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Apers H, Nöstlinger C, Van Beckhoven D, Deblonde J, Apers L, Verheyen K, Loos J. Identifying key elements to inform HIV-testing interventions for primary care in Belgium. Health Promot Int 2020; 35:301-311. [PMID: 31056680 PMCID: PMC7250498 DOI: 10.1093/heapro/daz037] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
General practitioners (GPs) play a key role in reducing the hidden HIV-epidemic, but many diagnostic opportunities are missed in primary care. This study aimed at informing the development of an HIV-testing intervention for GPs in Flanders (Belgium) using formative research with a participatory approach. Through the active involvement of an advisory board and 16 group discussions with 122 Flemish GPs, GPs’ current HIV-testing practices and perceived practical relevance of 2 distinct HIV-testing strategies (i.e. provider-initiated testing of key populations and indicator condition-based testing) were explored in terms of their relevance and feasibility in routine primary care. Self-reported HIV-testing practices revealed that most tests performed were patient-initiated, pretest counseling was rarely done, and post-test counseling was offered mainly for patients with an HIV-diagnosis. GPs reported multiple barriers to provider-initiated HIV-testing, i.e. personal discomfort, fear of offending their patient, limited knowledge of benefits of early HIV-diagnosis, misconceptions about HIV-risks, lack of guidelines and time. Difficulties to identify patient’s sexual orientation or ethical concerns were mentioned as barriers for target group-based HIV testing. GPs assessed the current list of 64 indicator conditions as too difficult to integrate in routine care, deeming a reduced list of GP-relevant conditions as more feasible. Combined strategies (i.e. target group- and indicator-based testing) supported by official screening recommendations were perceived as successful strategies for provider-initiated HIV-testing in primary care. This formative research delivered qualitative evidence for the development of an HIV-testing intervention for primary care settings.
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Affiliation(s)
- Hanne Apers
- Group HIV and Sexual Health, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- Corresponding author. E-mail:
| | - Christiana Nöstlinger
- Group HIV and Sexual Health, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Dominique Van Beckhoven
- Epidemiology of Infectious Diseases Unit, Department of Public Health and Surveillance, Sciensano - Belgian Scientific Institute of Public Health, Ixelles, Belgium
| | - Jessika Deblonde
- Epidemiology of Infectious Diseases Unit, Department of Public Health and Surveillance, Sciensano - Belgian Scientific Institute of Public Health, Ixelles, Belgium
| | - Ludwig Apers
- HIV/STI clinic, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Katleen Verheyen
- General Practitioner, Opglabbeek, Belgium
- ELIZA - Center for General Practice, Department of Primary & Interdisciplinary Care Antwerp, University of Antwerp, Antwerp, Belgium
| | - Jasna Loos
- Group HIV and Sexual Health, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
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Duracinsky M, Thonon F, Bun S, Ben Nasr I, Dara AF, Lakhdari S, Coblentz-Baumann L, Lert F, Dimi S, Chassany O. Good acceptability of HIV, HBV, and HCV screening during immigration medical check-up amongst migrants in France in the STRADA study. PLoS One 2020; 15:e0235260. [PMID: 32589652 PMCID: PMC7319329 DOI: 10.1371/journal.pone.0235260] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/11/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction The prevalence of HIV, hepatitis B, and hepatitis C amongst migrants in France is high. Thus, effective screening and follow-up is needed. The mandatory medical check-up for residency application is an opportunity to offer rapid HIV and hepatitis testing. The main objective of the STRADA study is to create a feasible and acceptable screening strategy for migrants. Within the STRADA study, this qualitative research examined the acceptability of conducting screening tests in the context of residency application. Methods We conducted a qualitative study amongst legal migrants over 18 years of age with sufficient knowledge of the French, English, or Arabic language. Interviews were performed following a semi-structured interview guide of open-ended questions. Interviews were transcribed verbatim and subsequently analyzed through thematic analysis. Results We interviewed 34 migrants. Mean age was 32.6 (min-max: 19, 59) years. The participants’ region of origin was mostly Sub-Saharan Africa and the main reason for migrating to France was family reunification. Migrants' acceptability of HIV and hepatitis testing was high. Participants who accepted testing indicated a benefit for individual health and to avoid transmission. Most preferred rapid tests; reluctance was related to anxiety about the immediate results and the perceived reliability of rapid tests. Migrants' knowledge about HIV was satisfactory, but inadequate for hepatitis. Screening in the context of a compulsory medical visit did not present an obstacle for acceptability. Some expressed concern in the case of HIV but when explained, the independence between obtaining the residence permit along with screening and access to medical care was well understood. Discussion Medical check-ups at immigration centers is an opportunity to screen for HIV and hepatitis which is considered acceptable by migrants. Informing migrants that test results do not affect residency applications, and incorporating their preferences, are all important to optimize the acceptability of screening.
