Long term effect of primary health care training on HIV testing: A quasi-experimental evaluation of the Sexual Health in Practice (SHIP) intervention

Abstract

BackgroundTo examine the effect of Sexual Health in Practice (SHIP) training for general practitioners (GPs) on HIV testing rates in Haringey, a deprived area of London, UK, with a population of over 250,000 and HIV prevalence of 0.7% (in 2014). SHIP is an educational intervention delivering peer-developed and peer-led face-to-face training to improve quality of sexual and reproductive health (SRH) care.MethodsWe carried out a quasi-experimental study of intervention effects across 52 GP practices (2008–2016). We used time variation in SHIP intervention exposure for effect estimation, controlling for practice and calendar month fixed effects in panel analysis. From 2008–2010, baseline data were collected, and in the subsequent six-year period, 78 GPs in Haringey (approximately 40% of all GPs) were SHIP trained. 46 Haringey practices (of 52) had at least one trained doctor. Outcome measures were monthly HIV tests and results by practice (obtained from the hospital laboratories).ResultsSHIP significantly increased HIV testing; for every GP trained, practice HIV testing rates increased by 16% (testing rate ratio (TRR) 1.16, 95% confidence interval (CI) 1.05–1.28, p value 0.004). This significant effect was demonstrated using an 8-year observation period, and was sustained over the post-intervention period. An average of 1.42% of HIV tests were positive.ConclusionSHIP training produces a significant and sustained increase in HIV testing for each GP trained. Compared with general population screening, HIV tests used in routine clinical care have a high probability of detecting a positive person. Unlike an RCT, this evaluation is a ‘real life’ measure of the effect that commissioners of SHIP could expect in comparable areas of the UK. The effectiveness of the SHIP training may be related to the programme components not included in interventions that did not demonstrate an effect, such as peer-led teaching, and use of approaches to communication and rapid risk assessment tailored to the setting.

Evaluation of an educational intervention to increase HIV-testing in high HIV prevalence general practices: a pilot feasibility stepped-wedged randomised controlled trial

“…Other sexual health testing educational interventions have been undertaken in the UK [35, 42]. HIV testing rates increased in general practices receiving a multifaceted educational intervention (Sexual Health in Practice -SHIP) in an extremely high diagnosed HIV prevalence area in London [35] and that these were sustained over 8 years [43]. This study used five rounds of training over a 24-month period which differs to the one-off training used in the current study, potentially illustrating the benefits of repeated training sessions over time.…”

“…The policy has a 96% acceptance rate in antenatal settings and has had a dramatic effect on reducing the number of women with undiagnosed HIV post-delivery and mother-to-child transmission [32]. Studies promoting IC-based testing [43] have shown a relatively low increase in testing compared to HIV screening studies such as the RHIVA trial of rapid HIV testing [31], although positivity rates tend to be higher in targeted interventions [10].…”

Qualitative evaluation of a pilot educational intervention to increase primary care HIV-testing

“…In contrast, SHIP (Sexual Health in Practice), a multi-component educational intervention, achieved significantly increased HIV testing rates in general practices in a high-HIV prevalence area in London [25, 28]. Unlike the current intervention, SHIP involved two afternoons of training for GPs (and three for nurses) [25].…”

“…The guidance recommends offering a test to all new practice patients [23] and to patients presenting with HIV ICs [19]. However, barriers to HIV testing experienced by HCPs include gaps in knowledge and training needs [17, 24, 25], anxiety or a lack of confidence to offer a test, concern about negative patient response [25, 26] and, privacy and confidentiality issues [25, 26]. These barriers and the opportunity to diagnose HIV through improved recognition of HIV ICs indicate a role for educational interventions to encourage increased testing [11].…”

“…These barriers and the opportunity to diagnose HIV through improved recognition of HIV ICs indicate a role for educational interventions to encourage increased testing [11]. Such interventions have shown encouraging results in high-HIV prevalence UK cities [25, 27–29].…”