Who can offer a test?

All doctors should be competent to offer an HIV test, regardless of medical specialty. Special counselling skills, beyond those used in routine clinical practice, are not needed.

There is no reason why nurses or other staff, such as physician’s assistants, working in dermatology and venereology should not also be able to offer an HIV test with appropriate training, unless this is restricted by national or local legal or regulatory constraints.

How to offer a test

Raising the subject of HIV with a patient who is not expecting it may feel difficult at first, but it can quickly become straightforward and routine. There is a wide range of evidence that most patients find the offer of a test acceptable, even those who decline the offer.

It is best to be direct and clear with the patient about the reason for offering an HIV test. If they understand that the offer is prompted by their clinical presentation, they will rarely refuse to have the test. In fact, patients who end up being diagnosed late with HIV when already seriously ill are often surprised and upset that no-one has previously offered them an HIV test during their contacts with the healthcare system.

It can help to have a standard phrase or ‘script’ to use when raising the subject. Here are some suggestions:

 

Pre-test discussion

The main purpose of the pre-test discussion is to obtain informed consent. Lengthy counselling is not required. One way to provide the necessary information is through a leaflet, with the opportunity for the patient to ask questions and confirm they have understood its content. The key points of information to provide in the pre-test discussion are:

The benefits of testing: These include timely access to effective HIV treatment, avoidance of serious longer-term ill-health and premature death, better management of the patient’s presenting condition, and the opportunity to prevent HIV transmission to sexual partners.

How and when the result will be given: Will this be at their next appointment or in some other way? On most occasions, the result will be negative but, if positive, it is preferable to give the result face-to-face so it may be necessary to contact the patient and ask them to come in. It is important to find out how the patient prefers to be contacted, to check that their contact details are correct and ask if it is acceptable to leave a message. In case there is difficulty contacting the patient later, you should also ask whether their test result may be shared with their primary care physician. You should tell them when to expect the result and what to do if they do not receive it.

Obtaining consent

Unless obtaining written consent is a legal requirement (and in most countries it is not), consent for an HIV test can be given verbally, as with other tests. European guidelines state that test rates increase if written consent is not required.

The anxious patient

In the vast majority of cases, the pre-test discussion will be brief. However, if a patient seems particularly anxious about having a test, they should be given the opportunity to express their concerns. They may be fearful about the potential impact of HIV, and the stigma that can be associated with it, on different aspects of their life. They may also be worried about the confidentiality of the test result. Clear information and reassurance (where possible) should be offered. If the patient remains reluctant to test, you can repeat the offer at their next appointment after they have had time to consider, or it may be helpful to arrange for them to see a counsellor at the local HIV service.

How to test for HIV / Giving test results

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