Reflecting on your practice HIV testing rate



If you've done the Audit, you can interpret your results by looking at the dropdowns  below for low, medium and high prevalence areas. You'll be able to see how your practice testing rates compare with what the testing rate for your prevalence area should be.

If you've not done the Audit, you need to estimate the HIV prevalence in your practice area. First find the diagnosed prevalence:

i) See Public Health England's Sexual and Reproductive Health Profiles

ii) select the indicator HIV diagnosed prevalence rate / 1000 aged 15 to 19

iii) Select your area to see the prevalence

Low = 0 to 1 per 1000 adults
Medium = 1-2 per 1000 adults
High = Over 2 per 1000 adults

Now consider whether there is any reason that your practice area might differ from the wider area. For example, do you have a much higher, or lower, number of people from high prevalence countries? Would you be inclined to round 'your' prevalence up or down?

Now select from the options below:
 
Interpreting your results in a low prevalence area
The catch for low prevalence areas is that HIV is less likely to be thought of as a cause for symptoms, and so HIV is more likely to be diagnosed at a late stage. This can be life-threatening. There is evidence for this here.

Click here to find out how your area is doing on late diagnosis of HIV. (Select the indicator HIV late diagnosis (%) (PHOF Indicator 3:04))

What might a guideline HIV testing rate be for my area?

‘Aware’ practices in low prevalence areas, adopting a safety-first approach to patients with symptoms and with good use of risk assessment might have testing rates of 2-3/1000 registered patients per year.

You should certainly be concerned if you are not doing any HIV tests (excluding any testing for insurance reasons or antenatal testing). The differential diagnosis list for HIV is so broad; it will need to be excluded in at least some patients.

If your testing rate is high:

•    consider whether this is thanks to the whole team, or could be skewed by one or two individuals

•    give positive feedback and congratulations where they are due!

If you think your testing rate might usefully be increased, then use the HIV TIPs assessments and resources to help change practice in your team.

If you are re-auditing, and still find a low testing rate:

•    consider re-use of some of the assessments and interventions on TIPs

•    do you have new staff members, or staff who missed the training, who you should work with?

As you consider what your practice might need to do to increase testing rates, think through the different kinds of HIV testing in turn:

•    Diagnostic testing of those with symptoms

•    Opportunistic testing of those found to be at risk

•    HIV screening

•    Patient request HIV tests

TIPs will help you address any possible area of weakness.

Even in a low prevalence area, there is possibility of protecting health – or even saving a life with HIV testing.

Will you measure your practice HIV testing rate again in 3 months? Or 6 months? Set your reminder now!

Interpreting your results in a medium prevalence area
What might a guideline HIV testing rate be for my area?
Your practice should certainly be using HIV tests regularly. Practices with higher testing rates are better at diagnosing HIV. Experience from practices in medium prevalence areas who have had training on HIV suggests that you might expect a rate higher than 3-5 tests per 1000 patients per year. Some practices in medium prevalence areas have much higher testing rates than this.

Click here to find out how your area is doing on late diagnosis of HIV. (Select the indicator HIV late diagnosis (%) (PHOF Indicator 3:04))

If your testing rate is high:

•    consider whether this is thanks to the whole team, or could be skewed by one or two individuals

•    give positive feedback and congratulations where they are due!

If you think your testing rate might usefully be increased, then use the HIV TIPs assessments and resources to help change practice in your team.

If you are re-auditing, and still find a low testing rate:

•    consider re-use of some of the assessments and interventions on TIPs

•    do you have new staff members, or staff who missed the training, who you should work with?

As you consider what your practice might need to do to increase testing rates, think through the different kinds of HIV testing in turn:

•    Diagnostic testing of those with symptoms

•    Opportunistic testing of those found to be at risk

•    HIV screening

•    Patient request HIV tests

TIPs will help you address any possible area of weakness.

Set a reminder for a re-audit now. Will you measure your practice HIV testing rate again in 3 months? Or 6 months? Set your reminder now!

 
Interpreting your results in a high prevalence area
What might a guideline HIV testing rate be for my area?
Extensive experience of monitoring GP HIV testing rates in high prevalence areas (including Haringey, London) show that practices that increase their HIV testing rates do find more HIV. Many practices in high prevalence areas whose clinical staff are trained in HIV and engaged in testing do 10 or more HIV tests per 1000 registered patients per year.  Some have testing rates  well about this level.

In a high prevalence area there is a strong clinical imperative to engage all your team members in all aspects of HIV testing. All members of your team have a part to play.

Click here to find out how your area is doing on late diagnosis of HIV. (Select the indicator HIV late diagnosis (%) (PHOF Indicator 3:04))

If your testing rate is high:

•    consider whether this is thanks to the whole team, or could be skewed by one or two individuals

•    give positive feedback and congratulations where they are due!

If you think your testing rate might usefully be increased, then use the HIV TIPs assessments and resources to help change practice in your team.

As you consider what your practice might need to do to increase testing rates, think through the different kinds of HIV testing in turn:

•    Diagnostic testing of those with symptoms

•    Opportunistic testing of those found to be at risk

•    HIV screening

•    Patient request HIV tests

TIPs will help you address any possible area of weakness.

If you are re-auditing, and still find a low testing rate:

•    consider re-use of some of the assessments and interventions on TIPs

•    do you have new staff members, or staff who missed the training, who you should work with?

Will you measure your practice HIV testing rate again in 3 months? Or 6 months? Set your reminder now!




Did you know...

Human Immunodeficiency Virus, HIV, was identified by two different research groups in 1983.

Antiretrovirals were initially used singly however it quickly became apparent that this led to resistance and so now they are used in combinations of 3 or more.

Doctors