Overview of the study
At the UK, the number of newly diagnosed people keeps on decreasing due to several factors such as the global shift of focus to the pandemic (Public Health England,2018). Statistically, 10% fall between 2018 to 2019, 25% testing increase in London between 2019 to 2020 whiles 34% decrease within the same period outside London (J.Lester et al.,2020).
Despite the efforts of the United Kingdom government to reach the 90-90-90 UN goal of tackling HIV challenges in the world by 2020, which has been reviewed to 95-95-95 by 2030, the popularity of the uptake of HIV screening the country has received little attention and concentration by the people (Hatzold, K., et al.,2019). It was assessed that the EU around a third of those infected are not aware of their serostatus, while in some countries in eastern Europe and central Asia, more than 60% of people with HIV remain undiagnosed. Lack of knowledge of HIV status is a key issue for both individuals and society. Hence, this research has been motivated by the above challenges and will advancedthe study and contribute to the issue by assessing the barriers in the uptake of HIV screening especially among adults in UK.
1.1 Introduction
Globally, HIV still remains one of the health challenges in the health sector affecting more than 37.9 million people and 8.1 more who are unaware of their status (J.Lester et al.,2020). The fight for HIV is challenged by the possibility of early detection to prevent onward transmission via the administering of antiretroviral therapy (ART). In UK, in an effort to meet the 95% global target in diagnosis, HIV action plan has been activated to achieve 80% by 2025 (J.Lester et al., 2020). Records show a slight decline in new diagnosis in England between 2020 to 2021 but later rose by 3% compared to 2019 data. Overall UK health sector and England was among the first countries to report meeting the UNAIDS 90-90-90 diagnosis and treatment target prior the pandemic (J.Lester et al., 2020). However, late diagnosis detection post pandemic has become a significant concern to the health sector in UK. According to (WHO, ECDC, 2017), the international guidelines focus on increasing the rate of individuals being diagnose at an early and encouraging voluntary screening. It is estimated that, persons above 40 years has high rate of resisting HIV screening exercise (Brännström et al., 2017). Despite the excellent HIV care outcomes by the health sector in UK, the implementation of self-testing model in the country to encourage person to self-test in their various homes, to allow early detection and treatment, however, the gap in diagnosis detection by various health sectors threatens the global fight against HIV prevention and eradication, hence, this study will focus on assessing all possible barriers hindering the uptake of HIV screening especially by adults in the UK.
2.0 Research Aim and Objective
2.1 Research Aim
The purpose of this paper is to systematically examine credible studies in the literature that have explored and evaluated factors that affect screening of HIV and its diagnosis. Using the insights gained, the aim of the study is to assess barriers that affect the uptake of HIV screening especially among adults. Particularly, the study shall identify and understand why some adults in the United Kingdom are not getting tested and what can be done to increase the uptake of HIV screening in order to enhance treatment and early detection of the virus.
2.2 Research Objective
1. To assess the factors that hinders the uptake of HIV test among adults in the UK.
2. To examine the barriers to uptake of HIV screening among adults in the UK.
3. To identify interventions for increasing the uptake of HIV screening among adults in UK.
3.0 Methodology
The study will be guided by qualitative and systematic literature review approach. Secondary data will be highly depended on to assess the barriers to the uptake of HIV screening among adults in the UK. The PRISMA guide and QUASI analyses will be adopted, including meta-analysis model and peer-literature review. In as much as the proposed methodology is likely to reduce the ability to understand and know the potential of biasness and individual experiences and geographical difference in the searched data, the method will be appropriate to accurately and precisely analyse and generalize results.
3.1 Search Strategy
The aim of the search strategy is to efficiently uncover the most relevant and effective available information. It will utilize two key approaches: a thorough review of practical screening resources and peer-reviewed literature and meta-analysis. Under the peer-reviewed literature, six electronic databases will be searched: PubMed, Web of science, Embase, Coshrane Library, Central and Science Direct for resources published in English between 1 January, 2017 to 31 December, 2022. Scientific abstracts from five major HIV conferences will also be explored: AIDS, IAS, CROI conference, HIVR4P, ICASA. Practical resources information’s will also be solicited from HIV programmes, World Health Organisation.
