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PAPERS: James Read and S J Winceslaus New strategies for increasing the detection of HIV: analysis of routine data BMJ 2003; 326: 1066-1067 [Full text]

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New Strategies of increasing the detection rate of HIV Infection

Sarman Singh   (16 May 2003)

Don't forsake the consultation

Chaitu Cheruvu, Min Fang, Flora Cheang, Nicholas Collins   (10 June 2003)

New Strategies of increasing the detection rate of HIV Infection 16 May 2003
Sarman Singh, Professor of Clinical Microbiology All India Institute of Medical Sciences, New Delhi-110029 (India) Send response to journal: Re: New Strategies of increasing the detection rate of HIV Infection	THE EDITOR, I read with great interest the paper by Read & Winceslaus published in the BMJ.1 I fully agree with their view point that detail oral pre-test counseling is not possible with the ever-increasing burden of patients in all countries but more importantly in developing countries like India.2 The clinical departments at the premier medical institute of India, the All India Institute of Medical Sciences, New Delhi see more than 10, 000 patients daily, in various outpatient departments with an average of approximately 40-50 patients per consultant in 4 hour’s period per day.3 Therefore, it is impossible to counsel orally all the patients for the tests like HIV, cancer markers and TORCH etc. The analysis of HIV infection risk grades through proper counseling becomes rather more impractical due to the time constraint. Hence, at this Institute we have also used a modified patient and time friendly method, in which HIV/AIDS educative posters are displayed on various patient counters so that while the patient waits for his turn for consultation or sample receiving, he/she also can read salient features of various tests and about HIV/AIDS. Only HIV positive patients are post-test counseled in detail. This policy has been found very useful and acceptable to our patients, except minor resistance from AIDS activists in early and mid nineties. With this policy out of 10,000 serum samples tested 15 (0.15%) additional cases have been diagnosed only in the last one year in our laboratory. These 15 patients had no high risk of HIV infection except receiving some injectable medications for minor ailments and were never suspected of having HIV or any other sexually transmitted disease. However, all were married. Hence, with time, we think that HIV activists will also realize and HIV testing will become a routine laboratory investigation and more unsuspected cases will be diagnosed in time. This will help the society and the families in a long run when the infected person continues to transmit the HIV infection to others unknowingly, before he is medically suspected to have got HIV infection. Dr. Sarman Singh, Head, Clinical Microbiology Division, All India Institute of Medical Sciences, New Delhi-110029 India): sarman_singh@yahoo.com Reference: 1.Read J, Winceslaus SJ. New Strategies for increasing the detection of HIV: analaysis of routine data. BMJ. 2003; 326: 1066-67. 2.www.naco.nic.in 3.www.aiims.ac.in Competing interests:   None declared
Don't forsake the consultation 10 June 2003
Chaitu Cheruvu, Year 4 Medical Student Macarthur Health Service, P O Box 149, Campbelltown NSW 2560, Min Fang, Flora Cheang, Nicholas Collins Send response to journal: Re: Don't forsake the consultation	We read, with interest, the paper by Read & Wincelaus1. Decreased consultation time will not necessarily be achieved through presenting patients with written salient points before the actual consultation. It is highly possible that patients will have more questions for the health professional after their pre-reading. Patients with low education levels or illiteracy may have limited understanding of the points presented on paper and press for a verbal explanation during the consult. Patients with a high education level may be better informed than the information sheet on the subject of HIV through the many available media forms. Both situations will result in questions brought forth during the consultation, perhaps even producing the reverse effect of lengthening the consultation to what it would have been had the previous protocol been kept. The initial goal of shortening the consultation thus fails. The substitution of oral consultations for written information also has other disadvantages. While a health professional may alter his manner in which the information is presented and the complexity of information delivery to suit the needs of the individual patient and target different groups, written information would be limited in terms of mobility and flexibility of information presentation. Moreover, it is important to remember that HIV testing and detection may have serious physical, social and psychological implications for an individual and replacing much of the oral consult with written material can potentially avert the psychological support that can be offered through a face-to-face consultation. Additionally, it is important to consider that even if written facts are provided to the patient, they will not necessarily read it in the waiting room. In the presence of others in the clinic, the patient may feel that the act of reading this material is a sign to others of possible acquisition of the disease. Their fear of being stigmatised may prevent them from reading the information. We would, therefore, be hesitant in removing the personal, confidential and supportive environment that oral counselling provides, to be replaced with a piece of paper. Chaitu Cheruvu Year 4 medical student, Macarthur Health Service, UNSW Min Fang Year 4 medical student, Macarthur Health Service, UNSW Flora Cheang Year 4 medical student, Macarthur Health Service, UNSW Nicholas Collins MBBS, FRACGP, Staff Specialist in Ambulatory Care, Macarthur Health Service; Conjoint Lecturer UNSW. References 1. Read J Winceslaus SJ New strategies for increasing the detection of HIV: analysis of routine data BMJ 2003; 326: 1066-1067. Competing interests:   None declared