Use and Effectiveness of HIV Indicator Conditions in Guiding HIV Testing: A Review of the Evidence

Davies, Charlotte; Gompels, Mark; May, Margaret T

doi:10.9734/isrr/2017/36373

Cited by 5 publications

(6 citation statements)

References 48 publications

(122 reference statements)

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“…The system was found to be useable and acceptable by hospital doctors, GPs and nurses and there was a 6% increase in testing rates over the 3-month study period [54]. A recent literature review has provided evidence that HIV ICs have the potential to be used more effectively as triggers for earlier HIV testing [55].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of an educational intervention to increase HIV-testing in high HIV prevalence general practices: a pilot feasibility stepped-wedged randomised controlled trial

et al. 2018

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BackgroundHIV-infected patients often present to primary care several times with HIV-indicator conditions before diagnosis but the opportunity to test by healthcare professionals (HCPs) is frequently missed. Current HIV testing rates in primary care are low and educational interventions to facilitate HCPs to increase testing and awareness of HIV are needed.MethodWe implemented a pilot feasibility stepped-wedged randomised controlled trial of an educational intervention in high HIV prevalence practices in Bristol. The training delivered to HCPs including General Practitioners (GP) aimed to increase HIV testing and included why, who, and how to test. The intervention was adapted from the Medical Foundation for HIV and Sexual Health HIV Testing in Practice (MEDFASH) educational tool. Questionnaires assessed HCP feedback and perceived impacts of the intervention. HIV testing rates were compared between control and intervention practices using 12 monthly laboratory totals.Results169 HCPs (from 19 practices) received the educational intervention. 127 (75%) questionnaires were completed. Delivery of the intervention was received positively and was perceived as valuable for increasing awareness, confidence and consideration of testing, with HCPs gaining more awareness of HIV testing guidelines. The main pre-training HIV testing barrier reported by GPs was the patient not considering themselves at risk, whilst for nurses it was a concern about embarrassing or offending the patient. Most HCPs reported the intervention addressed these barriers. The HIV testing rate increased more in the control than in the intervention practices: mean difference 2.6 (95% CI 0.5,4.7) compared with 1.9 (− 0.5,4.3) per 1000 patients, respectively. The number of HIV tests across all practices increased from 1154 in the first 6 months to 1299 in the second 6 months, an annual increase in testing rate of 2.0 (0.7,3.4) from 16.3 to 18.3 per 1000 patients.ConclusionThere was a small increase in HIV testing rates over the study period, but this could not be attributed to the educational intervention. More effective and sustainable programmes tailored to each practice context are needed to change testing culture and HCP behaviour. Repeated training, supported by additional measures, such as testing prompts, may be needed to influence primary care HIV testing.Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0880-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Evaluation of an educational intervention to increase HIV-testing in high HIV prevalence general practices: a pilot feasibility stepped-wedged randomised controlled trial

et al. 2018

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“…An electronic prompt almost doubled the rates of universal HIV screening by primary care providers in a Midwest practice in the USA and reduced racial disparities 29. Federman et al added a reminder to the medical records within the Veterans Affairs healthcare system in the USA based on the risk factors for HIV, leading to an increase in testing of 369% 12. Schrantz et al developed a web-based patient tracking software to flag selected patients for testing and found an association between the use of the system and a 262% increase in testing frequency (from 29.6 to 80.5 tests per month) 12.…”

Section: Discussionmentioning

confidence: 99%

“…Federman et al added a reminder to the medical records within the Veterans Affairs healthcare system in the USA based on the risk factors for HIV, leading to an increase in testing of 369% 12. Schrantz et al developed a web-based patient tracking software to flag selected patients for testing and found an association between the use of the system and a 262% increase in testing frequency (from 29.6 to 80.5 tests per month) 12. Goetz et al used reminders triggered by STI and behavioural risk factors and found an increase in the frequency of testing and the number of new diagnoses made 12…”

Section: Discussionmentioning

confidence: 99%

Indicator condition-guided HIV testing with an electronic prompt in primary healthcare: a before and after evaluation of an intervention