Titles and abstracts will be screened to determine resources that will be relevant or not. Relevant resources in other languages and geographic centred will be assess and translate into English.
Smart strategy for searching will be adopted to uncover in-depth information about the research topic. Keywords and key concepts of the research topic will form as an anchor search input. Additionally, indexes of the reseachkey words, symbols such as $,#,*,”” will be added to combine separate variables into a single search. Also, the use of synonyms, paraphrasing research topic will also be abducted, Boolean search model will be used to enable effective scope of search: ( HIV OR “human immunodeficiency virus”, AND “screen*for HIV , “HIV screen”* AND barriers, “assessment”* OR “identification”* OR “understanding*” OR “symptom screening” OR “HIV screening assessment*” OR “Hindrance*” AND “barrier assessment*” OR “United Kingdom*” OR “UK*” AND “uptake*” OR “adults*”.”HIV screening,” “barriers to HIV testing,” “uptake of HIV testing,” “HIV testing in the UK,” and “adults and HIV testing.
3.2 Inclusion criteria
Resources will be assessed and included base on the two search strategy. The inclusion criteria for resources under the peer-review literatures will include resources that cover barriers in HIV testing and any relevant HIV testing results. Practical resources that are based on research demographic areas, HIV screening records and conditions will be assessed and included.
Inclusion
Exclusion
Language
English
Non-English
Year of publications
2017 or later
Prior 2017
Demographic
Adults (25 years above)
Below 25 years ( Children & adolescents)
Medical setting
HIV testing
Non-HIV testing
Data
UK concentrated
Outside UK
Type of data
Secondary data
Primary data
Table 1: Inclusion and Exclusion Criteria
As disclosed in the methodology above, PRISMA guideline to report the systematic reviews and meta-analysis of the study will be used to ensure the credibility of the study and reduce biasness. The study will follow the PRISMA guidelines identified below:
Identification
Resources identified by other sources.
Resources identified through
Screening
Resources after duplicates removed
Resources excluded
Resources screened by title and abstract
Eligibility
Full text resources excluded
Not high country
Text not available
Participant type
study type
Additional reasons
not adding value to study
absent of intervention
Not Rural background
Full text resources assessed for eligibility
Included
Resources included for full analyses
Figure 1: PRISMA guideline
4.0 Critical Appraisal
Studies on HIV are very critical which require quality and critical appraisal approach to accurately validate and rely on results for generalization of results. Therefore, to critically appraise this study, the study will be quality assessed via Cochrane risk of bias, QUADAS-2, PEDroscale and Jadad scale will be employed to critically appraise the assessment of barriers to the uptake of HIV screening in the UK. The Joanna Briggs Institute (JBI 2020) checklist found in appendix I will be utilized, along with a meta-analysis of statistical evaluation and systematic review instrument, to filter relevant information and pinpoint the resources that are most relevant to the research subject. The results of the critical appraisal will be reported in the study, and any limitations of the data sources will be considered when interpreting the results. Also, the quasi-systematic will be adopted to rapidly update data more quickly
5.0 Analyses and Synthesis
Several studies identified depended on different theories approach analysis (Sasse, 2016). Based on the literature identified and the research objective to assess barriers to the uptake of HIV, a thematic, systematic literature- review and meta-analysis approach will be used to analyse and synthesise data on the study. This analysis will to provide a comprehensive overview and understanding of the barriers that hinders the uptake of HIV screening by adults.
6.0 Ethical Consideration
The nature and sensitivity of the research topic deem it necessary for the research to consider ethics. The study will be based on secondary data analysis hence, ethical approval will not be relevant however, ethical consideration is relevant in secondary data to ensuretransparency, and replicable. This study will re-identify, consider data confidentiality and the data and data will adhere to UK data service policies and guidance. The researcher will ensure accurate and transparency in the research process and outcome and ensuring the study will be used for the intended aim and nothing else.
