New strategies for increasing the detection of HIV: analysis of routine dataBMJ 2003; 326 doi: http://dx.doi.org/10.1136/bmj.326.7398.1066 (Published 15 May 2003) Cite this as: BMJ 2003;326:1066
- 1 Guy's, King's College, and St Thomas's School of Medicine, London SE5 9RJ,
- 2 Preston Hall Hospital, Maidstone ME17 7NJ
- Correspondence to: S J Winceslaus
- Accepted 1 April 2003
Despite a gradual increase in the incidence of HIV infection in the United Kingdom over the past decade,1 many people with the infection remain undiagnosed.2 To increase detection, the Department of Health released the first national strategy for sexual health and HIV in July 2001.3 The publication recommended that all people attending genitourinary medicine clinics should be offered an HIV test on their first screening for sexually transmitted infections. Many would agree that this target is impossible to achieve using the prevailing protocol for HIV testing in genitourinary medicine clinics. After consultation with client groups in the Preston Hall clinic, we changed our HIV testing protocol.
Methods and results
In May 2001 we began offering the HIV test to all clients attending the genitourinary medicine clinic instead of only those who were at high risk or who requested it.
To cope with the anticipated increase in HIV testing without greatly increasing the clinic's workload, we changed the testing protocol. We replaced the detailed oral counselling before testing with a shorter, written explanation of the salient points. These points included a brief explanation of HIV and AIDS and of the “window period” (the first three months of infection, during which the test may not show a positive result); the advantages of the test; and the effect of positive (or negative) results on life insurance. Before testing, clients had to read and sign the information sheet, acknowledging their understanding of and consent to the test.
Using the clinic's quarterly KC60 returns (forms for recording the activity of genitourinary medicine clinics), we compared clinic attendance, number of HIV tests performed, and number of HIV positive diagnoses from 1 April 2001 (a month before the new protocol) to 31 December 2001 with the same data for the three years before 1 April 2001.
The average clinic attendance per quarter increased from 232 to 352 clients, and the average number of HIV tests performed per quarter also increased-from 33 to 130 (table). The proportion of clients who had an HIV test thus rose from 14% to 37%. Three cases of HIV infection were diagnosed from 1 April to 31 December 2001, compared with no cases diagnosed in the preceding three years (table).
By modifying our HIV testing protocol, we more than doubled the rate of testing among clients attending our genitourinary medicine clinic.
The reasons that attendance increased in the quarter in which the protocol was changed are complex as similar changes were seen nationally. The changes are due partly to increased referrals to the genitourinary medicine services (after publication of the national strategy for sexual health and HIV3) and to the public's response to the reported national increase in sexually transmitted infections.
Many young people attending our clinic, however, do so after hearing about us from friends and peers. We therefore feel that such publicity about the “user friendly” local services that the new HIV testing policy had generated could also have contributed to attracting more clients.
Although our clinic has now achieved the Department of Health's 2004 target for HIV testing-that 40% of patients attending genitourinary medicine clinics should receive the test-we still need to identify the factors preventing some clients from taking up the test.3
The increase in attendance and testing also led to an increase in the number of HIV cases diagnosed. Two of the three cases were in women considered to be at low risk of infection; these women would not have been tested under the old system, thus delaying diagnosis.
Overall, we are satisfied with the outcome of our new policy for HIV testing and detection and recommend it to other clinics.
JR is now a house physician at the Kent and Sussex Hospital, Tunbridge Wells.
Contributors JR was responsible for collecting, critically analysing, and interpreting all the data and for writing the report. SJW planned, designed, and implemented the new protocol, revised the paper, and approved the final version. SJW will act as guarantor.
Competing interests None declared.
Funding No special funding.