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Standards of care for people living with HIV

Standard 1: HIV testing and diagnosis

People attending health care services (primary, secondary and tertiary care) should be offered diagnostic tests for HIV in accordance with current national guidance

Quality statements

  • We recommend that a routine offer of HIV diagnostic testing should be made by competent health care professionals to all attendees in all the following settings and clinical scenarios:
    • contraceptive and sexual health services
    • termination-of-pregnancy services
    • drug-dependency programmes
    • antenatal services
    • services for TB, lymphoma and hepatitis B and C
    • all people with symptoms that are consistent with primary HIV infection
    • all people presenting with a clinical indicator condition specified in the UK
    • national HIV testing guidelines
  • People presenting to clinical services where HIV may be an explanation for their condition should be recommended to have an HIV test
  • In areas where the prevalence of diagnosed HIV infection is 2:1000 or greater, all men and women admitted for secondary general medical care should have routine, opt-out HIV testing included in their initial health checks and medical work-up
  • In areas where the prevalence of diagnosed HIV infection is 2:1000 or greater, all men and women registering with a general practice should have routine, opt-out HIV testing included in their initial health checks and medical work-up
  • In areas where the prevalence of diagnosed HIV infection is 2:1000 or greater, local authorities’ commissioning services should take into account the demographic of their local HIV epidemic in planning services, particularly ensuring that high-risk groups who do not routinely access NHS services have outreach services funded for testing appropriate for their needs
  • All those who present to medical services with identifiable risk factors (behavioural and geographical) should be offered an HIV test in accordance with national guidance
  • The use of diagnostic HIV assays which can simultaneously identify both antibodies to HIV and HIV p24 antigen (fourth-generation assays) is recommended to increase the opportunity to diagnose primary HIV infection
  • The time between performing an HIV diagnostic test and the results being available to the patient should be reduced to a minimum, preferably within 48 hours, compatible with the assays available and the context in which the test is carried out

Standard 2: Access to, and retention in, HIV treatment and care

People newly diagnosed with HIV, wherever they are tested, should be offered a full assessment, carried out by an appropriately trained practitioner with specialist expertise in HIV, at the earliest possible opportunity and no later than 2 weeks after receiving a positive HIV test result

Services must have mechanisms in place for those who miss appointments or who transfer their care to another centre, to ensure people with HIV are retained in specialist care

Quality statements


  • All services that offer diagnostic testing for HIV must have an agreed pathway into specialist HIV care for people who are diagnosed HIV positive
  • People who have a new diagnosis of HIV should expect to have their HIV fully assessed by appropriately trained staff within 2 weeks of receiving an HIV-positive test result
  • People who have a new diagnosis of HIV and have symptoms and/or signs potentially attributable to HIV infection (including those of primary infection) must be referred for urgent (within 24 hours) specialist assessment
  • People who receive their diagnosis within a hospital setting should expect to be reviewed by appropriately trained staff within 24 hours if their admission may be HIV-related, or within 2 weeks as an outpatient if unrelated to HIV infection
  • People who have a new diagnosis of HIV should expect to have access to appropriately trained HIV specialist professionals for opportunities to discuss emotional, psychosocial and partner notification issues relating to their HIV diagnosis as well as access to community and peer support
  • People who have a new diagnosis of HIV should receive/have access to emotional support/information within 2 weeks of diagnosis
  • HIV outpatient units should have a policy/pathway for support and onward referral for those individuals who present in a situation of social and/or financial crisis
  • Adolescents moving from paediatric into adult care should expect their transition to be managed sensitively in accordance with separate guidance developed by Children's HIV Association (CHIVA) and British HIV Association (BHIVA)
  • People who have a new diagnosis of HIV should have the initial investigations/evaluations as recommended within the BHIVA guidelines for investigation and monitoring within 2 weeks of receiving their HIV-positive result
  • People who have a new diagnosis of HIV should be informed of their CD4 count and have the opportunity to discuss management, antiretroviral therapy, and opportunistic infection prophylaxis within 2 weeks of this initial assessment (i.e. within 1 month of initial diagnosis)