7.0 Gantt Chart
A Gantt chart will be used to outline the timeline for the study, which will take approximately 9 months to complete. The timeline is as follows:
Task
Duration
Month 1
Month 2
Month 3
Month 4
Month 5
Month 6
Month 7
Month 8
Month 9
Wk1
Wk2
Wk3
Wk4
Proposal phase
Approval of research topic
Literature search
Search strategy
Critical appraisal
Submitting and approval of proposal
Dissertation Phase
Screening of included abstract and titles
Screening of full articles
Screening of reference in full articles
PH1- Drafting of abstract and Introduction
Submission of PH1for approval
PH2- Drafting of methods and results
Submission of PH2for approval
PH3- analysing and discussing data, and conclusion
Submission of PH3 for approval
Submission of final draft and drafting of Appendix
NB: All submissions and approvals will be done before two weeks of the final date of submission.
Table 2: Gantt chart
8.0 Conclusion
This study will provide valuable insights into the barriers to the uptake of HIV screening among adults in the UK and identify effective strategies for increasing HIV testing. The results of this study will inform public health policies and programs aimed at increasing the uptake of HIV screening among adults in the UK.
References:
Brännström, J., Sönnerborg, A., Svedhem, V., Neogi, U., & Marrone, G. (2017). A high rate of HIV-1 acquisition post immigration among migrants in Sweden determined by a CD4 T-cell decline trajectory.
British Association for Sexual Health and HIV. (2019). Standards for the management of sexually transmitted infections (STIs).
Byrne, R., & others. (2018). A National Audit of late diagnosis of HIV: Action taken to review previous healthcare among individuals with advanced HIV. London, UK: British HIV Association.
Croxford, S. E., & others. (2022). Mortality among people with HIV in the UK in 2020: Findings from the National HIV Mortality Review. Journal, 23, 9.
Department of Health and Social Care. (2021). Towards Zero: An action plan towards ending HIV transmission, AIDS, and HIV-related deaths in England – 2022 to 2025.
ECDC. (2017). Continuum of HIV care: Monitoring implementation of the Dublin declaration on partnership to fight HIV/AIDS in Europe and Central Asia, 2017. Special Report. Retrieved from http://ecdc.europa.eu/en/publications/Publications/Continuum-of-HIV-care-2017.pdf
ECDC/WHO Regional Office for Europe. (2017). HIV/AIDS surveillance in Europe 2016. European Centre for Disease Prevention and Control.
Hatzold, K., et al. (2019). Journal of the International AIDS Society, 22(S1), e25244. https://doi.org/10.1002/jia2.25244
Health Protection Report. (2018). Progress towards ending the HIV epidemic in the UK: 2018 report − summary. Retrieved from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/813168/HIV_annual_report_2018_-_Summary_key_messages_and_recommendations.pdf
Health Protection Report. (2019). Trends in HIV testing, new diagnoses and people receiving HIV-related care in the UK: data to end December 2019, Volume 14, Number 20. Retrieved from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/959330/hpr2020_hiv19.pdf
Johnson, C. C., Kennedy, C., Fonner, V., Siegfried, N., Figueroa, C., Dalal, S., et al. (2017). Examining the effects of HIV self-testing compared to standard HIV testing services: a systematic review and meta-analysis. Journal of the International AIDS Society, 20(1), 21594. doi: 10.7448/IAS.20.1.21594
Johnson, W. D., O’Leary, A., & Flores, S. A. (2018). Per-partner condom effectiveness against HIV for men who have sex with men. AIDS, 32(11), 1499-1505.
Joint United Nations Programme on HIV/AIDS. (2019). Communities at the center: defending rights, breaking barriers, reaching people with HIV services. Geneva, Switzerland.
Lester, J., Martin, V., Shah, A., Chau, C., Mackay, N., Newbigging-Lister, A., Connor, N., Brown, A., Sullivan, A., & contributors. (2022). HIV testing, PrEP, new HIV diagnoses, and care outcomes for people accessing HIV services: 2022 report. The annual official statistics data release (data to end of December 2021). UK Health Security Agency, London.
Mitchell, H., & others. (2022). Routine commissioning of HIV pre-exposure prophylaxis (PrEP) in England: Monitoring and evaluation framework. London, UK: UK Health Security Agency.
NHS. (2019). HIV testing. Retrieved from https://www.nhs.uk/conditions/hiv-and-aids/hiv-testing/
Office for Health Improvement and Disparities. (2022). Wider Impacts of COVID-19 on Health (WICH) monitoring tool.
