A number of studies have shown that, while offering HIV testing to patients with HIV indicator conditions is very acceptable, some may decline to test. More significantly, healthcare professionals may omit to offer the test, running the risk that HIV infection remains undiagnosed and patients remain at serious risk of unnecessary ill-health or even death.
To check how successful you have been in establishing routine HIV testing for patients with certain conditions or increasing clinically appropriate HIV testing in your practice, you might undertake an audit. This could include reviewing case notes to identify whether opportunities for offering a test have been missed, or checking the proportion of all patients seen with specific indicator conditions who were tested. Numbers of HIV tests could be monitored over time to see if testing rates continue to increase or if they decline once the initial impetus has worn off.
Audit findings should be shared with relevant colleagues and staff and used to explore the reasons for any problems and address them. For example, is the receptionist uncomfortable about giving patients a leaflet about HIV testing, is the nurse forgetting to tick the form to request an HIV test, or does a medical colleague worry that patients will be offended if they suggest an HIV test?
As well as auditing testing rates, it is helpful to know whether HIV infections are actually being missed in your practice. The HIV specialist service could be asked to inform you if they ever see anyone with recently diagnosed HIV infection who has presented to your service within the last two to three years without being offered an HIV test.
On a broader scale, an exercise could be organised with other local dermatovenereologists, perhaps through the specialist association, and the HIV specialist service, whereby HIV case notes are reviewed over a fixed period of time for missed diagnoses in dermatology and venereology. The findings could be used to make improvements in the local area, for example by running educational sessions, revising local procedures, or developing new local standards.
You may wish to encourage colleagues in dermatology and venereology to increase HIV testing and help them improve their diagnostic skills in relation to HIV. The case histories in this resource are formatted in a way that makes them easy to share as part of a presentation. Alternatively, presenting case histories from your own practice might have the most impact.