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Rogstad et al1 showed an increase both in the number of patients who were offered the HIV test and those who took the test following the use of a leaflet. We report the increased uptake rate of HIV testing since the introduction of “opt out” testing and giving results by phone.
Before January 2002, patients attending our clinic were offered an HIV test if they belonged to high risk groups such as men who have sex with men or injecting drug users. Pretest counselling was done by our health advisers and patients were required to return to the clinic to receive their test results. In 2001, 904 of 2930 new and re-registered patients (31%) underwent HIV testing.
The UK government’s national strategy for sexual health and HIV set its target for reducing undiagnosed HIV in genitourinary medicine clinics by increasing the uptake of HIV testing to 40% by the end of 2004 and to 60% by the end of 2007.2
From 1 January 2002, we introduced an “opt out” system, whereby all patients were offered HIV tests, regardless of risk category. This led to an increase in HIV test uptake in the following 3 months to 37% (272 of 740 new patients).
This caused an increase in the workload of our health advisers, who were spending much time in pretest counselling low risk patients and giving negative HIV results. It became clear that exhaustive, in-depth HIV pretest counselling was impractical and inappropriate when the majority of those tested were “low risk.” Accordingly, we decided that only high risk patients should be referred pretest to the health advisers.
It was also observed that some patients who initially agreed to undergo HIV testing changed their minds when they learned that they would be required to return to the clinic to collect their result. We decided to offer HIV results by telephone, in line with our policy for all other screening tests. High risk patients, however, were encouraged to attend in person for their result. In the next 3 months 44% (293 of 663 new patients) took HIV tests. Five patients tested HIV positive, but only one received the result by telephone.
The introduction of a telephone HIV results system enabled us to exceed the Department of Health target for 2004. The new system was adopted after consideration of the pros and cons in a departmental meeting in which the opinions of all staff were canvassed. Some concern was expressed about the potential for self harm by patients given bad news outside the clinical setting. We tried to minimise such outcomes by encouraging patients to telephone in the presence of their partner, a friend, or a relative. Results were only given by telephone when the patient could be seen in clinic on the following day at the latest.
The telephone results system is very popular. One patient said, he would far rather receive bad news in the familiar surroundings of home, with the support of his partner, than in a clinic.
We do not know if it is psychologically harmful (or indeed beneficial) for patients to receive a positive HIV result by telephone; research is needed to answer this question. Given the drive to reduce the number of people with undiagnosed HIV infection and the demands of working life, we believe telephone results are here to stay.