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Affiliation(s)
- Martin Duracinsky
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
- Hôpital Bicêtre, Service d’infectiologie, Le Kremlin Bicêtre, France
- AP-HP, hôpital Hôtel-Dieu, Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Paris, France
- * E-mail:
| | - Frédérique Thonon
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
| | - Sonia Bun
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
| | - Imène Ben Nasr
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
| | - Aïchata Fofana Dara
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
| | - Sabrina Lakhdari
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
| | | | - France Lert
- Agence nationale de recherche sur le sida et les hépatites virales (ANRS), Paris, France
| | - Svetlane Dimi
- Hôpital Foch, Service d’Hépatologie, Suresnes, France
| | - Olivier Chassany
- Université Paris-Diderot & Inserm, UMR1123, Patient-Centered Outcomes Research, Paris, France
- AP-HP, hôpital Hôtel-Dieu, Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Paris, France
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Desai S, Tavoschi L, Sullivan AK, Combs L, Raben D, Delpech V, Jakobsen SF, Amato‐Gauci AJ, Croxford S. HIV testing strategies employed in health care settings in the European Union/European Economic Area (EU/EEA): evidence from a systematic review. HIV Med 2020; 21:163-179. [PMID: 31729150 PMCID: PMC7065119 DOI: 10.1111/hiv.12809] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Despite the availability of HIV testing guidelines to facilitate prompt diagnosis, late HIV diagnosis remains high across Europe. The study synthesizes recent evidence on HIV testing strategies adopted in health care settings in the European Union/European Economic Area (EU/EEA). METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and systematic searches were run in five databases (2010-2017) to identify studies describing HIV testing interventions in health care settings in the EU/EEA. The grey literature was searched for unpublished studies (2014-2017). Two reviewers independently performed study selection, data extraction and critical appraisal. RESULTS One hundred and thirty intervention and/or feasibility studies on HIV testing in health care settings were identified. Interventions included testing provision (n = 94), campaigns (n = 14) and education and training for staff and patients (n = 20). HIV test coverage achieved through testing provision varied: 2.9-94% in primary care compared to 3.9-66% in emergency departments. HIV test positivity was lower in emergency departments (0-1.3%) and antenatal services (0-0.05%) than in other hospital departments (e.g. inpatients: 0-5.3%). Indicator condition testing programmes increased HIV test coverage from 3.9-72% before to 12-85% after their implementation, with most studies reporting a 10-20% increase. There were 51 feasibility and/or acceptability studies that demonstrated that HIV testing interventions were generally acceptable to patients and providers in health care settings (e.g. general practitioner testing acceptable: 77-93%). CONCLUSIONS This review has identified several strategies that could be adopted to achieve high HIV testing coverage across a variety of health care settings and populations in the EU/EEA. Very few studies compared the intervention under investigation to a baseline, but, where this was assessed, data suggested increases in testing.
