Unlocking the potential: longitudinal audit finds multifaceted education for general practice increases HIV testing and diagnosis

Abstract

BackgroundThis longitudinal study aimed to evaluate the impact of a multifaceted educational intervention (Sexual Health in Practice, SHIP) on general practice HIV testing rates in a high prevalence London area.InterventionSHIP offered training in sexual health clinical skills to general practitioners (GPs) and practice nurses (PNs) in Haringey. SHIP training aims to break down stigma in sexual health and provide sexual history and communication tools (e.g. differential diagnosis), and provides resources to practices (including condoms).DesignNumbers of GP HIV tests were collected from laboratories for 24 months prior, 19 months during and 5 months after training. Attendance data and practice list sizes were obtained.Results39 of 51 practices had at least one trained individual. These `trained' practices conducted an average 526 HIV tests p.a. before training began which rose to a projected 1556 p.a. (on the basis of the last 6 months of data). Testing rates of trained and untrained practices increased from 2.29 to 6.66 and 1.54 to 1.90 tests/1000 registered patients/year (p=0.0016 and p=0.5195) respectively. The rate of positive diagnosis was high in the trained group (18.0 and 16.7 positives/1000 tests before and after training began; p=0.7908). This equates to a rise from 9.5 to 22 new diagnoses p.a.ConclusionsThe training intervention has been found to significantly increase general practice HIV testing rates in the absence of financial incentives. Positivity rates are substantially higher than that found in pilots of screening in London, suggesting that the training nurtured and supplemented complex clinical skills.

Public attitudes towards opt-out testing for HIV in primary care: a qualitative study

“…20 Training interventions in GP surgeries in the UK have been shown to significantly increase staff comfort with offering tests and testing rates in the absence of financial incentives. 21 The 3Cs & HIV Programme 6 launched in January 2013 by Public Health England promotes greater involvement of general practice in sexual health (including opt-out HIV testing) through dedicated trainers, support, and monitoring.…”

“…In one UK paper, financial reimbursement has been found to be key to increasing primary care involvement in HIV care; 32 however, training interventions in GP surgeries have also been shown to increase testing rates in the absence of financial incentives. 21 This study identified that the policy will undergo a 'settling-in period' within the public understanding, but adjustment will also be required in the medical profession. A study in a UK teaching hospital found the stigmatisation of HIV was a significant barrier to consultants offering HIV tests.…”

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“…Routine offer to all attendees to health care settings is likely to increase uptake and yield of previously undiagnosed persons at an earlier stage of infection. There is evidence that rate of provider offer could be increased through education of medical staff, particularly junior doctors and medical students , or the use of electronic testing prompts and clinical decision‐making tools .…”

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“…The course was delivered by experts from the local and London-based GUM teams, and supplemented by clinical placements, which further forged relationships between primary care and specialist GUM staff. Indeed, education has been linked with increased testing for STIs, although there is variability in testing pattern changes for specific diseases 8 9…”