Post on 18-Dec-2015
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HIV testing – pre-HAART
Benefits of testingLimited treatmentPrognosis poorHighly stigmatisedBarriers to
testingClinicians:•Feeling deskilled•Time pressures•Specialists only•Patients:•Feeling affronted by presumed assumptions
•Who to tell, who not to tell•Implications of positive result
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HIV testing – post-HAART
Benefits of testing Effective treatment(Cost-effective!)Good prognosisLegal protections
Barriers to testingClinicians:•Skills used in daily practice•Routine investigation•Any healthcare professionalPatients:•Routine investigation•Clear information•Benefits explained
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What worked in other settings?
• Setting a national target for HIV testing– Antenatal: 90% uptake by 2002– GUM: 60% uptake by 2007
• Including HIV test in routine screen– Opt-out strategy
• Discarding routine in-depth pre-test ‘counselling’– Using patient information leaflets on HIV test– Emphasising benefits of knowing HIV status– NB: high-risk patients may need more in-depth work
Estimated proportion of HIV-infected pregnant women diagnosed before delivery1 and of exposed infants becoming infected with HIV2, England & Scotland
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Key partnerships
• Public Health• Microbiologists• Clinicians• PCT commissioners• Care Pathways
– Primary and secondary care providers– Voluntary organisations– Network development (sub-regional)
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“What was the WR result?”
Syphilis – the great mimic
The venereologist’s contribution
The Grand Round
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The Grand Round
“What was the HIV test result?”
HIV – the 21st century mimic
The GUM physician’s contribution
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What needs to be in place?
• Education– Grand rounds – think HIV!– Specialty rounds– Postgraduate seminars
• Support– Prepare local guidelines and protocols– Clarify referral and care pathways– Develop patient information
• Monitoring– Joint research / audit projects– PCT targets and audits– Auditable standards in HIV testing guidelines
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Summary
• Benefits of HIV detection far outweigh risks• Opt-out testing overcomes barriers
So…• Develop partnerships• Support colleagues and patients• Challenge stigma• Monitor outcomes• Learn from experience elsewhere