Download HIV TESTING IN PRIMARY CARE

HIV TESTING IN PRIMARY
CARE
AIM
To provide information enabling any
clinician to perform an HIV test within
good clinical practice and to encourage
normalisation of HIV testing
FACTS & STATISTICS
1. Early treatment improves outcome for the individual
& public health
2. Treatment reduces morbidity, mortality & onward
infectivity
3. Early diagnosis & treatment is cost effective
4. 24% of HIV deaths in 2006 were attributable to
diagnosis made too late for effective treatment
5. 1/3 of HIV infective adults in UK remain undiagnosed
Who should test ?
• Any doctor
• Any midwife
• Any nurse or trained healthcare
Who should be offered a test
1. Universal testing:
I.
II.
III.
IV.
Antenatal services
Drug dependency
Gum, sexual health & TOP
Diagnosed with TB, Hep B, Hep C &
lymphoma
2. Prevalence in local population > 2 in 1000
3. High risk groups:
I. UPSI ( African, SE Asia )
II.IVDU
III.All pts with STI
IV.Contacts of pts known HIV+
V.MSM ( & female contacts)
VI.Country with high prevalence
4. Where HIV may enter the
differential diagnosis
• Bacterial pneumonia
• Peripheral neuropathy
• Severe seborrhoeic
dermatitis
• Severe psoriasis
• Recurrent herpes
zoster
• Oral candidiasis
• Unexplained weight
loss
• Unexplained chronic
diarrhoea
• CIN grade 2 & above
• Unexplained blood
dyscrasia
• PUO
• Lymphadenopathy of
unknown cause
• Mononucleosis like
syndrome
5. In accordance with existing DOH
guidelines
• Blood donors
• Dialysis patients
• Organ transplant donors and recipients
Pre –test discussion
Purpose : Informed consent
Lengthy discussion is not a requirement
unless the patient requests or needs this
Low risk & High risk
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•
•
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Benefits of testing
Details of how results will be given
Questions
Document above
No need for written consent
High risk in Tayside HIV
Services
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•
•
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What support does the patient have
Referral pathway
Occupation & Impact
Insurances & Mortgages
Results
• Not on a Friday
• Telephone consultation if low risk
• Face to face if:
i. High risk
ii. Mental health issues
iii.English 2nd language
iv.< 16
v.Vulnerable / anxious
Post test discussion
• Negative result:
• Health promotion
• PEP
• Repeat testing
• Positive result
• Referral pathways
• Immediate concerns
• Support
Services in Tayside
• Referral pathways
– I.D or GUM ( both have a HIV nurse)
• Same day testing at NW
– Tuesday, Wednesday and Thursday
• Next clinic testing at PRI
– Monday & Thursday
• Body positive Tayside
Websites
• www.bashh.org
• www.bhiva.org
• www.sexualhealthtayside.org
Questions ???