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Affiliation(s)
- S Desai
- Centre for Infectious Disease Surveillance and ControlPublic Health EnglandLondonUK
| | - L Tavoschi
- European Centre for Disease Prevention and ControlSolnaSweden
- University of PisaPisaItaly
| | - AK Sullivan
- Directorate of HIV and Sexual HealthChelsea and Westminster Hospital NHS Foundation TrustLondonUK
| | - L Combs
- CHIPRigshospitalet ‐ University of CopenhagenCopenhagen ØDenmark
| | - D Raben
- CHIPRigshospitalet ‐ University of CopenhagenCopenhagen ØDenmark
| | - V Delpech
- Centre for Infectious Disease Surveillance and ControlPublic Health EnglandLondonUK
| | - SF Jakobsen
- CHIPRigshospitalet ‐ University of CopenhagenCopenhagen ØDenmark
| | - AJ Amato‐Gauci
- European Centre for Disease Prevention and ControlSolnaSweden
| | - S Croxford
- Centre for Infectious Disease Surveillance and ControlPublic Health EnglandLondonUK
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Deblonde J, Van Beckhoven D, Loos J, Boffin N, Sasse A, Nöstlinger C, Supervie V. HIV testing within general practices in Europe: a mixed-methods systematic review. BMC Public Health 2018; 18:1191. [PMID: 30348140 PMCID: PMC6196459 DOI: 10.1186/s12889-018-6107-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 10/10/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Late diagnosis of HIV infection remains a key challenge in Europe. It is acknowledged that general practitioners (GPs) may contribute greatly to early case finding, yet there is evidence that many diagnostic opportunities are being missed. To further promote HIV testing in primary care and to increase the utility of available research, the existing evidence has been synthesised in a systematic review adhering to the PRISMA guidelines. METHODS The databases PubMed, Scopus and Embase were searched for the period 2006-2017. Two authors judged independently on the eligibility of studies. Through a mixed-methods systematic review of 29 studies, we provide a description of HIV testing in general practices in Europe, including barriers and facilitators. RESULTS The findings of the study show that although various approaches to target patients are used by GPs, most tests are still carried out based on the patient's request. Several barriers obstruct HIV testing in general practice. Included are a lack of communication skills on sexual health, lack of knowledge about HIV testing recommendations and epidemic specificities, difficulties with using the complete list of clinical HIV indicator diseases and lack of experience in delivering and communicating test results. The findings also suggest that the provision of specific training, practical tools and promotion programmes has an impact on the testing performance of GPs. CONCLUSIONS GPs could have an increased role in provider-initiated HIV-testing for early case finding. To achieve this objective, solutions to the reported barriers should be identified and testing criteria adapted to primary healthcare defined. Providing guidance and training to better identify priority groups for HIV testing, as well as information on the HIV epidemic's characteristics, will be fundamental to increasing awareness and testing by GPs.
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Affiliation(s)
- Jessika Deblonde
- Sciensano, Health Services Research, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | | | - Jasna Loos
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Nicole Boffin
- Sciensano, Health Services Research, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - André Sasse
- Sciensano, Health Services Research, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Christiana Nöstlinger
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Virginie Supervie
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, INSERM, Sorbonne Université, 56 Bd. Vincent Auriol, CS 81393, 75646 Paris Cedex 13, France
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Demorat H, Lopes A, Chopin D, Delcey V, Clevenbergh P, Simoneau G, Evans J, Mouly S, Bergmann JF, Sellier P. Acceptability and feasibility of HIV testing in general medicine by ELISA or rapid test from finger-stick whole blood. Presse Med 2018; 47:e15-e23. [PMID: 29478794 DOI: 10.1016/j.lpm.2017.11.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 10/01/2017] [Accepted: 11/27/2017] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Guidelines recommend routine universal HIV testing in adults to reduce the pool of infected patients unaware of their status, without specific recommendations concerning the method. We compared acceptability and feasibility of HIV testing by ELISA tests or rapid tests from finger-stick whole blood. METHODS Prospective randomized multi-center study comparing acceptability and feasibility of routine universal HIV testing by ELISA tests, with a charge, subsequently reimbursed by Social Security for affiliated patients, or rapid tests from finger-stick whole blood, without any charge from the patients or the general practitioner for the study. A single investigator performed all interventions. After consent, all adults (18-70 years old) consulting their general practitioner in Paris, France, unaware of their status, were enrolled. Testing was performed immediately for the patients in the rapid test arm; a prescription was given for testing in a lab for the patients in the ELISA arm. The primary endpoint was acceptability of each method. The secondary endpoint was feasibility of each method, assessed one month after the consultation. RESULTS Two hundred and seventy patients were enrolled: 133 patients in the ELISA arm, 137 in the rapid test arm. Acceptability of the rapid test (92%) was higher than that of the ELISA (63.9%), P<0.0001. Feasibility of the rapid test (100%) was higher than that of the ELISA (50.5%), P<0.0001. A center effect was shown concerning feasibility of ELISA but not concerning feasibility of rapid tests. CONCLUSION Rapid testing from finger-stick whole blood is more acceptable and feasible than ELISA for routine universal HIV testing. A larger use of rapid tests, ideally free of charge, by general practitioners could reduce the pool of infected patients unaware of their status.
