Demand patterns for HIV-tests in general practice: information collected by sentinel networks in 5 European countries

Redes centinela sanitarias en España. Consenso para una guía de principios y métodos

Since the eighties, health sentinel networks have been active in our country, but with a variety of objectives, methods and different development levels in the autonomous communities. The necessity of standardising the management and harmonising the indicators has concluded in a research project on the Spanish health sentinel networks, one of whose objectives is to establish a guide for work principles and methods. A panel of 23 experts has made a study using the Delphi method to agree, in three consecutive phases, a definition of sentinel network, the objectives and the management principles and other aspects related to the organisation and functioning. Altogether, 41 questions were gathered from a previous draft which needed 80% of consensus in the first phase and 70% in the second. All the experts participated in the first phase, 22 in the second and 20 in the third. A consensus was achieved on 36 questions in the first phase and in 4 of the remaining ones in the second. In the third phase the shape of the guide document was given. The Delphi consensus method has been extremely useful in the resolution of discrepancies and divergences. The experts who were selected outside of the sentinel networks contributed with a wider vision on the objectives and applicability of the health sentinel networks in Spain.

Trends in voluntary HIV testing in general practices in France between 1987 and 2002

OBJECTIVES

To measure the level of voluntary HIV testing and to assess its changes in the French general population according to the evolution of HIV testing policies.

METHODS

When general practitioners belonging to the Sentinelles network (SGP) offer HIV testing to their patients, they send the network an anonymous description of the patient and a report of the test results.

RESULTS

The number of HIV tests peaked in 1993 at 1760 per 100,000 inhabitants. Since 1995 the rate has fallen slightly, from 1474 to 810 per 100,000 in 2002. Between 1987 and 2002 there was a significant fall in the proportion of persons with a history of STD (31.4-5.1%, p = 0.0001), clinical signs of HIV infection (9.1-4.5%, p = 0.0002) and a history of prior testing (19.3-13.6%, p = 0.0005).

CONCLUSIONS

Our results show that demand for HIV testing among the French general practice patient population has fallen since 1995, along with the frequency with which GPs offer HIV testing.

[Requests for HIV tests and their performance in primary health care. Study of the Sentinel Physician Network of Castilla y León in Spain, 1990-1996]

AIM

To describe the patterns of requests for and the carrying out of the HIV test in Primary Health Care and the epidemological characteristics of the individuals who have undergone the test.

METHOD

A retrospective descriptive study of requests for the HIV test in Primary Health Care, in the area covered by the Sentinel Network of Castile and Leon between 1991 and 1996. The validity of the results was assured through an initial study of geographical representativity and populational diversity, with periodical adjustments. The information was obtained through weekly reports from Sentinel doctors.

RESULTS

The request rate per 100.000 inhabitants showed a tendency to increase until 1993, levelling off in 1995 and 1996. There were significant differences between percentage of test requested by doctors (55.9%) and patients (40%), as well as between males/females and average for age of these. Of the 63.1% of patients with known risk factor: 17.5% were injected drug users (IDUs) and 11.2% were through unsafe heterosexual contact; these factors being modified over time. The predominant risk factors among males were: heterosexual contact (31.1%) and the use of injected drugs (27.9%). The case was similar for females: 22.7% and 6.9% respectively. The results were positive in 3.2% of the HIV tests.

CONCLUSIONS

An increase in requests and tests carried out between 1991 and 1993 was detected. The figures later stabilized and, in general, they were lower than in other studies. The doctor was predominantly the origin of the request. A decrease in IDUs and an increase in the percentage of unsafe heterosexual contact, were detected, both in line with data from other research. Primary Health Care had a predominant place in early detection of risk practice and in the areas of prevention, education and information.

Patterns of HIV testing in Scotland: a general practitioner perspective

General practitioners are one of the largest groups who offer HIV testing but little is known about the patient group who present for HIV counselling and testing in primary care. This study describes the risk factors, positivity rate, temporal trends and demographic profile of patients presenting to their general practitioner for HIV testing in central Scotland. Of 8,466 tests taken 1% (84%) were positive with an independent association between a positive result and age group, history of drug misuse, homosexuality and region of testing. The majority of tests were performed in those who were at low risk and because of patient concern about HIV. No increase in the number of positive tests was apparent over the five-year study period. Variations between GP testing for HIV occurs in different regions and may reflect the underlying HIV positivity rate. General practitioners performing HIV tests are well placed to educate their patients about HIV and encourage low risk sexual behaviour patterns.

