Abstract
BackgroundUK guidelines recommend a ‘routine offer of HIV testing’ in primary care where HIV diagnosed prevalence exceeds 2 in 1000. However, current primary care HIV testing rates are low. Efforts to increase primary care HIV testing are needed. To examine how an educational intervention to increase HIV testing in general practice was experienced by healthcare professionals (HCPs) and to understand the perceived impacts on HIV testing.MethodQualitative interviews with general practitioners (GPs) and nurses 3-months after receiving an educational intervention developed from an adapted version of the Medical Foundation for HIV and Sexual Health (MEDFASH) HIV Testing In Practice (TIPs) online educational tool which included training on HIV associated clinical indicator conditions, why, who, and how to test. The intervention was delivered in 19 high-HIV prevalence general practices in Bristol. 27 semi-structured interviews were conducted across 13 practices with 16 GPs, 10 nurses and the sexual health clinician who delivered the intervention. Transcripts were analysed thematically informed by Normalisation Process Theory.ResultsHCPs welcomed the opportunity to update their HIV knowledge through a tailored, interactive session. Post-training, HCPs reported increased awareness of HIV indicator conditions, confidence to offer HIV tests and consideration of HIV tests. Continued testing barriers include perceived lack of opportunity.ConclusionsThis qualitative study found that HIV education is perceived as valuable in relation to perceived awareness, confidence, and consideration of HIV testing. However, repetition and support from other strategies are needed to encourage HCPs to offer HIV tests. Future interventions should consider using behaviour change theory to develop a complex intervention that addresses not only HCP capability to offer an HIV test, but also issues of opportunity and motivation.
Highlights
UK guidelines recommend a ‘routine offer of human immunodeficiency virus (HIV) testing’ in primary care where HIV diagnosed prevalence exceeds 2 in 1000
Coherence Before the educational intervention, HIV testing was described as ad-hoc, opportunistic and informed by patient characteristics and behaviours, appointment type and consultation presentation with “obvious” indicator conditions
Coherence, or views and understanding of the intervention, we found that Healthcare professionals (HCP) thought that the HIV educational intervention was necessary and relevant and experienced the delivery and content positively
Summary
UK guidelines recommend a ‘routine offer of HIV testing’ in primary care where HIV diagnosed prevalence exceeds 2 in 1000. Efforts to increase primary care HIV testing are needed. To examine how an educational intervention to increase HIV testing in general practice was experienced by healthcare professionals (HCPs) and to understand the perceived impacts on HIV testing. Efforts to increase testing for human immunodeficiency virus (HIV) within primary care [2,3,4] are needed [5, 6] to address the proportion of people living with undiagnosed [7] and late diagnosed HIV [8, 9]. Delayed and late diagnosis is associated with negative outcomes for patients (greater chance of being hospitalised, reduced life expectancy [12,13,14]) and greater treatment and hospital care costs [15]. Anti-retroviral therapy increases life expectancy and effectively reduces infection transmission risk among treated individuals [16].
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