1

Barriers to HIV testing outside the HIV-specialist setting

and how to overcome them

2

HIV testing – pre-HAART

Benefits of testingLimited treatmentPrognosis poorHighly stigmatisedBarriers to

testingClinicians:•Feeling deskilled•Time pressures•Specialists only•Patients:•Feeling affronted by presumed assumptions

•Who to tell, who not to tell•Implications of positive result

3

HIV testing – post-HAART

Benefits of testing Effective treatment(Cost-effective!)Good prognosisLegal protections

Barriers to testingClinicians:•Skills used in daily practice•Routine investigation•Any healthcare professionalPatients:•Routine investigation•Clear information•Benefits explained

4

What worked in other settings?

• Setting a national target for HIV testing– Antenatal: 90% uptake by 2002– GUM: 60% uptake by 2007

• Including HIV test in routine screen– Opt-out strategy

• Discarding routine in-depth pre-test ‘counselling’– Using patient information leaflets on HIV test– Emphasising benefits of knowing HIV status– NB: high-risk patients may need more in-depth work

5

Uptake and outcome of HIV testing in sentinel GUM clinics, UK

Estimated proportion of HIV-infected pregnant women diagnosed before delivery1 and of exposed infants becoming infected with HIV2, England & Scotland

6

7

Key partnerships

• Public Health• Microbiologists• Clinicians• PCT commissioners• Care Pathways

– Primary and secondary care providers– Voluntary organisations– Network development (sub-regional)

8

“What was the WR result?”

Syphilis – the great mimic

The venereologist’s contribution

The Grand Round

9

The Grand Round

“What was the HIV test result?”

HIV – the 21st century mimic

The GUM physician’s contribution

10

What needs to be in place?

• Education– Grand rounds – think HIV!– Specialty rounds– Postgraduate seminars

• Support– Prepare local guidelines and protocols– Clarify referral and care pathways– Develop patient information

• Monitoring– Joint research / audit projects– PCT targets and audits– Auditable standards in HIV testing guidelines

11

Summary

• Benefits of HIV detection far outweigh risks• Opt-out testing overcomes barriers

So…• Develop partnerships• Support colleagues and patients• Challenge stigma• Monitor outcomes• Learn from experience elsewhere

12

Also contains

UK National Guidelines for HIV Testing 2008

from BASHH/BHIVA/BIS

Available from:

enquiries@medfash.bma.org.uk or 020 7383 6345