Demographic and behavioral predictors of knowledge and HIV seropositivity: results of a survey conducted in three anonymous and free counselling and testing centers

This paper deals with subjects seeking counselling and testing for human immunodeficiency virus (HIV); it analyses which sociodemographic and behavioral characteristics are related to beliefs concerning HIV infection and to HIV seropositivity. A one month survey among individuals who attended HIV testing in three anonymous and free centers (CIDAGs) was carried out in Paris city, on March 1994. 2059 subjects completed a self-administered questionnaire. Data collected included demographic information, sexual and IVDU behavior, and HIV seropositivity. Subjects also had to evaluate their own risk of getting the acquired immunodeficiency syndrome (AIDS) and the perceived risk of getting AIDS in specific situations such as unprotected anal/vaginal intercourse with a casual partner, with multiple partners, with a seropositive partner, current dental treatment, French kiss, etc.... Multiple linear and logistic regressions have been used to model the dependent variables. Subjects correctly evaluated the risk level of HIV transmission associated with different situations, and women, young men and those engaged in homo/bisexual behavior were in general more conscious of the increased danger resulting from high risk sexual practices. Among males, homo/bisexuals, drug users and the less educated considered themselves to be more at risk. The most important factors related to HIV seropositivity were sexual orientation, intravenous drug use (IVDU), and the perceived risk of getting aids. Despite a good awareness of HIV contamination and an accurate perception of their own risk, many subjects continued to engage in high risk AIDS activities. Better targeted interventions need to be developed to promote and maintain behavior changes.

Is HIV screening being requested appropriately? The experience of a Victorian public health laboratory

From the start of clinical testing for human immunodeficiency virus (HIV) antibody in 1985 until the end of June 1994, the Microbiological Diagnostic Unit tested 134 346 serum samples from 109 391 individuals, identifying 672 as infected. A suitable database, using coded identities, was established from the beginning. Because the sera came from a variety of clinical settings, it was possible to extract information about patterns of requests for tests and about the yield of seropositive cases. The data were able to highlight factors associated with high rates of positive tests that can be lost in amalgamated statewide data. The discovery of HIV-positive females was sporadic and there was a much lower detection rate than from testing males. While males were most commonly diagnosed through specialist venereology services, 61 per cent of diagnoses in females were through nonspecialised practices, often those without previous experience in diagnosis and management of HIV infection. Despite some individual exceptions, the requesting of HIV tests appears generally to have been justifiable (particularly in view of the direction of official preventive campaigns) and not profligate. Overall, where practice was unsatisfactory, this lay less in thoughtless ordering of tests than in failing to include with the specimen the elementary, but vital, epidemiological information requested.

A review of research on the nature and quality of HIV testing services: a proposal for process-based studies

Considerable research has been conducted on various issues associated with HIV testing. However, rather than conceptualizing HIV testing as a dynamic process which consists of interrelated elements, this body of work has focused on discrete aspects of the HIV testing process. As an example of such research, studies which have examined HIV testing in terms of various behavioural and psychological outcomes are critically reviewed. Their limitations are attributed to their failure to account for all the elements involved in the HIV testing process that-singly and in dynamic combination-could have produced the measured outcomes. It is contended that if research on HIV testing is to be of use in the development and improvement of HIV testing services, it should be able to identify and describe in detail the factors that might lead to various outcomes of testing. This requires an in-depth examination of all aspects of the HIV testing process and their interrelationships from the perspectives of those undergoing testing and those providing testing services. The principal process elements in HIV testing are described; existing research on these topics is critically reviewed; and recommendations are made for future research. The process elements of HIV testing are identified as making a decision to be tested; accessing testing services; test counseling; and waiting for the test result. Of these, most consideration is accorded to the HIV test counselling process. It is contended that research is needed which examines both clients' and counsellors' expectations, experiences of and satisfaction with HIV test counselling. Specific issues that could usefully be addressed by future research include the process of obtaining clients' informed consent for testing; the ways in which test results are conveyed to clients; the strategies used in HIV counselling to help clients avoid or reduce behaviours in the future; partner notification; and which professional groups are best placed to conduct HIV test counselling. Finally, the question of which research methods might be suitable for process-based studies is considered. It is concluded that qualitative methods could be particularly appropriate as they are well-placed to chart in detail the varied aspects of the HIV testing process and their interrelationships.