Feasibility and acceptability of routine human immunodeficiency virus testing in general practice: your views

Abstract

Early diagnosis of human immunodeficiency virus (HIV) leads to a decreased morbidity and mortality. General practice offers an important window for earlier diagnosis. The British HIV Association produced guidelines in 2008 advocating an increase in HIV testing, with specific references to primary care. This study explores the awareness of, and opinions towards, these guidelines within general practice. An email questionnaire was sent to 191 general practitioners nationwide, in both areas of high and low HIV prevalence. A total of 80 doctors replied, giving a response rate of 42%. In all, 44% of the respondents were unaware of the guidelines and 89% felt comfortable discussing and carrying out an HIV test themselves; of the 11% that did not, all but one were from low prevalence areas (P = 0.037). Respondents felt that main barrier to HIV testing was patient acceptability. Having read the guidelines, 70% believed it would be feasible to follow them in practice. Those who disagreed felt that time implications were the most important reason not to adopt the guidelines. Almost half the respondents were not aware of the guidelines; having read them, the majority felt that implementation is feasible. This demonstrates the necessity for better dissemination of these guidelines. This study found that the main barrier to performing an HIV test was felt to be patient acceptance, a contradiction to findings from recent pilot studies.

Public and Healthcare Practitioner Attitudes towards HIV Testing: Review of Evidence from the United Kingdom (UK)

“…Studies included in the review (including both public and HCP attitudes to testing) were peer reviewed papers (n= 40) [16,[24][25][26][27][28]30,32,33,35,[38][39][40][41]43,[45][46][47][48][49][50][52][53][54][55][56][57]59,61,62,65,69,71,72,75,79,80,84] abstracts from BHIVA conference proceedings (n=20) [29,31,36,37,42,51,58,60] and published reports (n=4) [34,44,85]. UK locations of included studies were as follows; Scotland (n=9) [34,…”

“…The majority of the studies were conducted in areas of high HIV prevalence (> 2/1000 adult population) such as London, Brighton and Glasgow. Studies used a variety of different data collection methods which included: questionnaires (n= 29) [31,33,35,[38][39][40][41]47,48,[51][52][53]55,58,59,60,62,65,66,67,70,71,73,74,75,76,78] focus groups (n=5) [32,51,54 69,84] interviews (n=4) [29,30,50,56], surveys (n=13) [16,24-28, 44,64,68,72,77,80,85], questionnaires and surveys (n=1) [43], questionnaires and focus groups (n=1) [61], interviews and focus groups (n=3) [45,46,49], interviews and questionnaires (n=2) (study included in Table 1 (public attitudes) and also Table 2 (HCP attitudes) [34], survey and questionnaire (n=1) [43], survey and interviews (n=1) [63], audit and questionnaires (n=1) [79], and reviews of case notes/admission notes (n= 3) ...…”

“…For evidence on attitudes of HCP towards HIV testing the review included the following study populations; GPs in primary care practices (n=7) [34,51,[62][63][64]67,77] GPs and nurses in primary care practices (n=1) [66], GPs attending study day on STDs (n=1) [65], hospital doctors (n=8) (70)(71)(72)(73)76,(78)(79)(80), NHS staff working in hospital (n=2) [39,68], hospital consultant surgeons (n=1) [75], hospital Intensive Care Unit (ICU) staff (n=1) [74], staff working in four settings (Emergency Department, Acute care unit, Dermatology outpatients and primary care) (n=2) [53,69].…”

“…Perceived structural barriers to testing by GPs include concerns about patient acceptability of widespread testing [62,63] and difficulty knowing how to maintain patient confidentiality [64]. In addition recent research has highlighted time constraints as a barrier to offering testing in the primary care setting [62,63].…”

“…Studies of HCP have shown a lack of awareness, knowledge and adherence to the BHIVA HIV testing guidelines. A study of 80 GPs from high and low HIV prevalence areas in the UK showed that only 44% of responders were aware of the 2008 BHIVA guidelines, 70% believed it would be feasible to follow the guidelines in practice, but those that disagreed felt that time implications were the most important reason not to implement guidelines [62]. A recent study using a postal survey of 137 GPs in Liverpool found that 50% of GPs had not heard of the 2008 BHIVA HIV testing guidelines [63].…”