Quality standard

Quality statement 3: HIV indicator conditions

Quality statement 3: HIV indicator conditions

Quality statement

Young people and adults newly diagnosed with an HIV indicator condition are offered an HIV test.

Rationale

Increasing the uptake of HIV testing among people who may have been infected is important to reduce late diagnosis. Early diagnosis improves treatment outcomes and reduces the risk of transmission to other people. Offering HIV testing in primary and secondary care to people newly diagnosed with conditions that may indicate HIV infection could mean that potentially serious consequences of HIV infection are avoided. It may also improve response to treatment for the indicator condition.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

a) Evidence of local systems that alert healthcare professionals to the need to offer an HIV test when an indicator condition is diagnosed.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from system specification.

b) Evidence of local processes to offer an HIV test to young people and adults newly diagnosed with an indicator condition.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from service protocols.

Process

Proportion of young people and adults newly diagnosed with an indicator condition who receive an HIV test.

Numerator – the number in the denominator who receive an HIV test.

Denominator – the number of young people and adults newly diagnosed with an indicator condition.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from an audit of patient health records.

Outcome

a) Number of new HIV diagnoses.

Data source: Local data collection for Public Health England's HIV and AIDS reporting system.

b) Number of new HIV diagnoses made at a late stage of infection.

Data source: Local data collection for Public Health England's HIV and AIDS reporting system. Late stage of infection is defined as a CD4 count less than 350 cells per mm3.

What the quality statement means for different audiences

Service providers (such as hospitals including outpatient departments, general practices and sexual health services) ensure that staff are trained to offer and recommend an HIV test to young people and adults who are newly diagnosed with an indicator condition. Providers ensure that systems are in place to alert healthcare professionals to the need to offer and recommend an HIV test when a relevant diagnosis is made. Providers could offer an HIV test by an opt-out testing system.

Healthcare professionals (such as clinicians, GPs and nurses) offer and recommend an HIV test to young people and adults with HIV who are newly diagnosed with an indicator condition. If the test is declined, healthcare professionals should provide information on how to access other local HIV testing services.

Commissioners (such as integrated care systems, local authorities, clinical commissioning groups and NHS England) include HIV testing in the service specification for hospitals and GP practices. Commissioners ensure that providers have processes in place to offer and recommend an HIV test to all young people and adults who are newly diagnosed with an indicator condition.

Young people and adults with a health condition that may suggest they have HIV are offered an HIV test. This is so that they can be diagnosed and treated as early as possible if they are infected.

Definitions of terms used in this quality statement

Young people and adults

Young people are aged 16 and 17 years. Adults are aged 18 years and over. [Expert opinion]

HIV indicator conditions

HIV testing is recommended as identified in HIV in Europe's guidance on HIV indicator conditions. Service providers may wish to focus on the following priorities:

Potentially AIDS-defining conditions

Neoplasms:

  • Cervical cancer

  • Non-Hodgkin's lymphoma

  • Kaposi's sarcoma.

Bacterial infections:

  • Mycobacterium tuberculosis, pulmonary or extrapulmonary

  • Mycobacterium avium complex or Mycobacterium kansasii, disseminated or extrapulmonary

  • Mycobacterium, other species or unidentified species, disseminated or extrapulmonary

  • Pneumonia, recurrent (2 or more episodes in 12 months)

  • Salmonella septicaemia, recurrent.

Viral infections:

  • Cytomegalovirus retinitis

  • Cytomegalovirus, other (except liver, spleen, glands)

  • Herpes simplex, ulcer(s) for more than 1 month/bronchitis/pneumonitis

  • Progressive multifocal leucoencephalopathy.

Parasitic infections:

  • Cerebral toxoplasmosis

  • Cryptosporidiosis diarrhoea for more than 1 month

  • Isosporiasis for more than 1 month

  • Atypical disseminated leishmaniasis

  • Reactivation of American trypanosomiasis (meningoencephalitis or myocarditis).

Fungal infections:

  • Pneumocystis carinii pneumonia

  • Candidiasis, oesophageal

  • Candidiasis, bronchial/tracheal/lungs

  • Cryptococcosis, extrapulmonary

  • Histoplasmosis, disseminated/extrapulmonary

  • Coccidioidomycosis, disseminated/extrapulmonary

  • Penicilliosis, disseminated.

Conditions in which the prevalence of undiagnosed HIV is more than 0.1%

  • Sexually transmitted infections

  • Malignant lymphoma

  • Anal cancer/dysplasia

  • Cervical dysplasia

  • Herpes zoster

  • Hepatitis B or C (acute or chronic)

  • Mononucleosis-like illness

  • Unexplained leukocytopenia/thrombocytopenia lasting more than 4 weeks

  • Seborrheic dermatitis/exanthema

  • Invasive pneumococcal disease

  • Unexplained fever

  • Candidaemia

  • Visceral leishmaniasis.

Conditions likely to have an undiagnosed prevalence of HIV of more than 0.1%

  • Primary lung cancer

  • Lymphocytic meningitis

  • Oral hairy leukoplakia

  • Severe or atypical psoriasis

  • Guillain–Barré syndrome

  • Mononeuritis

  • Subcortical dementia

  • Multiple sclerosis-like disease

  • Peripheral neuropathy

  • Unexplained weight loss

  • Unexplained lymphadenopathy

  • Unexplained oral candidiasis

  • Unexplained chronic diarrhoea

  • Unexplained chronic renal impairment

  • Hepatitis A

  • Community-acquired pneumonia

  • Candidiasis.

Conditions likely to have an estimated prevalence of HIV lower than 0.1% but where not identifying HIV infection may have significant adverse implications for the person's care

  • Conditions requiring aggressive immunosuppressive therapy:

    • Cancer

    • Transplantation

    • Auto-immune disease treated with immunosuppressive therapy

  • Primary space-occupying lesion of the brain

  • Idiopathic/thrombotic thrombocytopenic purpura.

[HIV in Europe's guidance on HIV indicator conditions]