1. Purpose
A sexual health service tests for infection, gives results, treats, and offers HIV prevention. The biggest safety risk is a result that is not acted on, above all a reactive HIV or syphilis result that is missed or delayed. This policy sets out how the Service tests appropriately, makes sure every result is seen and acted on, treats and refers correctly, and runs PrEP safely.
The Service must verify this policy against current BASHH testing guidance and the BHIVA/BASHH PrEP guidelines before adoption.
2. Sources to verify before adoption
- British Association for Sexual Health and HIV (BASHH), testing and management guidelines: https://www.bashh.org/
- BHIVA/BASHH guidelines on the use of HIV pre-exposure prophylaxis (PrEP): https://www.bhiva.org/
- UK Health Security Agency, STI testing and surveillance guidance: https://www.gov.uk/government/organisations/uk-health-security-agency
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12 (safe care and treatment): https://www.legislation.gov.uk/uksi/2014/2936/regulation/12
3. Scope
This policy applies to:
- STI and blood-borne virus testing, results, treatment and PrEP
- the clinicians who test, treat and prescribe, and the staff who manage results
- patients tested or on PrEP at the Service
4. Testing
- the tests offered are based on the patient's risk and the current guidance, covering the relevant infections including HIV and syphilis where indicated
- the patient is told what they are being tested for, what the tests can and cannot detect, and that some infections have a window period during which a recent exposure may not yet show, so a repeat test may be needed
- consent to testing, including HIV testing, is taken and recorded
5. Results: the fail-safe
Every test result is seen and acted on. The Service:
- logs every test sent and tracks it until the result is back and actioned
- has a fail-safe so a result that does not arrive is chased, not assumed negative
- gives results in the way the patient agreed, protecting confidentiality (see the confidentiality policy)
- treats a reactive or positive result, especially HIV or syphilis, as needing prompt, sensitive action: the patient is contacted, supported, treated or referred without delay, and the contact is handled so it does not reveal the diagnosis to others
- records the result, the action taken and the communication with the patient
6. Treatment and onward referral
- infections are treated per current guidance, with the right drug, dose and follow-up, and a test of cure where indicated
- infections needing specialist care (for example a new HIV diagnosis) are referred promptly to the appropriate service, with the patient supported through the handover
- partner notification is offered for relevant diagnoses (see the partner notification policy)
- notifiable infections are reported as the law requires
7. PrEP
Where the Service provides HIV pre-exposure prophylaxis:
- eligibility and suitability are assessed against current guidance, and the patient is counselled on how PrEP works, that it does not protect against other STIs, and the importance of adherence
- baseline tests (including an HIV test to confirm the person is HIV negative, and renal function) are done before starting, and PrEP is not started on an unconfirmed HIV status
- monitoring, including regular HIV testing and renal monitoring at the intervals the guidance sets, is arranged and tracked, with the same fail-safe as other results
- PrEP is reviewed and continued only while monitoring is current
8. Recording
The Service records the tests done, the results, the treatment given, referrals made, PrEP assessments and monitoring, and the communication with the patient, all in line with the confidentiality policy.
9. Training
Clinicians who test, treat and prescribe PrEP keep current with the guidance and are competent for what they do; staff who manage results are trained in the fail-safe and confidentiality. The Service records who is competent and the next refresher date.
10. Audit cadence
The Service checks, on a stated cadence, that:
- testing matches risk and the patient was told about window periods and consented (including to HIV testing)
- every result was tracked, seen and acted on, with reactive results handled promptly and sensitively, and none outstanding unnoticed
- treatment, referral and notifiable-infection reporting followed guidance
- PrEP had baseline testing and tracked monitoring, with no PrEP continued on overdue monitoring
The Registered Manager and the clinical lead review the results and record the improvement actions that follow.