Appendix a: Classification of settings and populations for routine HIV testing (adapted from

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1 Appendix a: Classification of settings and populations for routine HIV ing (adapted from national ing guidelines, BHIVA 2008) [6] Persons diagnosed with a disease indicative of HIV infection Persons a service where routine HIV screening is undertaken Tuberculosis Pneumocystis Cerebral toxoplasmosis Primary Cerebral Lymphoma Cryptococcal meningitis Progressive multifocal leucoencephalopathy Kaposi s sarcoma Persistent cryptosporidiosis Non-Hodgkin s Lymphoma Cervical Cancer Cytomeglovirus retinitis Bacterial pneumonia Aspergillosis Aseptic meningitis/encephalitis Cerebral abscess Space occupying lesion of unknown cause Guillain-Barré syndrome Transverse myelitis Peripheral neuropathy Dementia Leucoencephalopathy Severe or recalcitrant seborrhoeic dematitis Severe or recalcitrant psoriasis Multidermatomal or recurrent herpes zoster Oral candidiasis Oral hairy leukoplakia Chronic diarrhoea of unknown cause Weight loss of unknown cause Salmonella, shigella or campylobacter Hepatitis B infection Hepatitis C infection Anal cancer or anal intraepithelial dysplasia Lung cancer Seminoma Head and neck cancer Hodgkin s lymphoma Castleman s disease Vaginal intraepithelial neoplasia Cervical intraepithelial neoplasia (Grade 2 or above) Any unexplained blood dyscrasia including: Thrombocytopenia Neutropenia Lymphopenia Infective retinal disease including herpesviruses and toxoplasma Any unexplained retinopathy Lymphadenopathy of unknown cause Chronic parotitis Lymphoepithelial parotid cysts Mononucleosis-like syndrome (primary HIV infection) Pyrexia of unknown origin Any lymphadenopathy of unknown cause Any sexually transmitted infection Termination of pregnancy services Drug dependency programmes All patients presenting for healthcare where HIV prevalence

2 (excluding GUM and antenatal services) All men and women registering in general practice where diagnosed HIV prevalence in the local population exceeds 2 in 000 population All general where diagnosed HIV prevalence in the local population exceeds 2 in 000 population

3 Appendix b: Characteristics of Studies Included: Methods, Measures and Testing Levels Author Risk group Setting (diagnosed HIV prevalence per,000 population 5-59 year olds) * Persons diagnosed with a disease indicative of HIV infection Gupta, N.D. & Lechelt, M. [] Thomas William, S., et [2] Hsu, D., et (202) [3] Page, I., et [4] Thomson-Glover, R., et [5] Inpatients with indicator diseases (tuberculosis, hepatitis B, hepatitis C, cervical intraepithelial neoplasia (grade I/II), lymphoma, anal cancer, seminoma, aspergillosis or Castleman's disease) with indicator disease (tuberculosis) Primary care patients presenting with glandular fever-like illness with indicator disease (tuberculosis, hepatitis B, hepatitis C, lymphoma) with indicator disease (hepatitis B, hepatitis C, candida South-west Essex (.28) Birmingham and Solihull (Birmingham East & North;.5, Heart of Birmingham; 3.29, South Birmingham;.66; Solihull; 0.58) South London (Lambeth 3.28, Southwark; 0.29) Blackpool (3.4) Warrington (0.6) Methods Electronic record audit of attendees one secondary care hospital Number eligible to Number offered Retrospective audit 94 Not Retrospective audit of patients 72 primary care clinics Retrospective audit of patients one secondary care hospital Case-note audit of patients two secondary care hospitals Number ed Number ing positive Not 045 Not 56 Not 249 Not 9 Not Not 5 0

4 Thorburn, F. (202) [6] Vas, A., et (202) [7] Byrne, L., et [8] Manavi, K., Gautam, N. (202) [9] Dodd, M. et al (203) [0] stomatitis) with indicator disease (diagnosed with tuberculosis) with indicator disease (tuberculosis, hepatitis B, hepatitis C) admitted to acute unit with community-acquired pneumonia diagnosed with clinical indicator conditions as specified in UK HIV ing guidelines with an HIV indicator illness in the presenting complaint or past history. Glasgow (.7) Manchester (5.22) London (Newham; 8.2, Tower Hamlets; 5.94) Birmingham (3.29) Sheffield (.4) Persons recommended ing settings in high prevalence areas Burns, F., et (202) [] Chan, S.Y., et [2] Rayment, M., et (202) [3] Perry, N., et [4] Bryce, G., (2009) [5] Acute Care unit and Dermatology outpatient clinic newly registering with GP London (5.24) Croydon (4.45) London (City and Hackney (8.25) Brighton & Hove PCT (7.57) Brighton & Hove PCT (7.57) Retrospective case-note review of TB patients one tertiary care clinic Retrospective case-note review of patients one secondary care hospital Retrospective case-note review of patients one acute unit Retrospective case note review of patients one secondary care hospital Retrospective case note review of patients in one General Intensive Care Unit Prospective, consecutive HIV offer to patients one acute unit Prospective offer of HIV to patients one acute unit Prospective study of patients one acute care unit Prospective HIV offer to patients one acute unit Prospective HIV offer to patients nine primary 338 Not * Not 43 Not 967 Not 307 Not Not 473 2

