The key to successful implementation of HIV testing in dermatology and venereology is to ensure systems and procedures are in place, staff and colleagues are fully informed and expert support is readily available.
Find out which types of HIV test are available at the laboratory that will process your tests, and agree with them which you will use. Establish clear procedures with them for sample labelling and collection, turnaround time, results management, confirmatory testing and so on. The lab should be able to answer queries about interpretation of test results, for example with regard to the window period and retesting.
If you are thinking of using point of care tests (POCTs), the laboratory should be able to advise on the pros and cons and the type of test to use, and they may be willing to offer training. According to the European Guideline on HIV testing, all POCT programmes should be overseen by the local laboratory and have a robust quality assurance programme. An additional issue to consider is how and whether POCT samples and results will be kept in case of any future investigations. As a minimum, batch numbers should be recorded in case of manufacturer concerns.
It is important to have links in place with the local HIV specialist team(s) so that referral pathways and protocols are clear and agreed in advance, before one of your patients has a positive HIV test result. Linkage to care should occur in a timely manner and processes should be agreed with the HIV team to follow up any non-attenders, whether this is done by you or the specialist team.
The team may be able to offer expert advice and run training on how to manage the testing process and assuage any anxieties you or your staff may have. If you decide to use a leaflet to inform your patients about HIV testing, you could ask if the specialists can assist in the writing of this. They should be able to advise whether and how any official reporting of new diagnoses for HIV surveillance purposes is needed. In due course, they may be able to help with designing or implementing an audit of your HIV testing practice.
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The HIV specialist team may also be able to provide a member of the team such as an HIV nurse or counsellor to help you with giving a positive test result, if this is ever required. Make sure you have the contact details of someone in the specialist service who can give you urgent clinical advice or arrange an immediate referral in case this is ever needed.
When one of your patients is diagnosed with HIV and referred for specialist HIV care, it is important to ensure good ongoing communication with the HIV specialist if you are also continuing to see the patient. In this way, you can both be fully informed about the patient’s progress and provide co-ordinated care, liaising as needed about any emerging problems and avoiding potential drug-drug interactions.
In many places there are local community or peer support organisations for people living with HIV. These can be a good source of support and information to help people come to terms with a new diagnosis. There is still stigma associated with HIV, so being able to talk to people who have personal experience of living with HIV can be very reassuring and reduce the potential sense of isolation following a positive HIV test. Have their contact details and literature available to give to patients when needed.
For more about HIV stigma, see the People Living with HIV Stigma Index which includes national reports from a range of countries worldwide on stigma and discrimination experienced by people living with HIV.
The technical aspects of HIV testing should be straightforward to incorporate into your practice, but some training may be helpful, especially in view of the stigma and fear that can still attach to HIV.
Make sure all staff are aware not only of the procedures to follow, but also of the reasons why HIV testing in dermatology and venereology is so important. They should understand the benefits of early diagnosis and access to treatment, and their part in making this happen.
A non-judgemental approach and an understanding of the importance of confidentiality are essential for all involved in the patient’s care, from the dermatovenereologist to the secretary and receptionist, if HIV testing is to be successfully incorporated as part of routine practice. When patients perceive negative attitudes about HIV, or fear that sensitive information about their lifestyle, such as HIV status or sexuality, might be shared, they are less likely to consent to testing or to share information that may be clinically relevant.