The latest UK national human immunodeficiency virus (HIV) testing
guidelines, released in September 2008, state that HIV testing should be offered
to all patients with indicator conditions and considered in all general medical
admissions in high-prevalence areas. We audited testing rates at Blackpool
Victoria Hospital, a high-prevalence area, one year before and one year after the
publication of the new guidelines. In the year after publication the rate of HIV
testing in patients with indicator diseases was as follows: hepatitis B 6%, hepatitis
C 28%, tuberculosis 9% and lymphoma 14%. The overall rate of HIV testing in
acute medical admissions was 0.5%. Our results demonstrate that traditional
methods of guideline dissemination did not lead to implementation. We are now
assessing alternative methods such as marking all positive laboratory results for
indicator diseases with the phrase ‘HIV testing should be considered’ and
implementing universal opt-out screening in our Clinical Decisions Unit.
