Abstract
ObjectivesIn the Netherlands, general practitioners (GPs) perform two-thirds of sexually transmitted infection (STI) consultations and diagnose one-third of HIV infections. GPs are, therefore, a key group to target to improve provider-initiated HIV testing. We describe the design and implementation of an educational intervention to improve HIV testing by Amsterdam GPs and explore trends in GPs’ testing behaviour.MethodsInteractive sessions on HIV and STI using graphical audit and feedback started in 2015. Participating GPs developed improvement plans that were evaluated in follow-up sessions. Laboratory data on STI testing by Amsterdam GPs from 2011 to 2017 were collected for graphical audit and feedback and effect evaluation. The primary outcome was the HIV testing rate: number of HIV tests per 10 000 person-years (PY). Secondary endpoints were chlamydia and gonorrhoea testing rates and HIV positivity ratios.ResultsSince 2015, 41% of GPs participated. HIV testing rate declined from 2011 to 2014 (from 175 to 116 per 10 000 PY), more in women than men (176 to 101 versus 173 to 132), and stabilized from 2015 to 2017. The HIV positivity ratio declined from 0.8% in 2011 to 0.5% in 2017. From 2011 to 2017, chlamydia and gonorrhoea testing rates declined in women (from 618 to 477 per 10 000 PY) but remained stable in men (from 270 to 278).ConclusionsThe stabilization of the downward trend in HIV testing coincided with this educational intervention. Follow-up data are needed to formally assess the intervention’s impact on GP testing behaviour whilst considering contextual factors and secular trends.
Highlights
General practitioners (GPs) play a pivotal role in provider-initiated testing and counselling (PITC) for HIV in the Netherlands
Over 60% of people newly diagnosed with HIV visited their GP in the year prior to diagnosis, and 61% had been diagnosed with indicator conditions in the 5 years prior to diagnosis [2]
The primary research questions in this programme are: ‘what is the uptake and evaluation of the intervention by GPs in Amsterdam? and what is the impact of the intervention on HIV, chlamydia and gonorrhoea testing rates by GPs in Amsterdam?’ Here, we describe the design and implementation of this educational intervention programme, as well as observed trends in HIV and sexually transmitted infection (STI) testing from 2011 to 2017
Summary
General practitioners (GPs) play a pivotal role in provider-initiated testing and counselling (PITC) for HIV in the Netherlands. About two-thirds of sexually transmitted infection (STI) consultations take place in primary care, and GPs diagnose a third of HIV infections [1]. Over 60% of people newly diagnosed with HIV visited their GP in the year prior to diagnosis, and 61% had been diagnosed with indicator conditions (i.e. conditions where HIV testing is recommended) in the 5 years prior to diagnosis [2]. This is disappointing, as the STI consultation guideline for GPs, as updated in 2013, includes guidance on appropriate HIV testing strategies [3]. A key approach to eliminating HIV is improving HIV testing strategies by GPs and addressing their barriers to timely testing [7,8]
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