  • All HIV services must have mechanisms to identify people with HIV, registered with their service, who become disengaged from care
  • Clinical HIV services must have mechanisms in place to follow up people with HIV who miss appointments, monitoring tests, or run low on supplies of medication
  • If a patient is unhappy with the care provided by an individual clinician, an alternative should be offered (including referral to another centre if necessary) after exploration of the basis for concerns and addressing as appropriate
  • HIV services must have defined pathways for the safe transition of care, both from the sending and receiving clinical services, with timely transfer of appropriate information between teams. Patients who transfer their care to another centre should have a full clinical summary provided from their former to their new treatment centre within 2 weeks of this being requested. This summary should contain as a minimum the information outlined in the BHIVA investigation and monitoring guidelines

Standard 3: Provision of outpatient treatment and care for HIV, and access to care for complex comorbidity

People with HIV attending an outpatient HIV service should have their HIV infection monitored and treated safely in accordance with national guidance, and be able to access a comprehensive range of specialist comorbidity services as required

Quality statements

  • People with HIV attending specialist HIV outpatient services should be in receipt of care and treatment that is in line with that defined by nationally recognised guidelines for the treatment of HIV infection and the complications of HIV infection and its therapy
  • People with HIV should be in receipt of care in an appropriate and designated waiting area, preferably dedicated, with privacy in consulting rooms, and with easy access to multidisciplinary support services—in particular: phlebotomy, specialist adherence/pharmacy advice, dispensing services, counselling, and welfare and advocacy support
  • People with HIV should have access to appropriate sexual health screening, treatment and advice (see Standard 7), as well as reproductive health services (see Standard 8)
  • All services should have access to essential diagnostic investigations for the routine management of HIV and the complications of HIV therapy
  • All persons living with HIV should have access to emotional, psychosocial, and welfare advice and support (see Standard 6)
  • People with HIV should have access to services to manage comorbidities safely, in collaboration with the appropriate non-HIV specialist team. The management of common comorbidities may be provided within the specialist HIV unit; otherwise clear pathways must be developed with regional services for people with complex and/or less-common comorbidities
  • All services providing HIV outpatient treatment and care should have a designated HIV inpatient unit(s) to which patients requiring admission to hospital with serious HIV-related pathology can be referred
  • The management of everyone who has HIV with >2-class resistance/drug intolerance or a comorbidity that significantly impacts on antiretroviral choice should be discussed with specialist colleagues as part of a real or virtual clinic
  • All HIV services must have a pathway in place so that patients have 24/7 access to emergency treatment and advice

Standard 4: Safe ARV prescribing: Effective medicines management

People living with HIV should be prescribed antiretroviral drugs by an appropriately qualified clinician and receive treatment and monitoring with such drugs that follow current national guidance

Quality statements

  • ARVs should only be prescribed by an appropriately qualified practitioner (see Standard 11)
  • Clinicians prescribing ARVs must maintain antiretroviral prescribing competencies on a continuing basis with evidence of HIV-specific CPD, and evidence of clinical Programmed Activities relevant to HIV care allocated in the job plan
  • Antiretroviral therapy should be prescribed in line with national guidance and best available evidence, in partnership with each patient, taking into account their wishes and concerns (see Standard 10)
  • Adherence to antiretroviral therapy should be assessed at each clinic visit, and all HIV services should follow a written protocol for supporting adherence to ARVs
  • People living with HIV should have access to adherence support, which should be provided by staff with appropriate skills, when starting or switching ARVs and at any time when viral failure or suspected low adherence occurs
  • There should be evidence of self-reported adherence at each clinician visit. Any patient reporting missed medication or viral load rebound should receive adherence support
  • Information relating to all treatments prescribed should be recorded in the patient’s clinical records alongside other medical conditions, and be identified by the patient’s name and date of birth
  • Drug histories should be undertaken at each clinic visit and should include details of all prescribed medication from primary care and HIV service, over-the-counter medication, herbal medication and recreational drugs. This information should be documented in the clinical record
  • A complete medication review should be undertaken at least annually by the specialist team, taking into consideration adherence, any difficulties with medication and drug–drug interactions. This should be documented in the clinical record
  • All prescribers of ARVs should be able to readily access and regularly use IT and decision-support tools to support best prescribing practice, and to help reduce medication errors
  • Antiretroviral prescriptions should be clinically verified by a competent pharmacist, prior to dispensing, with respect to appropriateness with other prescribed medication and comorbidities
  • Mechanisms should be in place to alert primary care to HIV drug–drug interactions and for primary care to verify non-HIV-related prescriptions issued to people with HIV
  • HIV clinics should provide pharmacist- and nurse-led interventions that provide educational information and outreach services to support antiretroviral therapy prescribing for difficult-to-reach patients in the local community
  • HIV services and patient representatives should collaborate with commissioners to develop strategies to maintain cost-effective prescribing
  • HIV services have a duty to participate in regular monitoring of efficacy and safety of antiretroviral (ARV) prescribing locally, regionally, and nationally