Office of National Statistics. (2011). 2011 Census. Retrieved from www.ons.gov.uk/census/2011census
Public Health England. (2016). Sentinel surveillance of blood borne virus testing in England: annual report 2015. Health Protection Report, 10(24). Retrieved from https://www.gov.uk/government/publications/sentinel-surveillance-of-blood-borne-virustesting-in-england-2015
Public Health England. (2018). Infectious diseases in pregnancy screening: programme handbook 2017 to 2018. Retrieved from https://www.gov.uk/government/publications/infectious-diseases-in-pregnancyscreening-programme-handbook
Public Health England. (2019). Safe supplies 2018: monitor, inform, progress. Retrieved from https://www.gov.uk/government/publications/safe-supplies-annual-review
Rodger, A. J., & others. (2019). Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): Final results of a multicentre, prospective, observational study. The Lancet, 393, 2428-2438.
Sasse, A., & others. (2016). Late presentation to HIV testing is overestimated when based on the consensus definition. HIV Medicine, 17, 231-234.
Sullivan, A. K., Rayment, M., Azad, Y., Bell, G., McClean, H., Delpech, V., et al. (2015). HIV partner notification for adults: definitions, outcomes and standards. Retrieved from https://www.bhiva.org/HIV-partner-notification-for-adults
UNAIDS. (n.d.). AIDSInfo. Retrieved from http://aidsinfo.unaids.org/
WHO. (2015). Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. In Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV.
WHO. (2019). WHO encourages countries to adapt HIV testing strategies in response to changing epidemic. Geneva, Switzerland: World Health Organization.
World Health Organization. (2019). Consolidated guidelines on HIV testing services. Web Annex L. Symptom and risk-based screening to optimize HIV testing services: a scoping review/ Caitlin Quinn, Vincent Wong, Muhammad S. Jamil, Rachel C. Baggaley, Cheryl C. Johnson.
World Medical Association. (1964).Declaration of Helsinki. Retrieved from https://www.wma.net/p
At the UK, the number of newly diagnosed people keeps on decreasing due to several factors such as the global shift of focus to the pandemic (Public Health England,2018). Statistically, 10% fall between 2018 to 2019, 25% testing increase in London between 2019 to 2020 whiles 34% decrease within the same period outside London (J.Lester et al.,2020).
Despite the efforts of the United Kingdom government to reach the 90-90-90 UN goal of tackling HIV challenges in the world by 2020, which has been reviewed to 95-95-95 by 2030, the popularity of the uptake of HIV screening the country has received little attention and concentration by the people (Hatzold, K., et al.,2019). It was assessed that the EU around a third of those infected are not aware of their serostatus, while in some countries in eastern Europe and central Asia, more than 60% of people with HIV remain undiagnosed. Lack of knowledge of HIV status is a key issue for both individuals and society. Hence, this research has been motivated by the above challenges and will advancedthe study and contribute to the issue by assessing the barriers in the uptake of HIV screening especially among adults in UK.
1.1 Introduction
Globally, HIV still remains one of the health challenges in the health sector affecting more than 37.9 million people and 8.1 more who are unaware of their status (J.Lester et al.,2020). The fight for HIV is challenged by the possibility of early detection to prevent onward transmission via the administering of antiretroviral therapy (ART). In UK, in an effort to meet the 95% global target in diagnosis, HIV action plan has been activated to achieve 80% by 2025 (J.Lester et al., 2020). Records show a slight decline in new diagnosis in England between 2020 to 2021 but later rose by 3% compared to 2019 data. Overall UK health sector and England was among the first countries to report meeting the UNAIDS 90-90-90 diagnosis and treatment target prior the pandemic (J.Lester et al., 2020). However, late diagnosis detection post pandemic has become a significant concern to the health sector in UK. According to (WHO, ECDC, 2017), the international guidelines focus on increasing the rate of individuals being diagnose at an early and encouraging voluntary screening. It is estimated that, persons above 40 years has high rate of resisting HIV screening exercise (Brännström et al., 2017). Despite the excellent HIV care outcomes by the health sector in UK, the implementation of self-testing model in the country to encourage person to self-test in their various homes, to allow early detection and treatment, however, the gap in diagnosis detection by various health sectors threatens the global fight against HIV prevention and eradication, hence, this study will focus on assessing all possible barriers hindering the uptake of HIV screening especially by adults in the UK.
