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Nurse‐delivered universal point‐of‐care testing for HIV in an open‐access returning traveller clinic
Author(s) -
Herbert R,
Ashraf AN,
Yates TA,
Spriggs K,
Malinnag M,
DurwardBrown E,
Phillips D,
Mewse E,
Daniel A,
Armstrong M,
Kidd IM,
Waite J,
Wilks P,
Burns F,
Bailey R,
Brown M
Publication year - 2012
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/j.1468-1293.2012.01001.x
Subject(s) - point of care testing , medicine , human immunodeficiency virus (hiv) , medical diagnosis , hiv screening , hiv diagnosis , family medicine , emergency medicine , pediatrics , antiretroviral therapy , viral load , immunology , men who have sex with men , pathology , syphilis
Background Early diagnosis of HIV infection reduces morbidity and mortality associated with late presentation. Despite UK guidelines, the HIV testing rate has not increased. We have introduced universal HIV screening in an open‐access returning traveller clinic. Methods Data were prospectively recorded for all patients attending the open‐access returning traveller clinic between A ugust 2008 and D ecember 2010. HIV testing was offered to all patients from M ay 2009; initially testing with laboratory samples (phase 1) and subsequently a point‐of‐care test ( POCT ) (phase 2). Results A total of 4965 patients attended the clinic; 1342 in phase 0, 792 in phase 1 and 2831 in phase 2. Testing rates for HIV increased significantly from 2% (38 of 1342) in phase 0 to 23.1% (183 of 792) in phase 1 and further increased to 44.5% (1261 of 2831) during phase 2 ( P < 0.0001). Two new diagnoses of HIV ‐1 were identified in phase 1 (1.1% of tested); seven patients had a reactive POCT test in phase 2, of whom five (0.4% of those tested) were confirmed in a 4th generation assay. The patients with false reactive tests had a concurrent P lasmodium falciparum infection. Patients travelling to the M iddle E ast and E urope were less likely to accept an HIV test with POCT . Conclusions A nurse‐delivered universal point‐of‐care HIV testing service has been successfully introduced and sustained in an acute medical clinic in a low‐prevalence country. Caution is required in communicating reactive results in low‐prevalence settings where there may be alternative diagnoses or a low population prevalence of HIV infection.