Standard 5: Inpatient care for people living with HIV

People with proven or suspected complications of HIV infection or its treatment who require admission to hospital should receive equitable and rapid access to care by appropriately trained staff either within a consultant-led HIV specialist multidisciplinary team or within an acute medical team supported by immediate and continued engagement with specialist HIV expertise and advice

Quality statements


  • People living with HIV requiring admission to hospital should receive the best care and treatment, as defined by nationally recognised guidelines for the treatment of HIV infection and complications of HIV disease and therapy
  • People living with HIV should expect that if they are hospitalised with a suspected or proven AIDS-defining opportunistic infection/cancer and/or with severe immunosuppression, their care is supervised by or discussed with a clinician experienced in the inpatient management of HIV disease. This clinical engagement should be immediate and continuous. In low-prevalence areas this will mean that their care will be discussed with the designated inpatient unit within the network

Care pathways

  • People who need admission or transfer to an acute HIV specialist inpatient unit, or who require access to specialist HIV inpatient expertise and advice, should be able to access these services within 24 hours of referral

Confidentiality, privacy and dignity

  • People who are HIV positive and require inpatient admission should experience high standards of confidentiality, privacy and dignity in line with the law, GMC guidance and national standards. People with HIV infection have the right to expect that their care is provided in a safe environment and that everyone is treated with dignity and respect regardless of race, sex or sexuality

Communication and discharge planning

  • People who are HIV positive and who require admission to hospital should experience effective discharge planning to ensure timely length of stay, appropriate arrangements for ongoing care and safe discharge
  • Health care professionals involved with the ongoing care arrangements of patients discharged from HIV specialist inpatient services should be in receipt of a summary of the treatment and care received and plans for ongoing care within 24 hours of the patient’s discharge

Infection control

  • People with advanced immune deficiency who are HIV positive and who are admitted to hospital should be protected appropriately from nosocomial and cross-infection. Service arrangements should be in place to reduce and avoid risk of nosocomial and cross-infection and to ensure immediate access to isolation facilities

Care arrangements of HIV inpatient units

  • Arrangements for care in specialist HIV inpatient services must ensure there is:
    • provision of 24-hour access for acute care
    • co-location with high dependency unit (HDU) and intensive therapy unit (ITU) services with appropriate escalation of care to HDU and ITU when indicated
    • 24-hour availability of pharmacy services and access to specialist HIV pharmacist advice
    • an HIV specialist consultant physician-led multidisciplinary team
    • a nursing team with HIV specialist nursing skills and expertise
    • 24-hour availability of HIV specialist inpatient consultant advice and expertise (locally or via a network)
    • access to diagnostic laboratory services as required
    • access to other medical and surgical specialty advice and services when required
    • access to psychosocial and welfare advice and support
    • access to peer support
    • access to dietetic, physiotherapy, occupational therapy, and speech and language services, including assessment and provision of inpatient rehabilitation
    • provision of 24-hour access to and use of on-site negative pressure units
    • access to a full range of on-site imaging services
  • Arrangements for care should ensure that access to the above services, advice and provision of results is not delayed and/or potentially impacts negatively on the quality of care provided and treatment outcome