2.0 Research Aim and Objective
2.1 Research Aim
The purpose of this paper is to systematically examine credible studies in the literature that have explored and evaluated factors that affect screening of HIV and its diagnosis. Using the insights gained, the aim of the study is to assess barriers that affect the uptake of HIV screening especially among adults. Particularly, the study shall identify and understand why some adults in the United Kingdom are not getting tested and what can be done to increase the uptake of HIV screening in order to enhance treatment and early detection of the virus.
2.2 Research Objective
1. To assess the factors that hinders the uptake of HIV test among adults in the UK.
2. To examine the barriers to uptake of HIV screening among adults in the UK.
3. To identify interventions for increasing the uptake of HIV screening among adults in UK.
3.0 Methodology
The study will be guided by qualitative and systematic literature review approach. Secondary data will be highly depended on to assess the barriers to the uptake of HIV screening among adults in the UK. The PRISMA guide and QUASI analyses will be adopted, including meta-analysis model and peer-literature review. In as much as the proposed methodology is likely to reduce the ability to understand and know the potential of biasness and individual experiences and geographical difference in the searched data, the method will be appropriate to accurately and precisely analyse and generalize results.
3.1 Search Strategy
The aim of the search strategy is to efficiently uncover the most relevant and effective available information. It will utilize two key approaches: a thorough review of practical screening resources and peer-reviewed literature and meta-analysis. Under the peer-reviewed literature, six electronic databases will be searched: PubMed, Web of science, Embase, Coshrane Library, Central and Science Direct for resources published in English between 1 January, 2017 to 31 December, 2022. Scientific abstracts from five major HIV conferences will also be explored: AIDS, IAS, CROI conference, HIVR4P, ICASA. Practical resources information’s will also be solicited from HIV programmes, World Health Organisation.
Titles and abstracts will be screened to determine resources that will be relevant or not. Relevant resources in other languages and geographic centred will be assess and translate into English.
Smart strategy for searching will be adopted to uncover in-depth information about the research topic. Keywords and key concepts of the research topic will form as an anchor search input. Additionally, indexes of the reseachkey words, symbols such as $,#,*,”” will be added to combine separate variables into a single search. Also, the use of synonyms, paraphrasing research topic will also be abducted, Boolean search model will be used to enable effective scope of search: ( HIV OR “human immunodeficiency virus”, AND “screen*for HIV , “HIV screen”* AND barriers, “assessment”* OR “identification”* OR “understanding*” OR “symptom screening” OR “HIV screening assessment*” OR “Hindrance*” AND “barrier assessment*” OR “United Kingdom*” OR “UK*” AND “uptake*” OR “adults*”.”HIV screening,” “barriers to HIV testing,” “uptake of HIV testing,” “HIV testing in the UK,” and “adults and HIV testing.
3.2 Inclusion criteria
Resources will be assessed and included base on the two search strategy. The inclusion criteria for resources under the peer-review literatures will include resources that cover barriers in HIV testing and any relevant HIV testing results. Practical resources that are based on research demographic areas, HIV screening records and conditions will be assessed and included.
Inclusion
Exclusion
Language
English
Non-English
Year of publications
2017 or later
Prior 2017
Demographic
Adults (25 years above)
Below 25 years ( Children & adolescents)
Medical setting
HIV testing
Non-HIV testing
Data
UK concentrated
Outside UK
Type of data
Secondary data
Primary data
Table 1: Inclusion and Exclusion Criteria
As disclosed in the methodology above, PRISMA guideline to report the systematic reviews and meta-analysis of the study will be used to ensure the credibility of the study and reduce biasness. The study will follow the PRISMA guidelines identified below:
Identification
Resources identified by other sources.
