Exploring staff attitudes to routine HIV testing in non-traditional settings: a qualitative study in four healthcare facilities
- Alicia Claire Thornton1,
- Michael Rayment2,
- Gillian Elam3,
- Mark Atkins2,
- Rachel Jones2,
- Anthony Nardone1,
- Patrick Roberts2,
- Melinda Tenant-Flowers4,
- Jane Anderson5,
- Ann Kathleen Sullivan2,
- on behalf of the HINTS Study Group
- 1HIV STI Department, Health Protection Agency, London, UK
- 2Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- 3Centre for Sexual Health and HIV Research, University College London, London, UK
- 4Caldecott Centre for Sexual Health and HIV, Kings College Hospital NHS Foundation Trust, London, UK
- 5Department of Sexual Health, Homerton University Hospital NHS Foundation Trust, London, UK
- Correspondence to Alicia Claire Thornton, Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, University College London, Royal Free Campus, London, NW3 2PF, UK;
Contributors ACT was involved in study conception and design, collecting the data, analysing the data and drafting and revising the manuscript. MR was involved in designing the study, collecting the data, analysing the data and drafting, reviewing and revising the manuscript. GE was involved in designing the study, collecting the data, provided technical advice on the analysis of the data and reviewed and revised the manuscript. MA was involved in conception and design of the study, provided technical advice, evaluated and authorised the HIV testing technology and reviewed and revised the manuscript. PR, RJ, AN, MT-F, JA and AKS were involved in the study conception and design and reviewing and revising the manuscript.
- Accepted 10 June 2012
- Published Online First 6 July 2012
Objectives To explore staff attitudes towards and experiences of the implementation of routine HIV testing in four healthcare settings in areas of high diagnosed HIV prevalence.
Methods As part of the HINTS (HIV Testing in Non-traditional Settings) Study, routine offer of an HIV test to all 16–65-year-old patients was conducted for 3 months in an emergency department, an acute admissions unit, a dermatology outpatients department and a primary care practice. The authors conducted focus groups with staff at these sites before and after the implementation of testing. Transcriptions of focus groups were subject to thematic analysis.
Results Four major themes were identified: the stigma of HIV and exceptionalisation of HIV testing as a condition; the use of routine testing compared with a targeted strategy as a means of improving the acceptability of testing; the need for an additional skill set to conduct HIV testing; and the existence within these particular settings of operational barriers to the implementation of HIV testing. Specifically, the time taken to conduct testing and management of results were seen by staff as barriers. There was a clear change in staff perception before and after implementation of testing as staff became aware of the high level of patient acceptability.
Conclusions The routine offer of HIV testing in general medical services is feasible, but implementation requires training and support for staff, which may be best provided by the local sexual health service.
- HIV testing attitudes staff
- epidemiology (general)
- sexual health
- risk factors
- sexual practices
- public health
Funding The qualitative arm of the HINTS Study was funded by the Department of Health. The funders of the study, and its sponsor (Chelsea and Westminster NHS Foundation Trust), had no role in the study design, data collection, data analysis, data interpretation or writing up of the report.
Competing interests None.
Ethics approval Ethics approval was provided by the National Research Ethics Service.
Provenance and peer review Not commissioned; externally peer reviewed.