Standard 6: Psychological care

People living with HIV should receive care and support which promotes their mental, emotional and cognitive well-being and is sensitive to the unique aspects of living with HIV

Quality statements

  • People living with HIV should have access to regular screening to identify their psychological support needs
  • When concerns are raised in screening, people living with HIV should have access to more comprehensive psychological and cognitive assessments, interventions and rehabilitation by suitably competent professionals
  • People living with HIV should be screened for the presence of symptoms of depression, anxiety, drug and alcohol misuse, acute stress disorder, risk of self-harm and cognitive difficulties within the first 3 months of receiving an HIV diagnosis
  • Such screening should be repeated regularly on an annual basis, and following events known to trigger or exacerbate psychological distress or cognitive difficulties
  • Screening may vary from documented responses to specific screening questions, to screening measures and cognitive tests, all of which should be empirically validated for use in HIV or with other chronic health conditions
  • Referral pathways must be in place for further assessment by a suitably competent professional should screening indicate potential support needs
  • People living with HIV should have access to a range of psychological support, services appropriate to their needs
  • People living with HIV should have access to a range of cognitive rehabilitation services appropriate to their needs
  • Psychological support and cognitive rehabilitation services should be organised and provided in line with the stepped-care model as endorsed in the Standards, for psychological support. Support services should be effectively coordinated within a managed clinical framework
  • Psychological support and cognitive rehabilitation should be provided by practitioners who are appropriately trained and have demonstrated required competencies

Standard 7: Sexual health and identification of contacts at risk of infection

People living with HIV should be supported in establishing and maintaining healthy sexual lives for themselves (and their partners)

People with HIV should be supported to protect themselves (and others) from acquiring new sexually transmitted infections, with access to regular screening and prevention interventions for all sexually transmitted infections

People living with HIV should be offered support from staff competent in partner/contact notification with expertise relevant to their individual circumstances. This should enable their personal contacts who are at risk of HIV, including their children, to access HIV testing with = appropriate consideration of confidentiality and safety

Quality statements

Sexual health

  • Sexual health assessment needs to be a regular part of health monitoring for people with HIV
  • All those living with HIV should have easy access to investigation, diagnosis and treatment for sexually transmitted infections (STIs), in line with national guidance. Referral pathways to genitourinary medicine (GUM) should be in place in all HIV services
  • Syphilis serology should be included in the baseline investigations for people at the time of initial HIV diagnosis and at regular intervals according to risk thereafter (3–6-monthly or annually, depending on risk)
  • Hepatitis B and C serology should be included in the baseline investigations for people at the time of initial HIV diagnosis and at regular intervals according to national guidance
  • People living with HIV must be able to access preventative vaccines for hepatitis B and other sexually transmitted infections as they become available
  • People living with HIV should be made aware of the range of interventions which have been shown to reduce risk of onward HIV transmission, including evidence that effective antiretroviral therapy is associated with reduced rates of HIV transmission

Contacts at risk of HIV infection

  • The HIV status of all children born to people living with HIV in the UK should be assessed for risks of vertical transmission, where children are defined as those who have not yet reached their 18th birthday
  • Testing children at risk of HIV infection should be discussed with at least one of the child’s parents or legal guardians if the mother is HIV positive or her HIV status is unknown, and appropriate testing and follow-up organised with paediatric colleagues
  • All those living with HIV should be offered support and guidance with partner notification (PN) at the time of HIV diagnosis, and whenever there are new partners whose HIV infection status is unknown
  • Patients should have the option of informing sexual partners themselves (patient referral) with support, or supplying information for a health worker to notify the partner anonymously (provider referral)
  • Progress with PN should be re-visited regularly until resolved, and outcomes documented in the clinical record
  • People living with HIV should be offered written and verbal information which is both culturally and age-appropriate about prevention of HIV transmission, including mechanisms for partners to access post-exposure prophylaxis
  • People living with HIV should be offered access to one or more one-to-one risk-reduction discussions based on a theory of behaviour change, such as motivational interviewing and/or a risk-reduction support group
  • People with HIV should be aware of the importance of avoiding future STIs to which they may be more susceptible, and be more infectious to others in the context of underlying HIV infection
  • People who have been diagnosed HIV positive should be made aware of their legal position on HIV transmission, and how to protect themselves from prosecution

