Four-Stage Audit Demonstrating Increased Uptake of HIV Testing in Acute Neurology Admissions Using Staged Practical Interventions

Abstract

BackgroundUK National Guidelines (UKNG) advise HIV testing in clinically indicated neurological presentations. We audited the impact of our practical strategies to increase uptake of HIV testing at a regional acute neurology admissions unit.MethodsWe audited HIV testing in 4 periods over 2 years: before we designed a UKNG-based “HIV testing in Neurology” protocol (“pre-protocol”); after dissemination of the protocol alone (“post-protocol”); post-protocol dissemination combined with both a tailored departmental admissions clerking proforma to prompt for HIV testing & consenting, and regular focussed tutorials to doctors on HIV testing in neurological patients (“post-proforma”); and finally one year after the post-proforma period (“+1 year”). We also looked at the total number of HIV tests sent from the unit during the two-year period. We assessed significance using Fisher’s exact test.Results47.8% of all acute neurology non-stroke admissions were eligible for HIV testing during all the audit periods. Testing rates were as follows: pre-protocol 21.9%; post-protocol 36.6%; post-proforma 83.3%; and at +1 year 65.4% (p<0.05 for both post-protocol and +1 year when compared to pre-protocol). Documentation of consent for HIV testing improved from 25% to 67.6% with the HIV-tailored clerking proforma. The total number of HIV tests requested from the unit doubled in the post-proforma period compared to pre-protocol (p<0.05).ConclusionIn conclusion: the combination of an HIV testing protocol, a tailored departmental clerking proforma and regular focussed teaching to doctors on indications for HIV testing led to a sustained increase in HIV testing uptake in our regional acute neurology admissions unit.

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

“…Twitter) and promotional materials . A significant number of educational intervention studies targeted providers ( n = 19), with the majority providing HIV testing training sessions to health care professionals including hospital doctors, general practitioners (GPs), medical students and nurses and pharmacists . One employed the plan, do, study, act (PDSA) methodology, which increased physicians’ willingness to test but did not increase testing .…”

“…Routine testing was most commonly implemented in hospital departments including emergency departments (n = 15) [20,21,25,35,36,64,69,78,92,93,[115][116][117]137,147], inpatient units (n = 10) [24,43,61,95,98,104,111,125,130,135] and outpatient departments (n = 4) [21,74,113,116]. Similarly, IC testing programmes were predominantly instigated in hospitals (n = 8) [109,114,116,[125][126][127][128]135] and primary care (n = 10) [26,38,47,57,88,110,114,116,127,128]. In contrast, integrated testing for HIV with other infections such as hepatitis B and C and STIs was adopted in diverse settings including prisons (n = 3)…”

“…Thirty studies evaluated the impact of a testing intervention by comparing the intervention data with baseline data (n = 24) [20,26,34,44,47,65,72,75,78,80,83,87,95,96,98,102,111,113,125,126,130,133,135,141] or with a control group (n = 6) [22,77,81,82,120,136] (Table 2). Twelve studies employed novel testing (10 rapid testing and two self-sampling) in diverse settings, of which one reported an increase in HIV test coverage from 2% before the intervention to 45% after [65], while others reported increases in HIV diagnoses [77,141], testing [44,75,83,102] and test acceptance [81] and higher positivity rates [34] after the intervention.…”

“…Another used serious incident reporting to improve testing awareness within clinics [140]. Where assessed, education provision resulted in an increase in the offer of HIV testing from 2 to 11% [146] and in the number of individuals tested from 11-13 before to 16-20 after the intervention in two smaller studies, and from 420-1056 before to 676-2333 after the intervention in two larger studies [83,105,112,126]. Two studies reported a decline in test offer from 8-15% to 0-10%, which may have been attributable to the small numbers of patients included in the studies (n = 4-26) [68,95].…”

Where do we diagnose HIV infection? Monitoring new diagnoses made in nontraditional settings in England, Wales and Northern Ireland

“…Routine offer to all attendees to health care settings is likely to increase uptake and yield of previously undiagnosed persons at an earlier stage of infection. There is evidence that rate of provider offer could be increased through education of medical staff, particularly junior doctors and medical students , or the use of electronic testing prompts and clinical decision‐making tools .…”