Identifying barriers to HIV testing in hospital admissions to improve HIV testing

In response to: Murthy L, Richardson J, Rowark A, Wasielewska. NICE public health guidance update. J Public Health 2017;39(3):647–649 Murthy et al.1 have highlighted recent NICE guidance on HIV testing in geographical areas of high prevalence. Locally, we have an extremely high prevalence of HIV (>8:1000). The British Association of Sexual Health & HIV, The British HIV Association and NICE recommend routine HIV testing in medical admissions in areas of high prevalence.1,2 We wanted to identify current practices and knowledge of HIV testing in our large acute urban hospital trust amongst staff working in acute admissions to identify barriers to testing An electronic survey of clinical staff was distributed via email and the hospital trust website in January 2017. A total of 42 responses were collected from 21/42 (50%) nurses, 6/42 (17%) medical staff and 15/42 (36%) other staff. The 33/42 of responses were from non-traditional settings (non-sexual health, non-infectious diseases). And 39/42 (93%) agreed that HIV testing should be part of regular healthcare and most (32/42 (76%)) agreed that offering HIV tests does not interfere with other healthcare services and (24/42 (57%)) that they have the resources to perform a test 30/42 (75%) feel comfortable in discussing HIV with patients and 20/42 (71%) feel comfortable in offering and performing an HIV test. In total, 18/42(43%) said they believed patients would be offended by being offered an HIV test. And 14/42 (34%) do not think that patients receive adequate pre-test information, while 20/42 (48%) said patients are not receiving adequate post-test information. And 17/42 (41%) do not know if test results are being given in an appropriate and confidential manner to patients. Overall clinical teams believe that HIV testing is a good idea and does not interfere with the provision of regular healthcare services. It is concerning that some healthcare workers believe that patients will be offended by being offered a test as there is no evidence for this and we have shown that patients often believe they are being tested anyway.3 However, the clinical teams offering tests need more information on what pre and post-test discussion is required and how patients receive results. We have shown before that barriers to HIV testing are all healthcare workers barriers rather than patient barriers and it is important to continue challenging these to increase HIV testing rates.4