Leading HIV organisations team-up to support GPs on when to test for HIV

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Two major HIV organisations have produced a new series of short videos for GPs around indicator conditions for HIV. The initiative is a collaboration between HIV-charity Terrence Higgins Trust and Fast Track Cities London, a partnership of organisations tackling HIV in the capital, and comes ahead of National HIV Testing Week, which kicks off on 10 February.

GPs are a crucial part of the England’s testing infrastructure, with over 139,000 tests carried out in primary care in 2023. However, 41% of people are still diagnosed at a late stage of infection, and an estimated 4,700 people in England are living with undiagnosed HIV.

The aim of the videos is to remind GPs of indicator conditions which should act as a prompt to test a patient for HIV, to try to ensure people get diagnosed as early as possible.

Key points mentioned in the videos include when a patient has possible immunosuppression or malignancy, has experienced a few common back-to-back illnesses, has symptoms which are taking longer to resolve than expected, or has slightly abnormal FBC or LFTs. All of these can be indicators to a GP to test a patient for HIV.

Islington based GP, Dr Sam Preston, a Fast-Track Cities GP Champion, who is featured in the videos, said “HIV testing week is a great opportunity to increase testing to make sure people aren’t diagnosed late and they can get onto effective HIV treatment as soon as possible. As GPs we are seeing 100s of people in our local community every day who could be missing out on a HIV test because they don’t think they are at risk.  The toolkit we’ve put together for GPs prompts them to remember to do an HIV test when this is necessary for example if the GP is worried about immunosuppression.”

The videos are in support of National HIV Testing Week. National HIV Testing Week is a campaign by Terrence Higgins Trust and commissioned by the Department of Health and Social Care to promote regular HIV testing, particularly among the groups most at risk of HIV.

During the week, anyone in England can order a free HIV test to do at home, but the campaign also promotes people considering testing in whatever way they feel comfortable, such as at a sexual health service or with their GPs.

The GP-focused content will be shared by the Royal College of GPs, Integrated Care Boards and via advertising on LinkedIn.

Watch the five videos

Worried about possible malignancy?

A few common illnesses back-to-back

Worried about possible immunosuppression

Slightly abnormal FBC or LFTs

Symptoms taking longer to resolve than expected

Using incentives to increase HIV testing: a case study from Wakefield

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Wakefield view from The Sandal Castle. The towers of The Wakefield Cathedral and The Town Hall are visible.

An innovative project in Wakefield, West Yorkshire has successfully increased testing rates in certain vulnerable populations by providing a £5 food voucher as an incentive – and key to the work was our partner, BHA for Equality working in collaboration with Turning Point.

In early 2023, public health officials at Wakefield Council identified that a new case of HIV was linked to a cluster of previous cases from 2021 among people who inject drugs (PWID) and those connected to homeless accommodation. It was clear that swift action was needed to prevent further transmissions.

Tackling HIV in vulnerable communities

PWID and individuals linked to homelessness often face multiple barriers to accessing healthcare, from stigma and misinformation to logistical challenges in navigating complex services.

That’s where commissioned services like BHA for Equality’s HIV Prevention and Support Service and Turning Point’s Drug and Alcohol Service come in. Along with Wakefield Council and UK Health Security Agency (UKHSA), they embarked on a multi-agency Incident Management Team (IMT) response to contain the cluster.

Incentivising HIV testing

To reach PWID and individuals in homeless accommodation, BHA Wakefield and Turning Point undertook extensive outreach activities. The primary focus was to raise awareness of HIV risks and offer point-of-care testing (POCT) for both HIV and syphilis, making testing both accessible and quick. What made this scheme stand out was a small but highly targeted intervention – an incentive program in the form of £5 food vouchers for individuals who agreed to take a test.

The rationale? Similar incentives had proven effective in boosting Hepatitis C testing uptake among PWID, and the hope was to replicate that success. These vouchers, redeemable for hot and cold food, were simple, but they addressed a basic need, providing a practical and immediate benefit.