Standard 8: Reproductive health

People living with HIV should have access to safe, effective, and acceptable methods of fertility regulation, both for conception and contraception. Women living with HIV must be able to access appropriate health care services for a safe pregnancy and childbirth which provide the best chance of having a healthy infant

Quality statements

  • The reproductive health of HIV-positive people should be addressed by HIV services, with reproductive counselling and support available within HIV services
  • All women who are HIV positive should have access to accurate information about contraceptive choices, including specialist advice on safe options for women using antiretroviral drugs. This should be available within the specialist HIV unit, and pathways should be developed with dedicated local contraceptive services (with knowledge of the issues pertaining to HIV) for provision of contraception if appropriate
  • People with HIV should have access to accurate information and support for safe conception, including pre-conception advice for themselves and their partners within their specialist HIV unit
  • People with HIV who require investigation and treatment for infertility should be able to access local or regional fertility/conception services. Pathways should be in place for referral of couples with fertility issues or in need of assisted conception
  • All trusts with obstetric units need explicit pathways both to ensure the appropriate handling of HIV serology results identified through the antenatal screening programme and to enable women with HIV-positive results rapid consultation with the HIV and pregnancy multidisciplinary team (outlined below)
  • Appropriate timelines for referral to the HIV and pregnancy multidisciplinary team would be:
  • Within 10 working days from the date of the initial HIV-positive result: for an asymptomatic pregnant woman, newly diagnosed HIV positive, booking before the end of the first trimester
  • Within 5 working days of the initial HIV-positive result: for an asymptomatic pregnant woman, newly diagnosed HIV positive, booking after the end of the first trimester or if any interventional diagnostic procedures are planned
  • Within hours of the initial result: for a pregnant woman newly diagnosed HIV positive, who has HIV-related symptoms, or is in labour or is within days of her expected delivery date
  • The management of pregnancy, childbirth and the immediate postnatal period for women with HIV should be in line with current national guidelines and undertaken by a specialist multidisciplinary team (to include obstetrician, HIV specialist physician, specialist midwife, specialist HIV pharmacist and paediatrician) with expertise in HIV and pregnancy. Designated individuals within a trust or network should be identified
  • Provision of antiretroviral drugs in pregnancy is within the scope of an outpatient HIV unit, but birth plans and plans for paediatric care must be managed in collaboration with obstetric services and local/regional paediatric HIV teams
  • All mothers known to be HIV positive should have access to the full range of interventions which have been shown to reduce the risk of onward HIV transmission, including free infant formula milk for those who are unable to afford it

Standard 9: Self-management

People living with HIV should be enabled to maximise self-management of their physical and mental health, their social and economic well-being, and to optimise peer-support opportunities

Quality statements

  • People living with HIV should have access to services which promote self-management of HIV including:
    • provision of practical and empowering support and information about HIV, treatment, healthy living with HIV, diet and lifestyle, and optimisation of general health
    • provision of support and information on maximisation of entitlement to health services and support
    • provision of support and information to enable people to optimise their entitlement and access to financial and housing support, and to optimise their ability to gain/regain employment
    • self-management services including access to peer-support opportunities should be available in a choice of modalities, and should be accessible both via HIV specialist clinical services and by direct access
    • HIV services should have referral arrangements in place to enable people living with HIV to access services delivered by HIV support services either locally or by remote access (e.g. online or via telephone)
    • services should be delivered by providers with appropriate expertise and competencies. Wherever appropriate and relevant, providers should have the requisite professional qualifications and be appropriately accredited HIV services should seek to optimise the involvement of skilled peer workers with HIV, in service delivery, thus optimising integral peer-to-peer self management support. These skilled peer workers should have a structured recruitment and training process and have access to appropriate supervision and professional development
    • HIV services should maximise opportunities for patients to self-manage their condition

