Abstract
BackgroundIn Switzerland, 30% of HIV-infected individuals are diagnosed late. To optimize HIV testing, the Swiss Federal Office of Public Health (FOPH) updated ‘Provider Induced Counseling and Testing’ (PICT) recommendations in 2010. These permit doctors to test patients if HIV infection is suspected, without explicit consent or pre-test counseling; patients should nonetheless be informed that testing will be performed. We examined awareness of these updated recommendations among emergency department (ED) doctors.MethodsWe conducted a questionnaire-based survey among 167 ED doctors at five teaching hospitals in French-Speaking Switzerland between 1st May and 31st July 2011. For 25 clinical scenarios, participants had to state whether HIV testing was indicated or whether patient consent or pre-test counseling was required. We asked how many HIV tests participants had requested in the previous month, and whether they were aware of the FOPH testing recommendations.Results144/167 doctors (88%) returned the questionnaire. Median postgraduate experience was 6.5 years (interquartile range [IQR] 3; 12). Mean percentage of correct answers was 59 ± 11%, senior doctors scoring higher (P=0.001). Lowest-scoring questions pertained to acute HIV infection and scenarios where patient consent was not required. Median number of test requests was 1 (IQR 0-2, range 0-10). Only 26/144 (18%) of participants were aware of the updated FOPH recommendations. Those aware had higher scores (P=0.001) but did not perform more HIV tests.ConclusionsSwiss ED doctors are not aware of the national HIV testing recommendations and rarely perform HIV tests. Improved recommendation dissemination and adherence is required if ED doctors are to contribute to earlier HIV diagnoses.
Highlights
It is well-recognized that late diagnosis of HIV in infected individuals is associated with an avoidable burden of morbidity [1], mortality and cost [2]
We recently reported that the new Federal Office of Public Health (FOPH) recommendations made no difference to testing practices in nine clinical services in our centre and observed that, of the tens of thousands of patients seen in our emergency department (ED) annually, only 1% are tested for HIV [6]
Participant characteristics Of 164 ED doctors invited to participate in the study, 144/164 (88%) completed the questionnaire
Summary
It is well-recognized that late diagnosis of HIV in infected individuals is associated with an avoidable burden of morbidity [1], mortality and cost [2]. In March 2010, the Swiss Federal Office of Public Health (FOPH) updated the 2007 HIV testing recommendations proposing ‘Provider Induced Counseling and Testing’ (PICT) [5] ( known as ‘Physician-Initiated Counseling and Testing’) These recommendations implicitly propose diagnostic testing and targeted screening rather than opt-out testing but, like the CDC recommendations, they decouple testing from pre-test counseling and consent, whilst maintaining a need to inform the patient when HIV testing is indicated. To optimize HIV testing, the Swiss Federal Office of Public Health (FOPH) updated ‘Provider Induced Counseling and Testing’ (PICT) recommendations in 2010 These permit doctors to test patients if HIV infection is suspected, without explicit consent or pre-test counseling; patients should be informed that testing will be performed. Improved recommendation dissemination and adherence is required if ED doctors are to contribute to earlier HIV diagnoses
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