Barriers to HIV testing outside the HIV-specialist setting and how to overcome them

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Barriers to HIV testing outside the
HIV-specialist settingand how to overcome them
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HIV testing pre-HAART
Benefits of testing Limited treatment Prognosis
poor Highly stigmatised

• Barriers to testing
• Clinicians
• Feeling deskilled
• Time pressures
• Specialists only
• Patients
• Feeling affronted by presumed assumptions
• Who to tell, who not to tell
• Implications of positive result

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HIV testing post-HAART

• Barriers to testing
• Clinicians
• Skills used in daily practice
• Routine investigation
• Any healthcare professional
• Patients
• Routine investigation
• Clear information
• Benefits explained

Benefits of testing Effective treatment (Cost-eff
ective!) Good prognosis Legal protections
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What worked in other settings?

• Setting a national target for HIV testing
• Antenatal 90 uptake by 2002
• GUM 60 uptake by 2007
• Including HIV test in routine screen
• Opt-out strategy
• Discarding routine in-depth pre-test
  counselling
• Using patient information leaflets on HIV test
• Emphasising benefits of knowing HIV status
• NB high-risk patients may need more in-depth work

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Uptake and outcome of HIV testing in sentinel GUM
clinics, UK
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Estimated proportion of HIV-infected pregnant
women diagnosed before delivery1 and of exposed
infants becoming infected with HIV2, England
Scotland
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Key partnerships

• Public Health
• Microbiologists
• Clinicians
• PCT commissioners
• Care Pathways
• Primary and secondary care providers
• Voluntary organisations
• Network development (sub-regional)

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The Grand Round
The venereologists contribution
What was the WR result?
Syphilis the great mimic
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The Grand Round
The GUM physicians contribution
What was the HIV test result?
HIV the 21st century mimic
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What needs to be in place?

• Education
• Grand rounds think HIV!
• Specialty rounds
• Postgraduate seminars
• Support
• Prepare local guidelines and protocols
• Clarify referral and care pathways
• Develop patient information
• Monitoring
• Joint research / audit projects
• PCT targets and audits
• Auditable standards in HIV testing guidelines

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Summary

• Benefits of HIV detection far outweigh risks
• Opt-out testing overcomes barriers
• So
• Develop partnerships
• Support colleagues and patients
• Challenge stigma
• Monitor outcomes
• Learn from experience elsewhere

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Also contains UK National Guidelines for HIV
Testing 2008 from BASHH/BHIVA/BIS
Available from enquiries_at_medfash.bma.org.uk or
020 7383 6345