Standard 10: Participation of people with HIV in their care

People living with HIV should have opportunities to be actively involved in decisions about their health care. People who use HIV clinical services should have opportunities to be involved in the design, planning and delivery of these services

Quality statements

Individual decisions about treatment and care

  • Services should ensure that decisions made together by people with HIV and practitioners follow national guidance and professional standards for shared decision-making in all aspects of care
  • Services should ensure that decisions about antiretroviral therapy (ART) follow BHIVA guidelines for patient involvement in decision-making
  • Services should ensure that people with HIV have access to written information about investigations, ART and other aspects of their HIV treatment and care, or are able to provide the equivalent orally if this is preferred or necessary. At a minimum, services should ensure access to written information about:
    • the purposes and methods of monitoring CD4 and viral load, and what these tests mean
    • how ART works, including the importance of adherence and the risks and benefits of treatment
    • the choices for ART, including potential side effects from individual drugs and how these will be managed if they occur
  • Services should ensure that information on ART and its risks and benefits supports the key decision issues of whether to start, change or cease treatment, using ART during pregnancy, and the impact of treatment to protect sexual partners
  • People with HIV should expect information to be available in language that is understandable and in a format relevant to individual needs, including age and literacy level, of the person receiving care
  • Making shared decisions about health care requires specific skills and confidence. Access to decision-making tools may help discussion on particular aspects of care
  • Developing capability for shared decision-making should be encouraged and facilitated in both clinicians and people with HIV, in particular for those whose background circumstances may militate against their full participation in evaluating options for treatment and care

Planning services

  • To ensure that services are fit for purpose and responsive to users’ needs, opportunities (formal and informal) should be available for people with HIV to be involved in service planning and review of delivery. Opportunities for service-user involvement should be multiple, varied and widely publicised
  • Service users should expect to be able to provide feedback, ranging from comment on individual consultations to involvement in service commissioning, as well as the chance to give named and anonymous input into service design, delivery and performance review at local, regional and national level. Service user involvement should be incorporated into national treatment guidelines
  • Information related to consultations about service planning and delivery should be published in appropriate physical (e.g. public notice boards) and virtual (e.g. service provider’s web site) locations
  • Formal structures for service design and review should always factor in adequate time for meaningful service-user input and include community representatives who should, as far as is practical, reflect the diversity of the population served. There should be transparent mechanisms for selection of community representatives and for the wider involvement of people with HIV in these structures
  • Practitioners and managers within HIV services should be supported to acquire the skills and resources needed for fruitful engagement and consultation with service users

Standard 11: Competencies

People living with HIV should receive care overseen by a consultant physician specialist in HIV and provided by practitioners with appropriate competencies within suitable and recognised governance and management structures

Quality statements

  • Provision of HIV care should be a recognised activity at the trust/organisational level. There must be clear lines of accountability through appropriate clinical directorate(s) right up to board level
  • People who are HIV positive should experience care that is delivered to the highest standards of confidentiality, privacy and dignity, in line with GMC guidance and national standards
  • HIV remains a stigmatising condition that disproportionately affects already vulnerable people, and all staff at all levels in any HIV service must have appropriate training and induction organised by the service in HIV awareness.
  • All health care professionals engaged with provision of specialist HIV services are required not only to maintain their competencies, but should also be supported to disseminate their expertise through teaching, training and sharing of best practice