5 care clinics Ashby, J., et (202) [6] Ellis, S., et [7] Rudran, B., et [8] Leber, W., et (202) [9] Bassett, D., et (202) [20] Rosenvinge, M., et (200) [2] Garrard, N., et (200) [22] Barbour, A., et (202) [23] Rycroft, J., et (202) [24] Page, I., et [4] Polyclinic attendees in high prevalence area newly registering with GP Women termination of pregnancy services Women termination of pregnancy service admitted to acute West London (Kensington & Chelsea; 8.3, Hammersmith & Fulham; 8.5, Westminster; 7.0) Newcastle Upon Tyne (.6) Bournemouth and Poole (2.32) Hackney (8.25) Manchester (5.22) Wandsworth (4.9) Southwark (0.39) and Lambeth (3.28) Croydon (4.45) Greenwich (5.58) Blackpool (3.4) Prospective study of patients one polyclinic Prospective audit of patients one acute unit Retrospective case-note review of patients one acute unit Cluster randomised control trial of patients 40 primary care units Prospective case-note review of patients one acute Retrospective review of HIV ing of patients who attended two termination of pregnancy clinic Prospective, consecutive offer to patients one termination of pregnancy clinic Prospective intervention at one acute unit Retrospective audit of patients who attended one acute Retrospective audit of patients who attended one secondary care hospital Not Not ,83 Not 3709 Not ** 970 Not 3,999 Not Not

6 French, S., et (202) [25] French, S., et (202) [25] Tillet, S., et (202) [26] newly registering with GP newly registering with GP Southwark (0.39), Lewisham (7.03), Lambeth (3.28) Southwark (0.39), Lewisham (7.03), Lambeth (3.28) Tower Hamlets (5.94) Prospective study of patients 3 primary care clinics Prospective study of patients 5 primary care clinics Prospective study of patients one secondary care hospital Prospective study of patients one primary care clinic Prospective study of patients 6, Not 24 2 Griffin, A., et [27] Patient newly registering with GP Manchester (5.22) 457 Not Palfreeman, A., et (203) [28] Leicester (3.22) 7226 Not admitted to AMU admitted to AMU * for patients diagnosed with TB only. ** 77 refusals were. Additional data regarding ing strategy (opt-in vs. opt-out), service model (standard care vs. specific staff training vs. GUM/Health advisor-led ing), and type of HIV (POCT vs. 4 th generation serology). Appendix c: Supplementary data tables for studies identified by group Study Title Article Primary ing outcome Exclusions Time period (duration) Population Number of centres Type of centre Measure/reporti ng method Persons diagnosed with a disease indicative of possible HIV infection Gupta, N.D. & Lechel t, M. Assessment of the implementation and knowledge of the UK national guidelines for HIV ing (2008) in key conditions at Yes - Audit Report Electronic department al record or HIV ing and Electronic pathology records Nonverifiable data August 2009 June 202 ( months) Inpatients at Basildon & Thurrock Hospital Secondary care hospital Electronic record of HIV

7 a UK district general hospital Thom as Willia m, S., et Hsu, D., et (202) Page, I., et Changes in HIV ing rates among patients with tuberculosis in a large multiethnic city in the UK Diagnosing HIV infection in patients presenting with glandular feverlike illness in primary care: are we missing primary HIV infection? The impact of new national HIV ing guidelines at a district general hospital in an area of high HIV seroprevalence Yes - Audit Report Yes - Short Commu nication Yes - Paper database record of HIV HIV record of HIV <8 years, private patients, chemoproph ylaxis patients, nontuberculosis mycobacteria, diagnosis outside catchment area Not HIV requests from GUM clinics September 2008 March 2009 (6 months) April June 200 (4 months) October 2008 September 2009 registered on the Birmingham Tuberculosis aftercare register Primary care patients in Lambeth and Southwark Inpatients in Blackpool > Various 72 Primary care clinics Secondary care hospital record of HIV record of HIV request record of HIV