Navigating ethical considerations

Offering an incentive to test can bring up extra ethical questions. The team in Wakefield were following examples from across the country, where incentive vouchers have been introduced for various behaviour changes when uptake is low. The team also kept track of whether any concerns or questions were raised by people not in the target group about why they weren’t receiving a voucher. During the pilot, no concerns of this nature were raised and Wakefield’s public health team continue to monitor the scheme, including outcomes and any challenges.

A dramatic uptake in testing

BHA Wakefield saw a 70% increase in POCT from the previous year, with 166 tests conducted over the 2023-24 period. More than half of these tests (51%) were linked directly to the voucher incentive scheme. There was one reactive HIV test and one reactive syphilis test linked to the scheme – with the person who got the reactive HIV result saying they only took the test because of the voucher.

The scheme didn’t just increase testing rates: it also helped break down common misconceptions around HIV. Comments like, “I thought you could only get it through sex,” and “I thought a test would be ages, but it’s really quick, it’s good to know!” highlight the critical need for ongoing education.

Lessons learned: What makes this scheme a success?

So, what can others in the HIV sector take away from this? Several key factors contributed to the success of Wakefield’s HIV testing incentive scheme:

Targeted approach: By focusing on a specific, high-risk group (PWID and homeless individuals), the scheme was able to channel resources where they were most needed.

Collaboration and partnerships: The collaboration between BHA for Equality, Turning Point, Wakefield Council and UKHSA was crucial. Each organisation brought its own expertise and networks, creating a comprehensive support system, responsive to the needs of the community.

Meaningful incentives: The £5 vouchers addressed an immediate need and resonated with the target population. Sometimes, simple incentives are all that’s needed to bridge the gap between intention and action.

Education and awareness: Outreach activities didn’t just focus on testing but also on education. Misconceptions about HIV transmission were prevalent, and this effort helped correct those while promoting testing as quick and accessible.

Building on success

Thanks to its success, the HIV testing incentive scheme in Wakefield secured additional funding for another year. The next challenge will be to assess its long-term sustainability and effectiveness, but for now, it’s clear that this innovative pilot has had a meaningful impact.

As we continue to face complex public health challenges, schemes like this remind us that even modest interventions, when thoughtfully implemented, can lead to significant results.

HIV Prevention England Conference 2024 – presentations and talks

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Kevin Fenton addresses a large conference. Behind him is a slide which reads HIV Prevention England 2024.

Nearly 300 delegates attended the HIV Prevention England Conference 2024, a one-day conference focussing on equity and impact in HIV prevention. The conference brought together community organisations, commissioners, clinicians and the private sector for vital conversations during this time of change in HIV prevention.

The question of how to end new cases of HIV ran throughout the conference, from the opening address of Andrew Gwynne MP (Minister for Public Health and Prevention) where he confirmed a new HIV action plan will be published next year, to the closing plenary panel discussion on the practical steps to the 2030 goal.

You can view the slides and watch selected sessions below, including our opening and closing plenaries.

Opening plenary

Speakers:

  • Richard Angell OBE, Terrence Higgins Trust
  • Andrew Gwynne MP, Minister for Public Health and Prevention
  • Professor Kevin Fenton, Department for Health and Social Care
  • Memory Sachikonye, UK-CAB

Insights into PrEP awareness and need

Chair : Catherine Dodds

Impactful approaches to address HIV stigma

Sexual health knowledge and key populations

Opt-out testing for HIV in emergency departments

Achieving equitable access to PrEP

Experiences of navigating health systems for Black African and Caribbean communities

Making an impact in re-engagement and retention in care

Developing better insights to achieve equity for underserved communities

Working in partnership for impact

Getting to zero by 2030. How do we make it a reality?

Closing plenary panel discussion.

Chair: Ian Jackson

Panellists: Christina Ganotakis (One Voice Network), Prof Claudia Estcourt (BASHH), James Woolgar (English Sexual Health Commissioners Group), Adam Winter (Department of Health and Social Care), Rachel Hill-Tout (NHS England – BBV Clinical Lead), Richard Angell OBE (Terrence Higgins Trust) & Sinead Ward (ViiV Healthcare)

The conference is organised by Terrence Higgins Trust for HIV Prevention England, which is commissioned by the Departments of Health and Social Care. Many thanks to our sponsors: Pasante Healthcare, ViiV Healthcare and, our lead sponsor, Gilead Sciences.