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Affiliation(s)
- Hubert Demorat
- Assistance publique-hôpitaux de Paris, Saint-Louis/Lariboisière-Fernand-Widal Hospital, Department of Internal Medicine, Unit of Infectious Diseases, 2, rue Ambroise Paré, 75475 Paris cedex 10, France
| | - Amanda Lopes
- Assistance publique-hôpitaux de Paris, Saint-Louis/Lariboisière-Fernand-Widal Hospital, Department of Internal Medicine, 75475 Paris cedex 10, France
| | - Dorothée Chopin
- Assistance publique-hôpitaux de Paris, Saint-Louis/Lariboisière-Fernand-Widal Hospital, Department of Internal Medicine, 75475 Paris cedex 10, France
| | - Véronique Delcey
- Assistance publique-hôpitaux de Paris, Saint-Louis/Lariboisière-Fernand-Widal Hospital, Department of Internal Medicine, Unit of Infectious Diseases, 2, rue Ambroise Paré, 75475 Paris cedex 10, France
| | - Philippe Clevenbergh
- Assistance publique-hôpitaux de Paris, Saint-Louis/Lariboisière-Fernand-Widal Hospital, Department of Internal Medicine, Unit of Infectious Diseases, 2, rue Ambroise Paré, 75475 Paris cedex 10, France
| | - Guy Simoneau
- Assistance publique-hôpitaux de Paris, Saint-Louis/Lariboisière-Fernand-Widal Hospital, Department of Internal Medicine, 75475 Paris cedex 10, France
| | - John Evans
- Assistance publique-hôpitaux de Paris, Saint-Louis/Lariboisière-Fernand-Widal Hospital, Department of Internal Medicine, Unit of Infectious Diseases, 2, rue Ambroise Paré, 75475 Paris cedex 10, France
| | - Stéphane Mouly
- Assistance publique-hôpitaux de Paris, Saint-Louis/Lariboisière-Fernand-Widal Hospital, Department of Internal Medicine, 75475 Paris cedex 10, France
| | - Jean-François Bergmann
- Assistance publique-hôpitaux de Paris, Saint-Louis/Lariboisière-Fernand-Widal Hospital, Department of Internal Medicine, 75475 Paris cedex 10, France.
| | - Pierre Sellier
- Assistance publique-hôpitaux de Paris, Saint-Louis/Lariboisière-Fernand-Widal Hospital, Department of Internal Medicine, Unit of Infectious Diseases, 2, rue Ambroise Paré, 75475 Paris cedex 10, France.
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Papadima D, Gauthier R, Prévoteau du Clary F, Bouée S, Conort G, Livrozet JM, Taulera O, Wajsbrot A, Majerholc C, Peter JM, Aubert JP. DEPIVIH 2: Use of three HIV testing methods in French primary care settings - ELISA laboratory screening versus two rapid point-of-care HIV tests. Med Mal Infect 2017; 48:122-129. [PMID: 29269203 DOI: 10.1016/j.medmal.2017.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 01/15/2017] [Accepted: 11/14/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The primary endpoint was to evaluate the use of HIV testing methods by French primary care providers: Elisa laboratory screening, instant result HIV diagnostic test and rapid result HIV diagnostic test. The secondary endpoints were the population screening rate of unknown HIV status consulting during the study period, reasons for screening and for choosing the specific screening method, the investigators' satisfaction with the rapid diagnostic test (RDT) and problems encountered. PATIENTS AND METHODS National prospective interventional study with French family physicians (FP) from December 2013 to December 2014. FPs enrolled all consenting adults consulting for an HIV screening test during a 6-month period: the choice was an Elisa laboratory test or one of the two RDTs. RESULTS During the study period, 43 FPs included 981 patients. HIV screening was performed for the first time for 31.6% of patients; 767 (78.2%) Elisa laboratory test prescriptions and 214 (21.8%) RDTs were performed, leading to a screening rate of 1.3%. For 120 (15.7%) of the Elisa laboratory tests, the result was not reported and six RDTs were not valid. Nine patients were diagnosed as HIV-infected (0.9%): five with Elisa laboratory test and four with RDT. Almost 90% of FPs were willing to keep on using RDTs in their daily practice. CONCLUSION In general practice, RDTs may be an important additional tool to traditional HIV screening. They could account for one in five tests prescribed in this context.
