BackgroundThis study aims to contribute to the improvement of European progress towards 90–90–90 targets and to identify an intervention with a strong evidence base used in better performing countries such as routine testing in primary care.AimTo evaluate the efficacy of routine HIV testing in primary care and identify the barriers and solutions towards successfully implementation.MethodPeer-reviewed studies which measure changes in provider offer rates, patient uptake rates, seroprevalence or CD4 counts after the implementation of routine HIV testing. Studies which identified barriers and solution to implementation were also included. EMBASE and MEDLINE were searched through April 2018. Risk of bias was assessed using the CASP framework, regarding participant selection, randomisation incomplete outcome data, blinding, and use of sensitivity analyses.ResultsRoutine HIV testing shows increased rates of case finding with earlier diagnosis when compared to standard practice. Factors such as sex, ethnicity, local prevalence, and stigma were found to affect patient uptake, while gaps in training, awareness and organisational implementation affected provider uptake. Provider offer rates require adequate education regarding intervention efficacy, electronic medical record use, and result communication. Addressing time constraints with nurse-initiated testing and combined condition testing can improve the clinical workflow. Normalising HIV testing, including reforming pre-test counselling, rapid testing, and education to reduce stigma can improve patient uptake. Further analysis of cost-effectiveness is also required to effectively consider implementation.ConclusionRoutine HIV testing across primary care can improve testing rates, with consideration to barriers towards implementation and further study.

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AimsLiaison psychiatry provides psychiatric care to medical patients. Patients include those attending emergency departments, general hospital inpatients and outpatients. Liaison teams work hand in hand with several general hospital teams to offer advice, review and manage these patients. Over the last few months, the Liaison service in City Hospital have been receiving many inappropriate referrals. Inappropriate referrals are defined as patients who are referred to services, with one of the following reasons: 1.Insufficient presenting complaint2.No documented Past psychiatric history3.Insufficient Mental state Examination (MSE)4.No risk assessment5.No documented Drug/alcohol history6.Patients having not consented to referral.7.If one or more of the above criteria is not metOur aim was to evaluate the appropriateness of the referrals received from D15, D17, D27 inpatients wards in City Hospital over a 3-month period from July to September 2021. These wards were chosen as they commonly refer patients to liaison services.MethodsWe collated data retrospectively on the nature of all referrals from D15, D17 and D27 ward over a 3-month period. The patient referral portal was used, and referral content of each patient was analysed. An audit tool was devised to assess whether the referrals followed the liaison referral pathway and guidelines set by NHS England for referral structure to liaison services.Results18 patients were referred to the Liaison psychiatry from the three wards over the three-month period. We observed 77.8% (n = 14) of the referrals having insufficient information for the presenting complaints, whilst 22.2% (n = 4) of them did not state past psychiatric history. Approximately 94.4%(n = 17) did not state sufficient details of MSE. In 83.3% (n = 15) of referrals appropriate detailed risk assessment was not done, 27.8% (n = 5) of them did not have alcohol/ drug use stated and 22.2% (n = 4) of patients referred did not consent to the referral being made.ConclusionThe results demonstrated that ward referrals lack quality and contain inadequate information to allow for safe screening of patients and for the implementation of appropriate actions by the liaison team. A possible reason for inappropriate referrals may be due an existing knowledge gap and lack of confidence taking detailed psychiatric histories, assessing risk, and performing MSE in non-psychiatric trainees making referrals to liaison services.