The purpose of the post-test discussion is to give the patient the HIV test result, explain what it means and discuss their next steps. Unless a rapid point of care test has been used while the patient waits, there will be time to check the result and prepare for the discussion before the patient attends.
The procedure for giving the result of an HIV test should be the same as for other tests, and you will need to use the same skills. HIV is not the only condition where a positive result means breaking bad news, and there are great benefits to knowing this result. But in most cases, the result will be negative and straightforward.
Usually, you can reassure the patient that they do not have HIV. They should be reminded or informed about the window period. (If they have earlier been given a leaflet including this information, they could be encouraged to read it.) If they think they may have been exposed to the risk of HIV within the window period, or if the clinical reason for the test was very recent, you should give them advice about whether, when and where to re-test. This is particularly important if there is a possibility the patient is at the seroconversion stage, for example if they have symptoms which resemble those of infectious mononucleosis.
It may be helpful to have leaflets, educational websites and/or details of local HIV support organisations available, in case patients need information about how to avoid getting HIV in future.
Before seeing the patient, it is helpful to prepare by:
When the patient attends, give the result as soon as possible. Be factual, clear and direct, and allow the patient time to absorb the information which may come as a shock. Emphasise the value of knowing that they have HIV and having the opportunity to deal with it, rather than having untreated HIV cause further damage to their health. Inform them that they will receive further assessment and treatment from an HIV specialist team.
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Answer the patient’s initial questions if you can, but reassure them that the infectious diseases or HIV specialist team will be able to answer all their questions and provide advice on matters such as treatment options, prognosis, and how to stay healthy. It is important to advise the patient not to have sexual intercourse with anyone until they have had information about avoiding onward transmission, disclosing their HIV status, and informing sexual partners (partner notification). If the patient says they have had unprotected sex within the last 72 hours, advise them to tell their partner to seek post-exposure prophylaxis (a short course of antiretroviral medication to prevent HIV acquisition) urgently and give details of where this can be obtained.
It is useful to ask the patient who they are planning to tell about their HIV diagnosis and to suggest that initially they only tell people they know they can trust, until they have had time to think about who they really want to know.
Having a member of the specialist team such as a nurse or counsellor present at, or available immediately after, your appointment with the patient can help in covering these issues and addressing any other concerns expressed by the patient.
It is very important that the patient attends the HIV specialist service. Make sure they understand the reasons for this and explore any concerns they may have about it. They may prefer a referral to a particular clinic.
The patient should be informed that they will be contacted if they do not attend their specialist appointment. Discuss and agree with the HIV specialist team who will do this follow-up call.
Procedures should be in place to ensure results are communicated to patients, with active follow-up if any do not attend to receive these.