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Affiliation(s)
- D Papadima
- Département de médecine générale, université Louis-Pasteur, 4, rue Kirschleger, 67000 Strasbourg, France; Groupe d'études et recherché ville-hôpital, 75, rue du Ruisseau, 75018 Paris, France.
| | - R Gauthier
- Groupe d'études et recherché ville-hôpital, 75, rue du Ruisseau, 75018 Paris, France; Departement médecine générale, université Paris-Diderot, Sorbonne Paris Cité, 75018 Paris, France; EA recherche clinique coordonnée ville-hôpital, méthodologies et société (REMES), 75018 Paris, France
| | - F Prévoteau du Clary
- Groupe d'études et recherché ville-hôpital, 75, rue du Ruisseau, 75018 Paris, France; Cité de la santé, hôpitaux de Toulouse, 31059 cedex 9 Toulouse, France
| | - S Bouée
- Groupe d'études et recherché ville-hôpital, 75, rue du Ruisseau, 75018 Paris, France; Cemka Eval, 43, boulevard du Maréchal-Joffre, 92340 Bourg-la-Reine, France
| | - G Conort
- Groupe d'études et recherché ville-hôpital, 75, rue du Ruisseau, 75018 Paris, France; Département de médecine générale, université de Bordeaux, 33076 Bordeaux cedex, France
| | - J-M Livrozet
- Groupe d'études et recherché ville-hôpital, 75, rue du Ruisseau, 75018 Paris, France; Service des maladies infectieuses et tropicales, hôpital Édouard-Herriot, 69003 Lyon, France
| | - O Taulera
- Groupe d'études et recherché ville-hôpital, 75, rue du Ruisseau, 75018 Paris, France; Hôpital Saint-Louis, 75010 Paris, France
| | - A Wajsbrot
- Groupe d'études et recherché ville-hôpital, 75, rue du Ruisseau, 75018 Paris, France; Médecine générale, hôpital d'Avignon, 84000 Avignon, France
| | - C Majerholc
- Groupe d'études et recherché ville-hôpital, 75, rue du Ruisseau, 75018 Paris, France; Departement médecine générale, université Paris-Diderot, Sorbonne Paris Cité, 75018 Paris, France; EA recherche clinique coordonnée ville-hôpital, méthodologies et société (REMES), 75018 Paris, France; Service de médecine interne, hôpital Foch, 92150 Suresnes, France
| | - J-M Peter
- Groupe d'études et recherché ville-hôpital, 75, rue du Ruisseau, 75018 Paris, France; Groupe hospitalier Émile-Muller, 68100 Mulhouse, France
| | - J-P Aubert
- Groupe d'études et recherché ville-hôpital, 75, rue du Ruisseau, 75018 Paris, France; Departement médecine générale, université Paris-Diderot, Sorbonne Paris Cité, 75018 Paris, France; EA recherche clinique coordonnée ville-hôpital, méthodologies et société (REMES), 75018 Paris, France
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Fraisse T, Fourcade C, Brazes-Sanz J, Koumar Y, Lavigne JP, Sotto A, Laureillard D. A cross sectional survey of the barriers for implementing rapid HIV testing among French general practitioners. Int J STD AIDS 2015; 27:1005-12. [PMID: 26429893 DOI: 10.1177/0956462415605413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/18/2015] [Indexed: 11/17/2022]
Abstract
In France, almost 30,000 people are unaware of their HIV-positive status. Innovative screening strategies are essential to reach this population. The aim of this study was to describe the acceptability of rapid HIV testing (RHT) among French general practitioners (GPs) working in the south of France and barriers for implementing this strategy. We analysed an anonymous questionnaire sent by mail to GPs about demographic data, routine practice, knowledge of RHT and barriers to its use. Between 1 April and 30 September 2013, out of the 165 GPs contacted, 78 returned the questionnaires. The GPs' mean age was 52 years; 49 were men. Fifty-one GPs reported that their registered patients included at least one HIV-infected person and 70 GPs reported taking care of high-risk patients. Sixty-three percent of GPs reported being interested in using RHT in their daily practice. The main reasons reported by uninterested GPs were: greater confidence in standard HIV testing, difficulties including RHT during the routine consultation, difficulties to screen for other sexually transmitted infections simultaneously, and difficulties to deliver a positive result. French National Authorities for Health propose to screen the population at least once in their lifetime and high-risk people at least once a year. In order to achieve this aim, RHT should be included in the GPs' arsenal for HIV testing. We showed a high acceptability of RHT by GPs. If specific and adapted training is developed, and if solutions to barriers reported by GPs are found, RHT could be implemented in to their routine activity.
