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Uptake of HIV testing in patients with a confirmed sexually transmitted infection
  1. S Day,
  2. D Lakhani,
  3. C Rodgers
  1. Department of Genitourinary Medicine, Guy’s and St Thomas’s Hospital, London, UK
  1. Correspondence to:
 Sara Day, Lydia Department, Department of Genitourinary Medicine, St Thomas’s Hospital, London SE1 7EH, UK;
 Sarah.Day{at}gstt.sthames.nhs.uk

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UK seroprevalence rates indicate that up to 50% of HIV positive patients in genitourinary medicine (GUM) clinics remain undiagnosed.1 HIV is mainly identified in high risk patient groups. Sexually transmitted infections other than HIV (STIs) have been shown to facilitate and be associated with enhanced HIV transmission.2 Risk assessment for HIV, therefore, should target patients with an STI or history of recurrent STIs as a high risk group.

Targeting these patients to test for HIV at the time or 3 months after their STI diagnosis, is important as it will lengthen the “diagnosis interval” of patients testing HIV positive thereby conferring a better outcome, with respect to HAART3; identify patients with recent concurrent acquisition of HIV and a STI, entering a highly infective seroconversion phase; identify individuals with undiagnosed, established HIV infection and a newly acquired STI which promotes higher infectivity due to increased HIV viral shedding into genital secretions.4,5

Our study analysed the uptake of HIV testing among attendees who had a genitourinary screen at St Thomas’s Hospital genitourinary medicine department between 1 and 31 December 1999.

It compared the uptake of HIV testing, either at the index visit in December or deferred to within the ensuing 3 months, between patients diagnosed with an STI (gonorrhoea, chlamydia, herpes simplex virus, and trichomoniasis (study group)) and patients receiving a negative STI screen (control group).

Of 318 attendees, 242 and 76 patients comprised the study and control groups respectively. Only 18% (59/318) of patients tested for HIV on the initial visit. Significantly fewer of the study group tested for HIV (14%) compared to the control group (33%) (p<0.01).

Of those who did not test for HIV, 11 and one patients deferred testing in the study and control groups respectively (table 1) However, none of the deferrers or initial non-testers re-attended for HIV testing in the following 3 months.

Table 1

Timeliness of HIV testing

In view of this unacceptably low rate of HIV testing, both overall and in those patients with a confirmed STI, the following interventions are now being introduced, aiming to improve these figures and comply with the sexual health strategy 2001 targets.6

  • An “opt out” policy of HIV testing

  • Additional waiting room posters and a new patient information leaflet about HIV is given to all patients at registration to read while they wait to be seen explaining the natural history, treatments available, benefits of early diagnosis, and mechanisms of reducing transmission. This enhances patient education and may expedite consultation length and waiting times for patients with restricted “time off” and/or other more pertinent issues to discuss

  • Pretest counselling is reserved for high risk groups instead of being required routinely

  • Patients are able to obtain their HIV results indirectly, without the inconvenience of a previously required second visit

  • Educating all GUM staff to encourage a high offer rate of HIV testing to all patients, especially targeting high risk patients, which incorporates those with a confirmed STI.

Contributors

SD, CAR, and DL designed the study; SD and DL gathered and statistically analysed the data; SD, DL, and CAR contributed to writing the paper.

Conflicting interests: There were no conflicting interests and no costs incurred.

References

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