Redondo¹,

Ruíz²,

Kostov

et al. 2019

Sex Transm Infect

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ObjectiveIndicator condition (IC)-guided HIV testing is a strategy for the diagnosis of patients with HIV. The aim of this study was to assess the impact on the proportion of HIV tests requested after the introduction of an electronic prompt instructing primary healthcare (PHC) physicians to request an HIV test when diagnosing predefined IC.MethodsA prospective interventional study was conducted in 2015 in three PHC centres in Barcelona to assess the number of HIV test requests made during the implementation of an electronic prompt. Patients aged 18–65 years without HIV infection and with a new diagnosis of predefined IC were included. The results were compared with preprompt (2013) and postprompt data (2016).ResultsDuring the prompt period, 832 patients presented an IC (median age 41.6 years [IQR 30–54], 48.2% female). HIV tests were requested in 296 individuals (35, 6%) and blood tests made in 238. Four HIV infections were diagnosed (positivity rate 1.7%, 95% CI 0.5% to 4.4%). The number of HIV tests requested based on IC increased from 12.6% in 2013 to 35.6% in 2015 (p<0.001) and fell to 17.9% after removal of the prompt in 2016 (p<0.001). Younger patient age (OR 0.97, 95% CI 0.96 to 0.98), birth outside Spain (OR 1.53, 95% CI 1.06 to 2.21) and younger physician age (OR 0.97, 95% CI 0.96 to 0.99) were independent predictive factors for an HIV test request during the prompt period. The electronic prompt (OR 3.36, 95% CI 2.70 to 4.18) was the factor most closely associated with HIV test requests. It was estimated that 10 (95% CI 3.0 to 26.2) additional new cases would have been diagnosed if an HIV test had been performed in all patients presenting an IC.ConclusionsA significant increase in HIV test requests was observed during the implementation of the electronic prompt. The results suggest that this strategy could be useful in increasing IC-guided HIV testing in PHC centres.

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“…Evidence suggests that more effective use of HIV ICs has the potential to trigger earlier HIV testing [37]. In support of this finding, a retrospective case-notes review in NHS City and Hackney Primary Care Trust of patients known to be HIV positive found that despite 51 out of 89 (57.3%) patients presenting to their GP with at least one HIV IC in the 2 years prior to diagnosis, only 17 (33.3%) were subsequently diagnosed with HIV by their GP [11].…”

Section: Discussionmentioning

confidence: 99%

Qualitative evaluation of a pilot educational intervention to increase primary care HIV-testing

et al. 2019

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Background UK guidelines recommend a ‘routine offer of HIV testing’ in primary care where HIV diagnosed prevalence exceeds 2 in 1000. However, current primary care HIV testing rates are low. Efforts to increase primary care HIV testing are needed. To examine how an educational intervention to increase HIV testing in general practice was experienced by healthcare professionals (HCPs) and to understand the perceived impacts on HIV testing. Method Qualitative interviews with general practitioners (GPs) and nurses 3-months after receiving an educational intervention developed from an adapted version of the Medical Foundation for HIV and Sexual Health (MEDFASH) HIV Testing In Practice (TIPs) online educational tool which included training on HIV associated clinical indicator conditions, why, who, and how to test. The intervention was delivered in 19 high-HIV prevalence general practices in Bristol. 27 semi-structured interviews were conducted across 13 practices with 16 GPs, 10 nurses and the sexual health clinician who delivered the intervention. Transcripts were analysed thematically informed by Normalisation Process Theory. Results HCPs welcomed the opportunity to update their HIV knowledge through a tailored, interactive session. Post-training, HCPs reported increased awareness of HIV indicator conditions, confidence to offer HIV tests and consideration of HIV tests. Continued testing barriers include perceived lack of opportunity. Conclusions This qualitative study found that HIV education is perceived as valuable in relation to perceived awareness, confidence, and consideration of HIV testing. However, repetition and support from other strategies are needed to encourage HCPs to offer HIV tests. Future interventions should consider using behaviour change theory to develop a complex intervention that addresses not only HCP capability to offer an HIV test, but also issues of opportunity and motivation.

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Use and Effectiveness of HIV Indicator Conditions in Guiding HIV Testing: A Review of the Evidence

Cited by 5 publications

References 48 publications

Evaluation of an educational intervention to increase HIV-testing in high HIV prevalence general practices: a pilot feasibility stepped-wedged randomised controlled trial

Evaluation of an educational intervention to increase HIV-testing in high HIV prevalence general practices: a pilot feasibility stepped-wedged randomised controlled trial

Indicator condition-guided HIV testing with an electronic prompt in primary healthcare: a before and after evaluation of an intervention

Qualitative evaluation of a pilot educational intervention to increase primary care HIV-testing

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