A cross sectional survey of the barriers for implementing rapid HIV testing among French general practitioners

Abstract

In France, almost 30,000 people are unaware of their HIV-positive status. Innovative screening strategies are essential to reach this population. The aim of this study was to describe the acceptability of rapid HIV testing (RHT) among French general practitioners (GPs) working in the south of France and barriers for implementing this strategy. We analysed an anonymous questionnaire sent by mail to GPs about demographic data, routine practice, knowledge of RHT and barriers to its use. Between 1 April and 30 September 2013, out of the 165 GPs contacted, 78 returned the questionnaires. The GPs' mean age was 52 years; 49 were men. Fifty-one GPs reported that their registered patients included at least one HIV-infected person and 70 GPs reported taking care of high-risk patients. Sixty-three percent of GPs reported being interested in using RHT in their daily practice. The main reasons reported by uninterested GPs were: greater confidence in standard HIV testing, difficulties including RHT during the routine consultation, difficulties to screen for other sexually transmitted infections simultaneously, and difficulties to deliver a positive result. French National Authorities for Health propose to screen the population at least once in their lifetime and high-risk people at least once a year. In order to achieve this aim, RHT should be included in the GPs' arsenal for HIV testing. We showed a high acceptability of RHT by GPs. If specific and adapted training is developed, and if solutions to barriers reported by GPs are found, RHT could be implemented in to their routine activity.

HIV testing strategies employed in health care settings in the European Union/European Economic Area (EU/EEA): evidence from a systematic review

“…Results also suggest that rapid testing is acceptable to both groups (patient studies, n = 5; provider studies, n = 6), with providers willing to use rapid tests [24,53,56,57,107] and finding their interpretation easy [50]. Some feasibility studies highlighted that nontraditional health care settings can target populations not previously tested for HIV (n = 4) [18,85,132,145], with the reported percentage of first-time testers in such settings ranging from 51 to 75%.…”

HIV testing within general practices in Europe: a mixed-methods systematic review

“…It was perceived as a way to reduce HIV-related stigma [ 36 ]. Two studies in France ( N = 352; N = 78) and another in the UK ( N = 144) reported that a majority of GPs were favourable to implement routine testing [ 37 – 39 ]. Nevertheless, a study among GPs in the Pays de Loire (France) ( N = 871) indicated that routine screening of all patients was not a standard practice [ 40 ].…”

“…Nevertheless, a study among GPs in the Pays de Loire (France) ( N = 871) indicated that routine screening of all patients was not a standard practice [ 40 ]. Instead HIV testing was offered to populations at high risk for HIV acquisition, including people who inject drugs, sex workers, MSM and people coming from high HIV endemic countries [ 37 , 40 ].…”

“…Excluding those episodes for which an HIV test was planned, 23.3% never had a test (planned). Fraisse, 2015 [ 37 ] France Cross-sectional questionnaire survey, 2013 78 GPs c working in a 150,000-population district in the south of France For high risk populations, including PWID, d sex workers, MSM e and people coming from high endemic countries, 61% of the GPs proposed HIV testing once a year. Hall, 2015 [ 40 ] France Cross-sectional questionnaire survey among family physicians in the Pays de la Loire, 2011–2012 871 GPs Routine screening of all patients was not a standard practice.…”

“…Offering an HIV test without a patient’s specific request, an immediate diagnostic need, or outside of ‘a window of opportunity’ such as a blood test for other clinical indications or a sexual or reproductive health consultation caused feelings of discomfort among GPs, who expressed concern with regard to the patient’s potential reaction [ 42 , 48 , 49 ]. Therefore, HIV testing practices were generally limited to the above-mentioned situations [ 29 , 32 , 35 – 37 , 40 , 49 ]. However, this observation is not applicable to all settings.…”