Medical team

  • The HIV-related knowledge and skills required for GU medicine specialist trainees to complete training are outlined in the syllabus of the GU medicine curriculum (Learning objectives 21–38 www.jrcptb.org.uk). For infectious disease specialists the 2010 curriculum for infectious diseases (± tropical medicine) gives details of the competencies required to manage patients with HIV infection
  • Specialist knowledge of these areas is required for the management of HIV, and therefore consultant physicians overseeing care should be competent in these areas. The Diploma of HIV Medicine (Dip HIV Med) is compulsory for specialist trainees in genitourinary medicine enrolled on the 2010 curriculum (or later). The syllabus for the exam is updated regularly. The exam is also highly recommended for ID trainees although it is not compulsory. In order for ID trainees to complete specialist training it is required that they pass the Specialty Certificate Examination (SCE), which includes assessment of HIV medicine. The details of this exam, including the syllabus and blueprint, can be viewed atwww.mrcpuk.org/document/sce-infectious-diseases-blueprint2015-0
  • A majority of current consultants caring for patients with HIV do not at present hold the Dip HIV Med, but the examination syllabus can act as a useful resource for appraisal and re-validation. During appraisal (to be completed annually), HIV-specific continuing professional development (CPD) should be assessed and this should be further reviewed during 5-yearly re-validation. Personal development plans should include educational or training activities that relate directly to HIV care. Usually this will include attendance at a national or international meeting at least once every 2 years. For specialists undertaking inpatient care of people with HIV (see Standard 5), or who undertake care of people with complex comorbidities or coinfections, it is critical that the appraisal process includes these areas and also addresses the need to keep up to date in general medicine. Suitable CPD-approved general medicine courses include those organised by the RCP and BHIVA
  • For non-specialist doctors and trainees undertaking care it is essential that there is a named clinical supervisor who is a specialist in HIV medicine and that regular and appropriate clinical supervision takes place in addition to annual appraisal and 5-yearly re-validation

Nursing team

  • Specialist HIV nursing should be provided by registered nurses, with support from health support workers if appropriate. The knowledge and skills required for specialist HIV nursing care are outlined in the NHIVNA National HIV Nursing Competencies (June 2007; currently under review). Registered nurses should demonstrate competence to the appropriate level in the four core areas of assessment of health and well-being, management of ART, health promotion and working in partnerships; and additionally where relevant the specialist competencies for outpatients, inpatients, research or paediatrics. The competency levels required relate not only to job banding and job specification but also the level of specialist HIV care that is required. This level will differ for an HIV specialist nurse in an HIV clinical area compared to a generalist nurse providing some HIV care within their role, for example, a district nurse
  • The process of assessment of competence will be locally determined and should be multi-faceted including, for example, direct observation and reflective practice. Assessment should be part of appraisal, objective-setting and personal development planning and should be based on the NHIVNA competency framework
  • Nurses are required by the Nursing and Midwifery Council (NMC) to undertake and record 35 hours of learning activity relevant to their role over 3 years to retain their registration. Learning opportunities for specialist nurses are: NHIVNA on-line training 9 hours CPD at level 2, and 1.5 hours at level 3 (www.hivinsight.co.uk), some HIV modules at diploma and degree level and local/national conferences and study days. Nurses working in advanced practice should undertake non-medical prescribing and preferably undertake master’s-level education, although currently this is only locally determined by health trusts

Pharmacy team

  • Specialist pharmacy support should be provided by registered pharmacists and pharmacy technicians who are competent in the pharmaceutical care issues of people living with HIV. They should have current appropriate knowledge and skills and be appraised annually. They should complete at least nine mandatory CPD entries each year to retain registration. A proportion of these entries should be in HIV-related areas or associated comorbidities reflecting the proportion of their role in HIV clinical care
  • In addition, any requirements of competency assessment with the HIV Pharmacy Association (that may include a credentialing system under development with the Royal Pharmaceutical Society) should be met. Sole practitioners should be part of a wider, professional network. Specialist pharmacists who practise as non-medical prescribers will, in addition, fulfil the requirements of the National Prescribing Centre Competency Framework for Prescribers, under the supervision of an HIV consultant. They should have shared access to the patient care record and prescribe within their scope of practice

Allied professionals

  • The exact composition of the multidisciplinary team will depend on the sizand location of the HIV service. Members of the team should work within the relevant management and governance structure of their organisation and work within the competencies for the applicable profession. Annual appraisal, including an assessment of HIV-related activities, should be undertaken by all professions irrespective of discipline

