The objectives of the guidance are to:

• Encourage and support the inclusion of indicator condition-guided HIV testing in national HIV testing strategies, taking into account the local HIV prevalence, ongoing testing programmes and the local healthcare setting; • Recommend approaches and practical tools for education and training of healthcare professionals on overcoming barriers to recommending an HIV test.

HIV indicator conditions can be divided into 3 categories:

1. Conditions which are AIDS defining among PLHIV; 2. Conditions associated with an undiagnosed HIV prevalence of >0.1%; 3. Conditions where not identifying the presence of HIV infection may have significant adverse implications for the individual’s clinical management.

There is a large body of evidence from randomised controlled trials on the consequences of not treating people living with HIV who have AIDS defining conditions. Not recommending a test in these circumstances would not be considered good clinical practice. Routine testing for conditions with an HIV prevalence of >0.1% has been reported to be cost-effective and has the potential to increase earlier diagnosis of HIV, and thus lead to earlier opportunities for care and treatment.

Recommendations:

• Any person (without an HIV-positive test in the patient’s medical record) presenting with potentially AIDS defining conditions should be strongly recommended HIV testing. • Any person presenting with a condition with an undiagnosed HIV prevalence of >0.1% should be strongly recommended HIV testing. • For indicator conditions where expert opinion considers HIV prevalence likely to be >0.1%, but awaiting further evidence, it is recommended to offer testing. • For conditions where not identifying the presence of HIV infection may have significant adverse implications for the individual’s clinical management, testing should be offered to avoid further immune suppression with potentially serious adverse outcomes for the individual, and to maximize the potential response to the treatment of the indicator condition (despite that the estimated prevalence of HIV is most likely lower than 0.1%).

Guidance document: HIV Indicator Conditions: Guidance for Implementing HIV Testing in Adults in Health Care Settings

Guidance in short - English

Guidance in short - Spanish

Guidance in short - French

Guidance in short - German

Guidance in short - Russian

Appendix 4: Example of patient information leaflet

Appendix 5: Example of presentation of guidance

Appendix 6: Template letter to the editor