Resources identified through
Screening
Resources after duplicates removed
Resources excluded
Resources screened by title and abstract
Eligibility
Full text resources excluded
Not high country
Text not available
Participant type
study type
Additional reasons
not adding value to study
absent of intervention
Not Rural background
Full text resources assessed for eligibility
Included
Resources included for full analyses
Figure 1: PRISMA guideline
4.0 Critical Appraisal
Studies on HIV are very critical which require quality and critical appraisal approach to accurately validate and rely on results for generalization of results. Therefore, to critically appraise this study, the study will be quality assessed via Cochrane risk of bias, QUADAS-2, PEDroscale and Jadad scale will be employed to critically appraise the assessment of barriers to the uptake of HIV screening in the UK. The Joanna Briggs Institute (JBI 2020) checklist found in appendix I will be utilized, along with a meta-analysis of statistical evaluation and systematic review instrument, to filter relevant information and pinpoint the resources that are most relevant to the research subject. The results of the critical appraisal will be reported in the study, and any limitations of the data sources will be considered when interpreting the results. Also, the quasi-systematic will be adopted to rapidly update data more quickly
5.0 Analyses and Synthesis
Several studies identified depended on different theories approach analysis (Sasse, 2016). Based on the literature identified and the research objective to assess barriers to the uptake of HIV, a thematic, systematic literature- review and meta-analysis approach will be used to analyse and synthesise data on the study. This analysis will to provide a comprehensive overview and understanding of the barriers that hinders the uptake of HIV screening by adults.
6.0 Ethical Consideration
The nature and sensitivity of the research topic deem it necessary for the research to consider ethics. The study will be based on secondary data analysis hence, ethical approval will not be relevant however, ethical consideration is relevant in secondary data to ensuretransparency, and replicable. This study will re-identify, consider data confidentiality and the data and data will adhere to UK data service policies and guidance. The researcher will ensure accurate and transparency in the research process and outcome and ensuring the study will be used for the intended aim and nothing else.
7.0 Gantt Chart
A Gantt chart will be used to outline the timeline for the study, which will take approximately 9 months to complete. The timeline is as follows:
Task
Duration
Month 1
Month 2
Month 3
Month 4
Month 5
Month 6
Month 7
Month 8
Month 9
Wk1
Wk2
Wk3
Wk4
Proposal phase
Approval of research topic
Literature search
Search strategy
Critical appraisal
Submitting and approval of proposal
Dissertation Phase
Screening of included abstract and titles
Screening of full articles
Screening of reference in full articles
PH1- Drafting of abstract and Introduction
Submission of PH1for approval
PH2- Drafting of methods and results
Submission of PH2for approval
PH3- analysing and discussing data, and conclusion
Submission of PH3 for approval
Submission of final draft and drafting of Appendix
NB: All submissions and approvals will be done before two weeks of the final date of submission.
Table 2: Gantt chart
8.0 Conclusion
This study will provide valuable insights into the barriers to the uptake of HIV screening among adults in the UK and identify effective strategies for increasing HIV testing. The results of this study will inform public health policies and programs aimed at increasing the uptake of HIV screening among adults in the UK.
References:
Brännström, J., Sönnerborg, A., Svedhem, V., Neogi, U., & Marrone, G. (2017). A high rate of HIV-1 acquisition post immigration among migrants in Sweden determined by a CD4 T-cell decline trajectory.
British Association for Sexual Health and HIV. (2019). Standards for the management of sexually transmitted infections (STIs).
Byrne, R., & others. (2018). A National Audit of late diagnosis of HIV: Action taken to review previous healthcare among individuals with advanced HIV. London, UK: British HIV Association.
Croxford, S. E., & others. (2022). Mortality among people with HIV in the UK in 2020: Findings from the National HIV Mortality Review. Journal, 23, 9.
Department of Health and Social Care. (2021). Towards Zero: An action plan towards ending HIV transmission, AIDS, and HIV-related deaths in England – 2022 to 2025.
ECDC. (2017). Continuum of HIV care: Monitoring implementation of the Dublin declaration on partnership to fight HIV/AIDS in Europe and Central Asia, 2017. Special Report. Retrieved from http://ecdc.europa.eu/en/publications/Publications/Continuum-of-HIV-care-2017.pdf
ECDC/WHO Regional Office for Europe. (2017). HIV/AIDS surveillance in Europe 2016. European Centre for Disease Prevention and Control.
