NICE public health guidance
Issued: March 2011
PH34

Increasing the uptake of HIV testing among men who have sex with men

View the summary and implementation tools

This is an extract from the guidance. The complete guidance is available at guidance.nice.org.uk/ph34

Appendix D: Gaps in the evidence

PHIAC identified a number of gaps in the evidence related to the programmes under examination based on an assessment of the evidence. These gaps are set out below.

  1. There is a lack of robust UK studies that evaluate the effectiveness and cost effectiveness of interventions to improve the uptake of HIV testing among men who have sex with men. In particular, there are no studies that:

    • operate at the community level and, ideally, include interventions applying the principles described in NICE guidance on community engagement (NICE public health guidance 9 [2008])

    • assess ways of addressing the stigma and discrimination surrounding HIV testing and ways to promote positive attitudes about HIV testing

    • assess ways of increasing uptake among specific groups of men who have sex with men (for example, the under-16s  and middle aged men, those from different cultural, ethnic or faith groups, men with physical or learning difficulties and those who have a limited knowledge or understanding of English)

    • include groups that may be under-represented in the current evidence base, such as men who do not identify as gay or who are not openly gay.

  2. There is a lack of evaluation of how men who have sex with men view the universal offer and recommendation of an HIV test.

  3. There is a lack of useful psychological models of behaviour change relevant to men who have sex with men and HIV testing.

  4. There is a lack of evidence to inform economic evaluations of interventions to increase the uptake of HIV testing. For example, the following are absent:

    • utility data applicable to men who have sex with men, HIV testing and HIV in the UK

    • data on the sexual behaviour of men who have sex with men following testing, an HIV-positive result and treatment

    • the costs of disease progression, an increasing viral load and decreasing CD4 cell count.

  5. There is a lack of research on interventions to increase the uptake of HIV testing among men who have sex with men in a range of healthcare, social care, institutional (such as prisons and other Home Office facilities) and recreational settings. (The latter includes places used for socialising and meeting, including web-based services.)

  6. There is a lack of information on men who have sex with men and who leave sexual health services without having an HIV test (or who present with sexual health issues to other healthcare or advisory services without having an HIV test). For example, the epidemiology and proportion of men who have sex with men leaving a health service without having a test has not been assessed. In addition, there is a lack of qualitative research into the reasons why, if they were offered a test, they declined it.

  7. There is a lack of research into the role mass media could play in increasing awareness and uptake of HIV testing.

  8. There is a lack of research into the effectiveness, cost effectiveness and acceptability of 'home' HIV tests, internet-based HIV testing services and those offered by the private healthcare sector.

The Committee made five recommendations for research. These are listed in section 5.