Editor – We read with great interest the article by Ellis et al (Clin Med October 2012 pp 430–4). The authors suggest that there are probably low levels of testing in hospital medical admissions, representing a missed opportunity for testing.
We completed an audit to determine if guidelines for HIV testing among medical admissions were being followed. 200 case notes for patients admitted to an acute trust in 2011 were reviewed. Our patient population includes several areas of high HIV prevalence (>2/1,000). BHIVA guidelines recommend widespread testing in patients from areas of high HIV prevalence.
Of the patients presenting from areas of high HIV prevalence, only 1% were appropriately tested for HIV. 3% of patients from lower prevalence areas were tested. An additional 14% of patients from lower prevalence areas should have been offered an HIV test. 2% of patients had a history of intravenous drug use and 12% had a clinical indicator condition. Alarmingly, there was no evidence that any patients had been questioned about HIV risk factors.
We were concerned as to why medical admission was not seen as an opportunity for HIV testing. We devised a questionnaire based on the guidelines to assess doctors' knowledge and attitudes towards HIV testing. The survey was completed by 50 medical doctors (14 foundation year 1 doctors, 20 senior house officers, 8 specialist registrars and 8 consultants).
The survey showed that knowledge was poor. On average doctors could name 3.48 clinical indicator conditions out of a possible 38 (Table 1).1 A 5-point Likert scale was used to assess attitudes towards HIV medicine. 68% of doctors questioned felt confident asking about HIV risk factors and 74% felt confident offering patients an HIV test. In contrast, however, 88% felt they would like further training in HIV medicine.
Implications of testing form part of the Core Medical Training Curriculum (2009) and the importance of offering screening is highlighted in the Specialty Training Curriculum for General Internal Medicine (2009). Despite this, our survey might suggest that doctors' lack of knowledge may be one reason why HIV testing in medical admissions is indeed a missed opportunity.
Reference
- 1.The British HIV Association, the British Association for Sexual Health and HIV and the British infection Society. UK National Guidelines for HIV Testing 2008. London: BHIVA; 2008. www.bhiva.org/documents/Guidelines/Testing/GlinesHIVTest08.pdf [Accessed 7 December 2012]. [Google Scholar]