8 Thom son- Glover, R., et Diagnosing HIV in non-gum secondary care settings No - HIV not November April 200 (6 months) inpatients Warrington & Halton hospitals 2 Secondary care hospitals HIV Thorb urn, F. (202) The impact of a multi-disciplinary meeting on the rates of HIV in ing in TB patients No - HIV offer not (duration not ) Tuberculosis patients virology centre in Glasgow Tertiary care clinic record of HIV administration Vas, A., et (202) Byrne, L., et HIV ing and in TB and Hepatitis services in a district general hospital HIV specialists must lead the way to make HIV ing truly routine No - No- HIV HIV not, <8, non specialty, underlying chronic lung disease, hospitalacquired pneumonia 2009 (duration not ) February - April 200 (3 months) Indicator disease patients in a Manchester hospital admitted with communityacquired pneumonia Secondary care hospital unit HIV administration Case-note record of HIV administration Persons services where routine HIV screening should be undertaken Chan, S.Y., et Acceptance of HIV ing in inpatients: A local acceptability study Miscella neous Consent to have an HIV <5 and >59 years, total time admitted <24 hours, assessed as unable to consent, known to be HIV-positive September 2009 (2 weeks) Acute in Croydon unit Offer and acceptance of HIV

9 Raym ent, M., et (202) Perry, N. et Bryce, G. (2009) Ashby, J., et (202) HIV Testing in Non-Traditional Settings - the hints study: A multi-centre observational study of feasibility and acceptability. HIV ing in acute general must be universally offered to reduce undiagnosed HIV A study to assess the acceptability, feasibility and costeffectiveness of universal HIV ing with newly registering patients (aged 6-59) in primary care HIV ing uptake and acceptability in an inner city polyclinic Article Article Offer of HIV to eligible individual HIV Acceptance of HIV offer Acceptance of HIV offer <6, >65 years, known HIV positive, not accessing healthcare for the first time in ing period, not able to consent <6 and >79 years, known HIV positive <6 and >59 years <6, >65 years, unable to consent January September 200 (2 weeks each site) August 2009 January 200 (5 months) May - November 200 (4 months) 20 dates not specified (random 4- hour duration over a 4 week period) primary and secondary healthcare services in 4 London centres Acute in Brighton primary care services in Brighton Polyclinic attendees in west London 4 9 Acute care units, Dermatology OPD unit Primary care clinics Polyclinic Administration of HIV oral fluid or 4 th generation HIV serology HIV result HIV POCT Rapid point-ofcare HIV

10 Ellis, S., et Offering HIV ing in an acute unit in Newcastle upon Tyne Clinical Medicin e research HIV <8 years, no capacity for consent September - October 2009 ( weeks) and January - March 200 (6 weeks) Acute in Newcastle unit HIV offer and administration Rudra n, B., et HIV ing in acute HIV not exact date not specified ( week) Acute in Bournemouth unit Hospital or laboratory database record of HIV Leber, W., et (202) Basse tt, D., et (202) Can point-of-care HIV ing in primary care increase identification of HIV? The RHIVA 2 Cluster randomised control trial - update Practical challenges implementing national HIV ing guidelines in general Offer of rapid pointof-care HIV HIV <6 years, not May 200 end date not specified July 20 (two weeks) primary care services in London Acute in central Manchester 40 Primary care units Administration of rapid point-ofcare HIV HIV administration

11 Rosen vinge, M., et (200) A successful uptake of HIV ing in south London termination of pregnancy services consent for an HIV Known HIV positive, recent (< 6 months) HIV negative, repeat attendance April - December 2009 (9 months) Women termination of pregnancy services in south London 2 Termination of pregnancy clinics Paper and electronic record of HIV administration Garrar d, N., et (200) Barbo ur, A., et Rycrof t, J., et (202) Page, I., et Opt-out HIV ing pilot in termination of pregnancy services - - month service evaluation Opt-out HIV ing policy implemented as routine standard of care for acute in a high prevalence area HIV ing in the acute unit - setting the scene for universal opt-out ing The impact of new national HIV ing guidelines at a district general hospital in an area of high Paper HIV recommend ation HIV record of HIV record of HIV not <6 and >79 years, Not HIV requests from GUM clinics November September 2009 ( months) July 20 December 20 (6 months) June & November 20 (audited 2 weeks for each cycle) October 2008 September 2009 Women termination of Pregnancy services north London acute in Croydon acute in south east London Inpatients in Blackpool Termination of pregnancy clinic Secondary care hospital Documentation of HIV result HIV ing HIV in laboratory database record of HIV

12 HIV seroprevalence Palfre eman, A., et (203) HIV ing for acute : evaluation of a pilot study in Leicester, England Paper record of HIV Not September 2008 August 20 (36 months) admitted to AMU in Leicester Secondary care hospital record of HIV

