hiv testing in primary care. aim to provide information enabling any clinician to perform an hiv...
TRANSCRIPT
AIM
To provide information enabling any clinician to perform an HIV test within good clinical practice and to encourage normalisation of HIV testing
FACTS & STATISTICS1. 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 be offered a test
1. Universal testing:I. Antenatal servicesII. Drug dependency III. Gum, sexual health & TOP IV. 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
• Benefits of testing
• Details of how results will be given
• Questions
• Document above
• No need for written consent
High risk in Tayside HIV Services
• 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