HIV Testing Practices by Clinical Service before and after Revised Testing Guidelines in a Swiss University Hospital

Abstract

ObjectivesTo determine 1) HIV testing practices in a 1400-bed university hospital where local HIV prevalence is 0.4% and 2) the effect on testing practices of national HIV testing guidelines, revised in March 2010, recommending Physician-Initiated Counselling and Testing (PICT).MethodsUsing 2 hospital databases, we determined the number of HIV tests performed by selected clinical services, and the number of patients tested as a percentage of the number seen per service (‘testing rate’). To explore the effect of the revised national guidelines, we examined testing rates for two years pre- and two years post-PICT guideline publication.ResultsCombining the clinical services, 253,178 patients were seen and 9,183 tests were performed (of which 80 tested positive, 0.9%) in the four-year study period. The emergency department (ED) performed the second highest number of tests, but had the lowest testing rates (0.9–1.1%). Of inpatient services, neurology and psychiatry had higher testing rates than internal medicine (19.7% and 9.6% versus 8%, respectively). There was no significant increase in testing rates, either globally or in the majority of the clinical services examined, and no increase in new HIV diagnoses post-PICT recommendations.ConclusionsUsing a simple two-database tool, we observe no global improvement in HIV testing rates in our hospital following new national guidelines but do identify services where testing practices merit improvement. This study may show the limit of PICT strategies based on physician risk assessment, compared to the opt-out approach.

Awareness of HIV Testing Guidelines Is Low among Swiss Emergency Doctors: A Survey of Five Teaching Hospitals in French-Speaking Switzerland

“…For the doctors who identified that HIV testing was indicated but stated a low probability that they would perform a test, we did not ask about perceived barriers to testing. We also did not compare reported testing rates with actual rates, although the low figures obtained from the questionnaire agree with our previous study in one of the five centers [6]. Finally, we did not ask about the methods of HIV testing in each centre, specifically, whether any participants use point-of-care rapid testing and whether this influenced the number of tests requested.…”

“…If we assume that all patients attending the EDs we studied are representative of the wider Swiss population, in which HIV seroprevalence is 0.4% [3], then, among the patients presenting to these centers, we would expect 525-700 to be HIV positive (based on Lausanne ED figures, up to 25% of patients present more than once per annum [OH, personal communication]). Using our figures for patient visits per annum (Table S4), we can estimate the HIV testing rate in the EDs we studied (=[tests performed / patients seen] x 100 [6]) by extrapolating the median number of tests performed per doctor per month (=1 test) to the number performed in one year (=1 x 12), and then multiplying by the number of practicing ED doctors. Based on our data in Table S4, the estimated testing rate is 1.1-1.5%.…”

“…We recently reported that the new FOPH recommendations made no difference to testing practices in nine clinical services in our centre and observed that, of the tens of thousands of patients seen in our emergency department (ED) annually, only 1% are tested for HIV [6]. In the present study, as a first step in determining why ED testing rates are so low, we set out to examine whether ED doctors are aware of the new recommendations.…”

Investigating Barriers in HIV-Testing Oncology Patients: The IBITOP Study, Phase I

“…We previously described HIV testing rates of B5% in our oncology centre, against a local HIV prevalence of 0.4% [1]. We have since worked with the Service of Oncology to identify, how HIV testing can be optimized, we have conducted a study on investigating barriers in HIV-testing oncology patients (IBITOP) among treating oncologists and their patients.…”

Investigating barriers in HIV‐testing oncology patients. The IBITOP study: phase I

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Background Since the advent of combined antiretroviral therapy (ART), the incidence of non-AIDS-defining cancers (non-ADCs) among HIV-positive patients is rising. We previously described HIV testing rates of <5% in our oncology centre, against a local HIV prevalence of 0.4% [ 1 ]. We have since worked with the Service of Oncology to identify, how HIV testing can be optimized, we have conducted a study on investigating barriers in HIV-testing oncology patients (IBITOP) among treating oncologists and their patients.

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