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Affiliation(s)
- Thibaut Fraisse
- Department of Geriatric Medicine, General Hospital, Alès, France
| | - Camille Fourcade
- Department of Infectious and Tropical Diseases, University Hospital, Nîmes, France
| | | | - Yatrika Koumar
- Department of Infectious and Tropical Diseases, University Hospital, Nîmes, France
| | | | - Albert Sotto
- Department of Infectious and Tropical Diseases, University Hospital, Nîmes, France
| | - Didier Laureillard
- Department of Infectious and Tropical Diseases, University Hospital, Nîmes, France
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8
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Platteau T, Fransen K, Apers L, Kenyon C, Albers L, Vermoesen T, Loos J, Florence E. Swab2know: An HIV-Testing Strategy Using Oral Fluid Samples and Online Communication of Test Results for Men Who Have Sex With Men in Belgium. J Med Internet Res 2015; 17:e213. [PMID: 26330138 PMCID: PMC4642797 DOI: 10.2196/jmir.4384] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 08/04/2015] [Accepted: 08/05/2015] [Indexed: 11/26/2022] Open
Abstract
Background As HIV remains a public health concern, increased testing among those at risk for HIV acquisition is important. Men who have sex with men (MSM) are the most important group for targeted HIV testing in Europe. Several new strategies have been developed and implemented to increase HIV-testing uptake in this group, among them the Swab2know project. Objective In this project, we aim to assess the acceptability and feasibility of outreach and online HIV testing using oral fluid samples as well as Web-based delivery of test results. Methods Sample collection happened between December 2012 and April 2014 via outreach and online sampling among MSM. Test results were communicated through a secured website. HIV tests were executed in the laboratory. Each reactive sample needed to be confirmed using state-of-the-art confirmation procedures on a blood sample. Close follow-up of participants who did not pick up their results, and those with reactive results, was included in the protocol. Participants were asked to provide feedback on the methodology using a short survey. Results During 17 months, 1071 tests were conducted on samples collected from 898 men. Over half of the samples (553/1071, 51.63%) were collected during 23 outreach sessions. During an 8-month period, 430 samples out of 1071 (40.15%) were collected from online sampling. Additionally, 88 samples out of 1071 (8.22%) were collected by two partner organizations during face-to-face consultations with MSM and male sex workers. Results of 983 out of 1071 tests (91.78%) had been collected from the website. The pickup rate was higher among participants who ordered their kit online (421/430, 97.9%) compared to those participating during outreach activities (559/641, 87.2%; P<.001). MSM participating during outreach activities versus online participants were more likely to have never been tested before (17.3% vs 10.0%; P=.001) and reported more sexual partners in the 6 months prior to participation in the project (mean 7.18 vs 3.23; P<.001). A total of 20 participants out of 898 (2.2%) were confirmed HIV positive and were linked to care. Out of 1071 tests, 28 (2.61%) with a weak reactive result could not be confirmed, and were thereby classified as false reactive results.
