders. Neurology 69: 1789–99 Crossref, Medline, Google ScholarCysique LA, Brew BJ (2009) Neuropsychological functioning and antiretroviral treatment in HIV/ AIDS: a review. Neuropsychol Rev 19: 169–85 Crossref, Medline, Google ScholarCysique LA, Brew BJ (2011) Prevalence of non-confounded HIV-associated neurocognitive impairment in the context of plasma HIV RNA suppression. J Neurovirol 17: 176–83 Crossref, Medline, Google ScholarFairbairn A, Gould N, Kandall Tet al. (2006) Dementia: A NICE-SCIE Guideline on supporting people with dementia and their carers in health and social care. National Clinical Practice Guideline Number 42. The British Psychological Society and Gaskell, London Google ScholarMarra CM, Zhao Y, Clifford Det al. (2009) Impact of combination antiretroviral therapy on cerebrospinal fluid HIV RNA and neurocognitive performance. AIDS 23(11): 1359–66 Crossref, Medline, Google ScholarMcMurtray A, Clarke DG, Christine D, Mendez MF (2006) Early-onset dementia: frequency and causes compared to late-onset dementia. Dement Geriatr Cogn Disord 21: 59–64 Crossref, Medline, Google ScholarNavia BA, Jordan BD, Price RW (1986) The AIDS dementia complex: I. Clinical features. Ann Neurol 19: 517–24 Crossref, Medline, Google ScholarPalfreeman A, Fisher M, Ong Eet al. (2008) UK National Guidelines for HIV Testing 2008. In British HIV Association, British Association of Sexual Health and HIV & British Infection Society (eds). British HIV Association, London Google ScholarPortegies P, Enting RH, De Gans J, Algra PR, Derix MM, Lange JM, Goudsmit J (1993) Presentation and course of AIDS dementia complex: 10 years of follow-up in Amsterdam, The Netherlands. AIDS 7: 669–75 Crossref, Medline, Google ScholarRobertson K, Kumwenda J, Supparatpinyo Ket al. (2011) A multinational study of neurological performance in antiretroviral therapy-naïve HIV-1-infected persons in diverse resource-constrained settings. J Neurovirol 17(5): 438–47 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails 1 July 2012Volume 73Issue 7ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 16 August 2013 Published in print 1 July 2012 Information© MA Healthcare LimitedPDF download

HIV Testing Practices by Clinical Service before and after Revised Testing Guidelines in a Swiss University Hospital

ObjectivesTo determine 1) HIV testing practices in a 1400-bed university hospital where local HIV prevalence is 0.4% and 2) the effect on testing practices of national HIV testing guidelines, revised in March 2010, recommending Physician-Initiated Counselling and Testing (PICT).MethodsUsing 2 hospital databases, we determined the number of HIV tests performed by selected clinical services, and the number of patients tested as a percentage of the number seen per service (‘testing rate’). To explore the effect of the revised national guidelines, we examined testing rates for two years pre- and two years post-PICT guideline publication.ResultsCombining the clinical services, 253,178 patients were seen and 9,183 tests were performed (of which 80 tested positive, 0.9%) in the four-year study period. The emergency department (ED) performed the second highest number of tests, but had the lowest testing rates (0.9–1.1%). Of inpatient services, neurology and psychiatry had higher testing rates than internal medicine (19.7% and 9.6% versus 8%, respectively). There was no significant increase in testing rates, either globally or in the majority of the clinical services examined, and no increase in new HIV diagnoses post-PICT recommendations.ConclusionsUsing a simple two-database tool, we observe no global improvement in HIV testing rates in our hospital following new national guidelines but do identify services where testing practices merit improvement. This study may show the limit of PICT strategies based on physician risk assessment, compared to the opt-out approach.

P9 Sustainable and embedded opt out HIV testing on an acute medical admissions unit

BackgroundOpt out testing for HIV in our hospital's acute medical unit (AMU) had been successfully piloted between August 2009 and September 2010. Our trust was selected a pilot site to...

A National Survey of HIV Testing in Intensive Care: Moving Forwards

There is currently no accepted national guideline for HIV testing in intensive care. This survey aimed to determine current HIV testing practices and attitudes to testing in English ICUs. The response rate was 44% from 120 units. There was a wide variation in testing practices in the absence of any ICU-specific HIV testing guidelines. Only 9% of units had written guidelines, and none of the units tested for all HIV-indicator diseases. A majority of units (57%) felt that GMC guidance should be changed to allow universal testing, and almost all (92%) felt that the patient should be tested when a member of staff experienced a needlestick injury. The authors suggest that there is a need for national HIV testing guidelines specific to intensive care.