Post-test discussion

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.

Giving a negative result

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.

Giving a positive result

Before seeing the patient, it is helpful to prepare by:

  • Checking the result has been confirmed as positive
  • Ensuring you have details of the infectious diseases or HIV specialist service to which you will refer the patient, or even making an appointment for them if that is appropriate
  • Arranging for an HIV specialist counsellor or nurse to be present when you see the patient, or available to see them immediately after that
  • Finding the details of any local HIV peer support or community organisations which the patient could contact for help in coping with their diagnosis

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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