Most of the 388 participants who completed posttest surveys (388/983, 39.5%) were very positive about their experience. The vast majority (371/388, 95.6%) were very satisfied, while 17 out of 388 (4.4%) reported mixed feelings. Conclusions Despite a high yield and a considerable number of false reactive results, satisfaction was high among participants. The project helped us to reach the target population, both in numbers of tests executed and in newly diagnosed HIV infections. Further optimization should be considered in the accuracy of the test, the functionalities of the website (including an online counseling tool), and in studying the cost effectiveness of the methodology.
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Affiliation(s)
- Tom Platteau
- Institute of Tropical Medicine, Department of Clinical Sciences, Antwerp, Belgium.
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9
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Poirier C, Aymeric S, Grammatico-Guillon L, Lebeau JP, Bernard L, Le Bret P, Le Moal G, Gras G. Rapid HIV test in family practice. Med Mal Infect 2015; 45:207-14. [PMID: 25982343 DOI: 10.1016/j.medmal.2015.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 01/19/2015] [Accepted: 03/24/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The 2010-2014 HIV/AIDS French program recommends using HIV rapid diagnostic tests in family practice. Our aim was to assess the acceptability and feasibility of the RDT in family practice in France. METHODS The first part of this study was to determine the opinions of family practitioners (FPs) concerning the news guidelines for screening and the possible use of rapid HIV tests in their practice. The second part was a feasibility study of the actual use of rapid HIV tests given to FPs during six months. The third part was a qualitative analysis of experience feedback to determine the impediments to using rapid HIV tests. RESULTS Seventy-seven percent of the 352 FPs interviewed were favorable to rapid HIV tests use. The three main impediments were: misinterpretation of test result, complexity of quality control, and lack of training: 23 of the 112 FPs having volunteered to evaluate the rapid HIV tests followed the required training session. Sixty-nine tests were handed out, and three rapid HIV tests were used; the qualitative study involved 12 FPs. The participants all agreed on the difficult use of rapid HIV tests in daily practice. The main reasons were: too few opportunities or requests for use, complex handling, difficulties in proposing the test, fear of having to announce seropositivity, significantly longer consultation. CONCLUSION Although FPs are generally favorable to rapid HIV tests use in daily practice, the feasibility and contribution of rapid HIV tests are limited in family practice.
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Affiliation(s)
- C Poirier
- Service de médecine interne et maladies infectieuses, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Université François-Rabelais, 60, rue du Plat-D'Étain, 37020 Tours cedex 1, France.
| | - S Aymeric
- Université François-Rabelais, 60, rue du Plat-D'Étain, 37020 Tours cedex 1, France; Service d'information médicale d'épidémiologie et d'économie de la santé, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Équipe émergente éducation éthique santé, 60, rue du Plat-D'Étain, 37020 Tours cedex 1, France.
| | - L Grammatico-Guillon
- Université François-Rabelais, 60, rue du Plat-D'Étain, 37020 Tours cedex 1, France; Service d'information médicale d'épidémiologie et d'économie de la santé, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Équipe émergente éducation éthique santé, 60, rue du Plat-D'Étain, 37020 Tours cedex 1, France
| | - J P Lebeau
- Université François-Rabelais, 60, rue du Plat-D'Étain, 37020 Tours cedex 1, France; Équipe émergente éducation éthique santé, 60, rue du Plat-D'Étain, 37020 Tours cedex 1, France; Département universitaire de médecine générale, 60, rue du Plat-D'Étain, 37020 Tours cedex 1, France
| | - L Bernard
- Service de médecine interne et maladies infectieuses, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; Université François-Rabelais, 60, rue du Plat-D'Étain, 37020 Tours cedex 1, France
| | - P Le Bret
- Réseau ville hôpital VIH 37, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
| | - G Le Moal
- COREVIH centre Poitou-Charentes, service de maladies infectieuses et tropicales, CHRU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - G Gras
- Service de médecine interne et maladies infectieuses, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 9, France
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