Hartney, Thomas; (2025) Clinical indicator-guided testing for HIV in general practice in the UK. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background: In 2020, 42% of adult HIV diagnoses in the UK were made late, indicating the need for timely HIV testing and diagnosis. UK general practice is an important setting for HIV testing, given high rates of attendance across all risk groups. National HIV testing guidelines recommend that HIV testing be routinely offered in non-specialist healthcare settings, including to patients who present with clinical indicator diseases (CID) that may indicate undiagnosed HIV infection. I set out to understand the relationship between CID and subsequent HIV diagnosis using routinely collected UK primary care data. Methods: I carried out a systematic review of the prevalence of HIV by CID and incidence of CID before HIV diagnosis. Using a primary care database, THIN, I investigated the incidence of HIV testing and diagnosis in UK general practice from 2005 to 2016. Finally, I examined which CID are most often seen among those who go on to be diagnosed with HIV, compared to the general population. Results: In the literature, all CID with data available showed a prevalence of previously undiagnosed HIV greater than the threshold typically used for recommending HIV testing as a public health measure. Rates of HIV testing in general practice increased from 2005-2010, and since then have remained steady: however rates of non-routine testing (i.e. not antenatal or new patients) have continuously increased across this period. In a case–cohort study, the incidence of CID was consistently higher among people with HIV than in the general population, ranging from a 1.5- fold increase for seborrhoeic dermatitis to nearly a six-fold increase for non-Hodgkin lymphoma. Conclusion: Late HIV diagnosis could be mitigated by indicator condition-guided testing for HIV. Recommendations for CID-guided HIV testing should be tailored for each setting, based on the best available evidence. Future research should focus on further implementation in primary care.

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