Qualitative impact assessment of an educational workshop on primary care practitioner attitudes to NICE HIV testing guidelines.

Rosalie L Allison,Ellie J Ricketts,Katy Town,Anthony Nardone,Cliodna Am Mcnulty,J Kevin Dunbar,Claire Rugman,Thomas Hartney,Kate Folkard

doi:10.3399/bjgpopen18x101433

Abstract

BackgroundIn 2013, Public Health England piloted the ‘3Cs (chlamydia, contraception, condoms) and HIV (human immunodeficiency virus)’ educational intervention in 460 GP surgeries. The educational HIV workshop aimed to improve the ability and confidence of staff to offer HIV testing in line with national guidelines.AimTo qualitatively assess the impact of an educational workshop on GP staff’s attitudes to NICE HIV testing guidelines.Design & settingQualitative interviews with GP staff across England before and after an educational HIV workshop.MethodThirty-two GP staff (15 before and 17 after educational HIV workshop) participated in interviews exploring their views and current practice of HIV testing. Interview transcripts were thematically analysed and examined, using the components of the theory of planned behaviour (TPB) and normalisation process theory (NPT) as a framework.ResultsGPs reported that the educational HIV workshop resulted in increased knowledge of, and confidence to offer, HIV tests based on indicator conditions. However, overall participants felt they needed additional HIV training around clinical care pathways for offering tests, giving positive HIV results, and current treatments and outcomes. Participants did not see a place for point-of-care testing in general practice.ConclusionImplementation of national HIV guidelines will require multiple educational sessions, especially to implement testing guidelines for indicator conditions in areas of low HIV prevalence. Additional role-play or discussions around scripts suggesting how to offer an HIV test may improve participants’ confidence and facilitate increased testing. Healthcare assistants (HCAs) may need specific training to ensure that they are skilled in offering HIV testing within new patient checks.

Highlights

In 2015, Public Health England (PHE) estimated that 101 200 people were living with HIV in the UK, of whom 13% (13 500) were unaware of their infection.[1]
HCAs may need specific training to ensure that they are skilled in offering HIV testing within new patient checks or blood test requests
In combination with the workshops (available at http://stitraining.eu/catte-resources/), additional role-play or discussion around scripts used to offer an HIV test would be useful in changing attitudes and helping to implement NICE HIV testing guidelines

Summary

Introduction

In 2015, Public Health England (PHE) estimated that 101 200 people were living with HIV in the UK, of whom 13% (13 500) were unaware of their infection.[1] The majority of new infections are transmitted from those who are undiagnosed,[2] and late diagnosis of HIV is associated with increased morbidity.[3,4] In 2011, NICE produced guidelines for HIV testing[5,6] aiming to expand testing in nongenitourinary (GU) medicine settings, including general practice staff. The 3Cs and HIV intervention, based on the TPB,[10,11] consisted of two educational workshops, delivered by trained local sexual health staff, and an optional follow-up with the trainer (see Figure 1 for details). The second workshop focused on facilitating HIV testing, and encouraged GP staff to offer HIV testing in line with the 2011 NICE guidelines;[5,6] that is, to patients with HIV indicator condition,[12] and to all newly registered patients in areas of high HIV prevalence (>2 diagnoses per 1000 people)

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Discussion

Conclusion