HIV TESTING IN PRIMARY CARE

AIM

To provide information enabling any clinician to perform an HIV test within good clinical practice and to encourage normalisation of HIV testing

FACTS & STATISTICS1. Early treatment improves outcome for the individual

& public health

2. Treatment reduces morbidity, mortality & onward

infectivity

3. Early diagnosis & treatment is cost effective

4. 24% of HIV deaths in 2006 were attributable to

diagnosis made too late for effective treatment

5. 1/3 of HIV infective adults in UK remain undiagnosed

Who should test ?

• Any doctor

• Any midwife

• Any nurse or trained healthcare

Who should be offered a test

1. Universal testing:I. Antenatal servicesII. Drug dependency III. Gum, sexual health & TOP IV. Diagnosed with TB, Hep B, Hep C &

lymphoma

2. Prevalence in local population > 2 in 1000

3. High risk groups:

I. UPSI ( African, SE Asia )

II.IVDU

III.All pts with STI

IV.Contacts of pts known HIV+

V.MSM ( & female contacts)

VI.Country with high prevalence

4. Where HIV may enter the differential diagnosis

• Bacterial pneumonia

• Peripheral neuropathy• Severe seborrhoeic

dermatitis• Severe psoriasis• Recurrent herpes

zoster• Oral candidiasis• Unexplained weight

loss

• Unexplained chronic diarrhoea

• CIN grade 2 & above• Unexplained blood

dyscrasia • PUO• Lymphadenopathy of

unknown cause• Mononucleosis like

syndrome

5. In accordance with existing DOH guidelines

• Blood donors

• Dialysis patients

• Organ transplant donors and recipients

Pre –test discussion

Purpose : Informed consent

Lengthy discussion is not a requirement unless the patient requests or needs this

Low risk & High risk

• Benefits of testing

• Details of how results will be given

• Questions

• Document above

• No need for written consent

High risk in Tayside HIV Services

• What support does the patient have

• Referral pathway

• Occupation & Impact

• Insurances & Mortgages

Results

• Not on a Friday

• Telephone consultation if low risk

• Face to face if:

i. High risk

ii.Mental health issues

iii.English 2nd language

iv.< 16

v. Vulnerable / anxious

Post test discussion

• Negative result:

• Health promotion

• PEP

• Repeat testing

• Positive result

• Referral pathways

• Immediate concerns

• Support

Services in Tayside• Referral pathways

– I.D or GUM ( both have a HIV nurse)

• Same day testing at NW

– Tuesday, Wednesday and Thursday

• Next clinic testing at PRI

– Monday & Thursday

• Body positive Tayside

Websites

• www.bashh.org

• www.bhiva.org

• www.sexualhealthtayside.org

Questions ???