Background In the Netherlands, general practitioners (GPs) diagnose 79% of STIs and 36% of HIV infections, but opportunities for earlier HIV diagnosis are being missed in primary care. We assessed changes in GPs’ HIV testing behaviour following an educational intervention using competitive feedback, to improve HIV testing in primary care in Amsterdam.
Methods The educational intervention, open for all Amsterdam GPs, was implemented from 2015 to 2020. The mean annual number of HIV tests per GP from 2011–2019 was calculated using data from diagnostic laboratories for primary care, and stratified by 4-digit postal code (PC4). Questionnaires and semi-structured interviews were conducted to identify perceived barriers and facilitators to HIV testing.
Results In total, 229 GPs (42%) participated in the educational intervention. Participation varied per PC4 area (median 27%, IQR 0%-60%). At baseline, the mean annual number of HIV tests per GP was similar for participants versus non-participants (26.8 versus 24.7, respectively). The number of tests per GP declined from 2011 to 2014 from 29.5 to 20.7, and increased thereafter to 27.1 in 2019. Testing was highest in PC4 areas with highest HIV prevalence. Qualitative analyses revealed various barriers to HIV testing, including taboo and stigma, a shrinking epidemic, and financial barriers. The use of competitive feedback was perceived as a motivator to improve testing behaviour. Of 59 GPs that completed the questionnaire, 68% stated the programme provided eye-openers, and 72% declared it improved their HIV testing behaviour.
Conclusion The observed increase in HIV testing coincided with the implementation of our intervention, but there was marked heterogeneity, with testing seemingly associated with local HIV prevalence. Amsterdam is well on its way towards zero new hiv infections, but it will be challenging to keep GPs engaged in proactive testing to prevent late presentations and missed opportunities for HIV diagnosis in primary care.
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