Hatzold, K., et al. (2019). Journal of the International AIDS Society, 22(S1), e25244. https://doi.org/10.1002/jia2.25244
Health Protection Report. (2018). Progress towards ending the HIV epidemic in the UK: 2018 report − summary. Retrieved from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/813168/HIV_annual_report_2018_-_Summary_key_messages_and_recommendations.pdf
Health Protection Report. (2019). Trends in HIV testing, new diagnoses and people receiving HIV-related care in the UK: data to end December 2019, Volume 14, Number 20. Retrieved from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/959330/hpr2020_hiv19.pdf
Johnson, C. C., Kennedy, C., Fonner, V., Siegfried, N., Figueroa, C., Dalal, S., et al. (2017). Examining the effects of HIV self-testing compared to standard HIV testing services: a systematic review and meta-analysis. Journal of the International AIDS Society, 20(1), 21594. doi: 10.7448/IAS.20.1.21594
Johnson, W. D., O’Leary, A., & Flores, S. A. (2018). Per-partner condom effectiveness against HIV for men who have sex with men. AIDS, 32(11), 1499-1505.
Joint United Nations Programme on HIV/AIDS. (2019). Communities at the center: defending rights, breaking barriers, reaching people with HIV services. Geneva, Switzerland.
Lester, J., Martin, V., Shah, A., Chau, C., Mackay, N., Newbigging-Lister, A., Connor, N., Brown, A., Sullivan, A., & contributors. (2022). HIV testing, PrEP, new HIV diagnoses, and care outcomes for people accessing HIV services: 2022 report. The annual official statistics data release (data to end of December 2021). UK Health Security Agency, London.
Mitchell, H., & others. (2022). Routine commissioning of HIV pre-exposure prophylaxis (PrEP) in England: Monitoring and evaluation framework. London, UK: UK Health Security Agency.
NHS. (2019). HIV testing. Retrieved from https://www.nhs.uk/conditions/hiv-and-aids/hiv-testing/
Office for Health Improvement and Disparities. (2022). Wider Impacts of COVID-19 on Health (WICH) monitoring tool.
Office of National Statistics. (2011). 2011 Census. Retrieved from www.ons.gov.uk/census/2011census
Public Health England. (2016). Sentinel surveillance of blood borne virus testing in England: annual report 2015. Health Protection Report, 10(24). Retrieved from https://www.gov.uk/government/publications/sentinel-surveillance-of-blood-borne-virustesting-in-england-2015
Public Health England. (2018). Infectious diseases in pregnancy screening: programme handbook 2017 to 2018. Retrieved from https://www.gov.uk/government/publications/infectious-diseases-in-pregnancyscreening-programme-handbook
Public Health England. (2019). Safe supplies 2018: monitor, inform, progress. Retrieved from https://www.gov.uk/government/publications/safe-supplies-annual-review
Rodger, A. J., & others. (2019). Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): Final results of a multicentre, prospective, observational study. The Lancet, 393, 2428-2438.
Sasse, A., & others. (2016). Late presentation to HIV testing is overestimated when based on the consensus definition. HIV Medicine, 17, 231-234.
Sullivan, A. K., Rayment, M., Azad, Y., Bell, G., McClean, H., Delpech, V., et al. (2015). HIV partner notification for adults: definitions, outcomes and standards. Retrieved from https://www.bhiva.org/HIV-partner-notification-for-adults
UNAIDS. (n.d.). AIDSInfo. Retrieved from http://aidsinfo.unaids.org/
WHO. (2015). Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. In Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV.
WHO. (2019). WHO encourages countries to adapt HIV testing strategies in response to changing epidemic. Geneva, Switzerland: World Health Organization.
World Health Organization. (2019). Consolidated guidelines on HIV testing services. Web Annex L. Symptom and risk-based screening to optimize HIV testing services: a scoping review/ Caitlin Quinn, Vincent Wong, Muhammad S. Jamil, Rachel C. Baggaley, Cheryl C. Johnson.
World Medical Association. (1964).Declaration of Helsinki. Retrieved from https://www.wma.net/p
