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Barriers to HIV testing outside the HIV-specialist setting and how to overcome them

Barriers to HIV testing outside the HIV-specialist setting and how to overcome them. HIV testing – pre-HAART. Benefits of testing Limited treatment Prognosis poor Highly stigmatised. Barriers to testing Clinicians: Feeling deskilled Time pressures Specialists only Patients:

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Barriers to HIV testing outside the HIV-specialist setting and how to overcome them

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  1. Barriers to HIV testing outside the HIV-specialist settingand how to overcome them

  2. HIV testing – pre-HAART Benefits of testing Limited treatment Prognosis poor Highly stigmatised • Barriers to testing • Clinicians: • 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 • Barriers to testing • Clinicians: • Skills used in daily practice • Routine investigation • Any healthcare professional • Patients: • Routine investigation • Clear information • Benefits explained Benefits of testing Effective treatment (Cost-effective!) Good prognosis Legal protections

  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

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

  7. Key partnerships • Public Health • Microbiologists • Clinicians • PCT commissioners • Care Pathways • Primary and secondary care providers • Voluntary organisations • Network development (sub-regional)

  8. The Grand Round The venereologist’s contribution “What was the WR result?” Syphilis – the great mimic

  9. The Grand Round The GUM physician’s contribution “What was the HIV test result?” HIV – the 21st century mimic

  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

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