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

2 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

3 HIV testing – post-HAART Benefits of testing Effective treatment (Cost-effective!) Good prognosis Legal protections Barriers to testing Clinicians: Skills used in daily practice Routine investigation Any healthcare professional Patients: Routine investigation Clear information Benefits explained

4 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

5 Uptake and outcome of HIV testing in sentinel GUM clinics, UK

Estimated proportion of HIV-infected pregnant women diagnosed before delivery 1 and of exposed infants becoming infected with HIV 2, England & Scotland 6

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

8 “What was the WR result?” Syphilis – the great mimic The venereologist’s contribution The Grand Round

9 “What was the HIV test result?” HIV – the 21st century mimic The GUM physician’s contribution

10 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

11 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

12 Also contains UK National Guidelines for HIV Testing 2008 from BASHH/BHIVA/BIS Available from: or