Acceptability and Feasibility of Universal Offer of Rapid Point of Care Testing for HIV in an Acute Admissions Unit: Results of the RAPID Project

Abstract

BackgroundUK guidance recommend all acute medical admissions be offered an HIV test. Our aim was to determine whether a dedicated staff member using a multimedia tool, a model found to be effective in the USA, is an acceptable, feasible, and cost-effective model when translated to a UK setting.DesignBetween 14th Jan to 12th May 2010, a Health advisor (HA) approached 19–65 year olds at a central London acute medical admissions unit (AAU) and offered a rapid HIV point of care test (POCT) with the aid of an educational video. Patients with negative results had the option to watch a post-test video providing risk-reduction information. For reactive results the HA arranged a confirmatory test, and ensured linkage into HIV specialist care. Feasibility and acceptability were assessed through surveys and uptake rates. Costs per case of HIV identified were established.ResultsOf the 606 eligible people admitted during the pilot period, 324 (53.5%) could not be approached or testing was deemed inappropriate. In total 23.0% of eligible admissions had an HIV POCT. Of the patients who watched the video and had not recently tested for HIV, 93.6% (131/140) agreed to an HIV test; four further patients had an HIV test but did not watch the video. Three tests (2.2%, 3/135) were reactive and all were confirmed HIV positive on laboratory testing. 97.5% felt HIV testing in this setting was appropriate, and 90.1% liked receiving the information via video. The cost per patient of the intervention was £21.DiscussionUniversal POCT HIV testing in an acute medical setting, facilitated by an educational video and dedicated staff appears to be acceptable, feasible, effective, and low cost. These findings support the recommendation of HIV testing all admissions to AAU in high prevalence settings, although with the model used a significant proportion remained untested.

New initiatives to develop self-testing for HIV

“…The first '90' is the largest gap with only 53% of those living with HIV currently being diagnosed. Efforts to increase testing rates has led to expansion of testing opportunities and testing interventions to meet the needs of a range of different groups in a variety of contexts (see Table 1) (7)(8)(9)(10). HIV self-testing (HIVST) is simply the latest iteration of testing modalities.…”

Health-care providers’ experiences with opt-out HIV testing: a systematic review

“…Certainly HCPs should receive training about the legislative requirements for pre-test counselling in their locality, but research shows that pretest counselling can be safely abbreviated (Buzdugan , 2012). System-related factors such as a dedicated staff member to do the testing and an educational patient video to provide pre-test information have been found to improve testing rates (Burns et al, 2012). While some HCPs mentioned the lack of pre-test counselling training as a systems-related barrier, they did not discuss post-test counselling, which may be a more important topic for training.…”

Effect of testing experience and profession on provider acceptability of rapid HIV testing after implementation in public sexual health clinics in Sydney

“…Although many studies have assessed acceptability of RHT in a variety of settings and patient groups, and among providers at various stages of implementation [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28], few studies have assessed differences in acceptability between professions [29,30]. To our knowledge, no published studies have examined if the number of tests performed and experience of false test results impact on provider acceptability.…”

“…In contrast, RHT involves finger-prick blood or oral fluid specimen collection with results provided during the same visit, which may make testing more convenient. Barriers to implementing RHT reported among service providers include: lack of time [12,13]; lack of confidence in their own competency and skills and fear of delivering positive results [14,15]; concern regarding reliability and false positive results [16,17]; and perceiving RHT as too difficult for nonexperts [18].Although many studies have assessed acceptability of RHT in a variety of settings and patient groups, and among providers at various stages of implementation [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28], few studies have assessed differences in acceptability between professions [29,30]. To our knowledge, no published studies have examined if the number of tests performed and experience of false test results impact on provider acceptability.…”