13 References. Gupta ND, Lechelt M. Assessment of the implementation and knowledge of the UK national guidelines for HIV ing (2008) in key conditions at a UK district general hospit International Journal of STD and AIDS 20;22(2): Thomas William S, Taylor R, Barrett S, et Changes in HIV ing rates among patients with tuberculosis in a large multi-ethnic city in the UK. International Journal of STD and AIDS 20;22(2): Hsu DTS, Ruf M, O'Shea S, et Diagnosing HIV infection in patients presenting with glandular fever-like illness in primary care: are we missing primary HIV infection? HIV Medicine 203;4(): Page I, Phillips M, Flegg P, et The impact of new national HIV ing guidelines at a district general hospital in an area of high HIV seroprevalence. Journal of the Royal College of Physicians of Edinburgh 20;4(): Thomson-Glover DM, Smalley L. Diagnosing HIV in non-gum secondary care settings. HIV Medicine 20;2(): Thorburn F. The impact of a multi-disciplinary meeting on the rates of HIV in ing in TB patients. HIV Medicine 202;3():- 7. Vas A, Morgan E, Padmankumar K, et HIV ing in TB and Hepatitis services in a district general hospit HIV Medicine 202;3():- 8. Byrne L, Whitburn T, Vearncombe S, et HIV specialists must lead the way to make HIV ing truly routine. HIV Medicine 20;2(): Manavi K, Gautam N. Does identification of patients with HIV clinical indicator diseases lead to offer of HIV ing? Evidence and resources to commission expanded HIV ing in priority services in high prevalence areas, Health Protection Agency Dodd MC, Collini PJ, Dockrell DH. Low concordance with HIV ing guidelines in a retrospective review of intensive care practice. Thorax 203;68(); Burns F, Edwards SG, Woods J, et Acceptability and Feasibility of Universal Offer of Rapid Point of Care Testing for HIV in an Acute Admissions Unit: Results of the RAPID Project. PLoS One 202;7(4) 2. Chan SY, Hill-Tout R, Rodgers M, et Acceptance of HIV ing in inpatients: a local acceptability study. International Journal of STD & AIDS 20;22(4): Rayment M, Thornton A, Mandalia S, et HIV Testing in Non-Traditional Settings The HINTS Study: A Multi-Centre Observational Study of Feasibility and Acceptability. PLoS One 202;7(6):e Perry N, Heald L, CasselL J, et HIV ing in acute general must be universally offered to reduce undiagnosed HIV. Health Protection Agency. Time to Test for HIV: Expanding HIV ing in healthcare and community services in England, Bryce N, Jeffery M, Hankins M, et A study to assess the acceptability, feasibility and cost-effectiveness of universal HIV ing with newly registering patients (aged 6-59) in primary care. Health Protection Agency. Time to Test for HIV: Expanding HIV ing in healthcare and community services in England, Ashby J, Braithewaite B, Walsh J, et HIV ing uptake and acceptability in an inner city polyclinic. AIDS Care 202;24(7): Ellis S, Graham L, Price DA, Ong ELC. Offering HIV ing in an acute unit in Newcastle upon Tyne. Clinical Medicine, Journal of the Royal College of Physicians of London 20;(6): Rudran B, Jarvis M, Thomas D, et HIV ing in acute. HIV Medicine 20;2(): Leber W, McMullen H, Bremner S, et Can point of care HIV ing in primary care increase identification of HIV? The RHIVA 2 cluster randomised controlled trial - update. HIV Medicine 202;3():-

14 20. Bassett D, Cousins D, Davies TL, et Practical challenges implementing national HIV ing guidelines in general. HIV Medicine 202;3():- 2. Rosenvinge M, Majewska W, Valcarcel E, et A successful uptake of HIV ing in south London termination of pregnancy services. HIV Medicine 200;(s): Garrard N, Peck J, Ruf M, et Opt-out HIV ing pilot in termination of pregnancy services - -month service evaluation. HIV Medicine 200;(s): Barbour A, Philips S, Draper S, et Opt-out HIV ing policy implemented as routine standard of care for acute in a high prevalence area: effective and sustainable. HIV Medicine 202;3():- 24. Rycroft J, Hall R, Kegg S. HIV ing in the Acute Medical Unit - setting the scene for universal opt-out ing. HIV Medicine 202;3(): French S, Vieu MN, Peck J, et Expanding new patient HIV ing in primary care in Lambeth, Southwark and Lewisham (LSL). Expanding access: HIV ing in extended settings. Health Protection Agency. Time to Test for HIV: Expanding HIV ing in healthcare and community services in England, Tillet S, Orkin C, Nori A. Introducing opt-out HIV ing in the Acute Admissions Unit: Experience of the first 2 months. Expanding access: HIV ing in extended settings. PHAST, Griffin A, Sarwar S, Shelton R, et HIV, Hepatitis B and C ing in primary care. Expanding access: HIV tesitng in extended settings. PHAST, Palfreeman A, Nyatsanza F, Farn H, et HIV ing for acute : evaluation of a pilot study in Leicester, England. Sexually Transmitted Infections 203;89(4):308-0

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