HIV TESTING IN PRIMARY CARE

AIM To provide information enabling any clinician to perform an HIV test within good clinical practice and to encourage normalisation of HIV testing

FACTS & STATISTICS 1.Early treatment improves outcome for the individual & public health 2.Treatment reduces morbidity, mortality & onward infectivity 3.Early diagnosis & treatment is cost effective 4.24% of HIV deaths in 2006 were attributable to diagnosis made too late for effective treatment 5.1/3 of HIV infective adults in UK remain undiagnosed

Who should test ? Any doctor Any midwife Any nurse or trained healthcare

Who should be offered a test 1.Universal testing: I.Antenatal services II.Drug dependency III.Gum, sexual health & TOP IV.Diagnosed with TB, Hep B, Hep C & lymphoma 2. Prevalence in local population > 2 in 1000

3. High risk groups: I.UPSI ( African, SE Asia ) II.IVDU III.All pts with STI IV.Contacts of pts known HIV+ V.MSM ( & female contacts) VI.Country with high prevalence

4. Where HIV may enter the differential diagnosis Bacterial pneumonia Peripheral neuropathy Severe seborrhoeic dermatitis Severe psoriasis Recurrent herpes zoster Oral candidiasis Unexplained weight loss Unexplained chronic diarrhoea CIN grade 2 & above Unexplained blood dyscrasia PUO Lymphadenopathy of unknown cause Mononucleosis like syndrome

5. In accordance with existing DOH guidelines Blood donors Dialysis patients Organ transplant donors and recipients

Pre –test discussion Purpose : Informed consent Lengthy discussion is not a requirement unless the patient requests or needs this

Low risk & High risk Benefits of testing Details of how results will be given Questions Document above No need for written consent

High risk in Tayside HIV Services What support does the patient have Referral pathway Occupation & Impact Insurances & Mortgages

Results Not on a Friday Telephone consultation if low risk Face to face if: i.High risk ii.Mental health issues iii.English 2 nd language iv.< 16 v.Vulnerable / anxious

Post test discussion Negative result: Health promotion PEP Repeat testing Positive result Referral pathways Immediate concerns Support

Services in Tayside Referral pathways –I.D or GUM ( both have a HIV nurse) Same day testing at NW –Tuesday, Wednesday and Thursday Next clinic testing at PRI –Monday & Thursday Body positive Tayside

Websites

Questions ???