HIV Testing in Primary Care: Feasibility and Acceptability of Provider Initiated HIV Testing and Counseling for Sub-Saharan African Migrants

Abstract

Provider-initiated HIV testing and counseling (PITC) is recommended to reduce late HIV diagnoses, common among Sub-Saharan African migrants (SAM) residing in Europe. Primary care represents an ideal entry point for PITC. To support Flemish general practitioners (GPs), we developed a culturally sensitive PITC tool. Over a 12-week period, 65 GPs implemented PITC to assess acceptability and feasibility of PITC. The qualitative evaluation showed high acceptability among physicians. Routine PITC was challenged by physicians' personal discomfort, assumptions of patients' sexual risk, perceived incoherence with reasons for consultation, and time pressure. The best opportunity for PITC was an indicated blood analysis for other medical reasons. Counseling skills improved during the implementation, but participants still advocated for reduced counseling requirements. PITC proved to be feasible in primary care settings, but the up-scaling requires a reformulation of counseling guidelines, a policy stipulating the role of GPs in the prevention-care continuum, and an investment in (continuous) training.

Evaluating a pilot process for reviewing late HIV diagnoses in England and Wales

“…13,14 However, there is evidence that provision of specific training, practical tools or an HIV testing promotion programme may improve HIV testing rates in general practice, particularly in areas of high prevalence. [15][16][17][18] In this pilot, PLWH for whom MO were identified were more likely to be white, and UK-born, consistent with other studies suggesting that individuals born in high-income countries may be inaccurately presumed to be low risk for HIV by healthcare providers when they present without apparent risk factors. 19,20 Data on the nature of MO were not specifically collected, however the most common indicator conditions identified were mononucleosis-like illness, recurrent leukopenia or thrombocytopenia, recurrent shingles, candidiasis, lymphadenopathy and weight loss.…”

Restricted access to antiretroviral treatment for undocumented migrants: a bottle neck to control the HIV epidemic in the EU/EEA

“…At the provider level, barriers consist primarily of discomfort when approaching the subject of sexual health and HIV, lack of training to increase health care providers’ competence in conducting HIV testing, lack of knowledge about symptoms of undiagnosed HIV infection and logistical barriers such as cost and time constraints [ 33 , 40 , 41 ]. Health care providers and administrators may also be unaware of undocumented migrants’ entitlements to access testing services or face complex procedures for the provision and the reimbursement of these services [ 38 ].…”

HIV testing strategies employed in health care settings in the European Union/European Economic Area (EU/EEA): evidence from a systematic review

“…Thirty studies evaluated the impact of a testing intervention by comparing the intervention data with baseline data (n = 24) [20,26,34,44,47,65,72,75,78,80,83,87,95,96,98,102,111,113,125,126,130,133,135,141] or with a control group (n = 6) [22,77,81,82,120,136] (Table 2). Twelve studies employed novel testing (10 rapid testing and two self-sampling) in diverse settings, of which one reported an increase in HIV test coverage from 2% before the intervention to 45% after [65], while others reported increases in HIV diagnoses [77,141], testing [44,75,83,102] and test acceptance [81] and higher positivity rates [34] after the intervention.…”