HIV testing in primary care in a low-prevalence area of Northeast England

Indicator condition-based HIV testing is recommended by the British HIV Association in all clinical settings, including in primary care. We estimated the frequency of non-obstetric HIV testing in primary care in an area of Northeast England with a low prevalence of HIV and examined the effects of clinical and demographic indicators on testing rates.

We collated data from 358 603 patients across 54 general practices. Multilevel logistic regression modelling was used to identify associations between clinical and demographic indicators and non-obstetric HIV testing.

People with any indicators for testing were more than four times as likely to be tested for HIV than those without (odds ratio [OR] 4.5; 95% confidence interval [CI] 4.10-4.94). Women were less likely than men to have been tested (OR 0.75; 95% CI 0.71-0.80). People aged 56-75 years were less likely to be tested (OR 0.67; 95% CI 0.62-0.72) compared to those aged 16-35; people of white ethnicity were less likely to be tested than those of non-white ethnicity (OR 0.66; 95% CI 0.59-0.73); there was a directional correlation between lower levels of deprivation and reduced likelihood of testing. The overall frequency of testing, however, was low (2.4% in whole study population; 4.9% in people with any indicators for testing).

Low rates of non-HIV testing in primary care, including where clinical and/or demographic indicators are present, represent a barrier to reducing late diagnoses and achieving the UK government's target of eliminating HIV transmission by 2030.