A systematic review of routine HIV testing in primary care

Abstract

BackgroundThis study aims to contribute to the improvement of European progress towards 90–90–90 targets and to identify an intervention with a strong evidence base used in better performing countries such as routine testing in primary care.AimTo evaluate the efficacy of routine HIV testing in primary care and identify the barriers and solutions towards successfully implementation.MethodPeer-reviewed studies which measure changes in provider offer rates, patient uptake rates, seroprevalence or CD4 counts after the implementation of routine HIV testing. Studies which identified barriers and solution to implementation were also included. EMBASE and MEDLINE were searched through April 2018. Risk of bias was assessed using the CASP framework, regarding participant selection, randomisation incomplete outcome data, blinding, and use of sensitivity analyses.ResultsRoutine HIV testing shows increased rates of case finding with earlier diagnosis when compared to standard practice. Factors such as sex, ethnicity, local prevalence, and stigma were found to affect patient uptake, while gaps in training, awareness and organisational implementation affected provider uptake. Provider offer rates require adequate education regarding intervention efficacy, electronic medical record use, and result communication. Addressing time constraints with nurse-initiated testing and combined condition testing can improve the clinical workflow. Normalising HIV testing, including reforming pre-test counselling, rapid testing, and education to reduce stigma can improve patient uptake. Further analysis of cost-effectiveness is also required to effectively consider implementation.ConclusionRoutine HIV testing across primary care can improve testing rates, with consideration to barriers towards implementation and further study.