Dietetics team

  • Specialist dietetic input should be provided by registered dietitians (RDs) and dietetic assistants competent in the dietetic care of people living with HIV. The knowledge and skills required for specialist HIV dietetic care are outlined in the DHIVA Dietetic Competency Framework (in publication). They should demonstrate competence to the level appropriate for the level of specialist HIV care that is required, reflected in their job banding and job specification. The process of assessment of competence will be locally determined and should be part of appraisal, objective-setting and personal development planning
  • Dietitians are required by the Health Professions Council to maintain an accurate record of their CPD activities. The HIV specialist dietitian should include a proportion of these activities in HIV-related areas and associated comorbidities, and ensure that their CPD has contributed to the quality of their practice and service delivery within the HIV MDT

Rehabilitation team

  • Physiotherapists, occupational therapists and speech and language therapists should be registered with the Health and Care Professionals Council (HCPC) and in addition to the HCPC more specific competencies are outlined in the RHIVA Competencies (2012). Physiotherapists working in any setting should have advanced or senior-level skills in neurological, respiratory and musculoskeletal practice, whilst occupational therapists and speech and language therapists should have advanced or senior-level skills in neurological practice and in particular neurocognitive assessment and treatment. Therapists working in HIV specialist settings should also be able to demonstrate HIV-related continuous professional development activity such as completing a RHIVA study day or an on-line HIV rehabilitation module

Competencies to prescribe ARVs

  • Possession of the requisite competencies to prescribe ARVs has been more clearly defined for some prescribers than for others
  • For medical practitioners, specialist training in infectious diseases and genitourinary medicine requires demonstration of competence in prescribing, monitoring and supporting antiretroviral therapy. This may be gained in practice or delivered through basic and advanced specialist courses, and assessed in training and through successful acquisition of diplomas in GUM, HIV or infectious diseases. Engagement in specialist training, or specialty certification in genitourinary medicine, infectious diseases or general internal medicine can provide evidence of ARV-prescribing competency, which may be supported by a demonstrable HIV caseload and acceptable treatment outcomes. Nurses and pharmacists carrying out advanced practice roles such as nurse/pharmacist consultant, senior clinical practitioner or senior nurse/pharmacist manager may prescribe under the supervision of an HIV consultant within the scope of supplementary or independent non-medical prescribing according to local and national protocols (NPC Competency Frameworks, 2012; NHIVNA National HIV Nursing Competencies, 2007; and HIVPA & Specialist Curriculum Group Handbook for Specialist & Advanced Practice in HIV, 2009)

Standard 12: Information for public health surveillance, commissioning, audit and research

Services delivering HIV care should actively provide data to national surveillance programmes and national and local audits, and for research purposes

People with HIV should expect to be informed of opportunities to take part in ethically approved research that is relevant to their health and care

Quality statements

  • People with HIV should expect that their health record will be used, in confidence, by a health professional or by a person who has the same duty of confidentiality. Only data that are useful for surveillance, commissioning, monitoring of care or research will be collected and the information will not be used for any other purpose.
  • All data must be held securely and according to information governance standards and the law.
  • All HIV service providers should have robust information systems with dedicated data-management staff to ensure accurate, complete and up-to-date information
  • All HIV services must have clear mechanisms for ensuring data quality – ideally direct extraction from an electronic clinical record system, which is accurately maintained in real time
  • Providers of HIV services must actively participate in public health surveillance, national clinical audits and applicable research programmes
  • Public health surveillance data should be submitted electronically via a secure web portal within 6 weeks of the end of the reporting period. Inconsistencies in data must be corrected within 2 weeks of notification
  • All providers of NHS HIV care (which may increasingly include independent providers) should take part in relevant national and local audit and applicable research programmes. Where taking part in a research programme, data should be provided in a timely manner, as agreed with study investigators.
  • All HIV services should have procedures to alert people to appropriate opportunities for them to join in ethically approved research programmes and clinical trials if they so wish

full guidelines available from…
British HIV Association, 1 Mountview Court, 310 Friern Barnet Lane, London, N20 0LD (Tel – 020 8369 5380)

British HIV Association. 2013 Standards of care for people living with HIV. London: BHIVA; 2012
First included: February 2014.