Registration of HIV risk factors in the Electronic Medical Record (EMR): what do GPs in Flanders prefer?

There is an increase of HIV-diagnoses in Belgium among men who have sex with men. GPs take a key position in discussing sexuality with their patients. They have an overall picture of their patients health, including the health risks (e.g. smoking). Yet it is unclear whether GPs are aware of the (extent of) sexual risk behaviour and the sexual orientation of their patients before problems occur. However, at least the awareness of sexual risk behaviour and/or the sexual orientation of patients seems to be necessary for the prevention of HIV. This study explores the views of GPs in Flanders regarding the discussion and registration of HIV risk factors in primary care

Collecting and registering sexual health information in the context of HIV risk in the electronic medical record of general practitioners: a qualitative exploration of the preference of general practitioners in urban communities in Flanders (Belgium)

Background and aim: Current health-care delivery requires increasingly proactive and inter-professional work. Therefore, collecting patient information and knowledge management is of paramount importance. General practitioners (GPs) are well placed to lead these evolving models of care delivery. However, it is unclear how they are handling these changes. To gain an insight into this matter, the HIV epidemic was chosen as a test case. Methods: Data were collected and analysed from 13 semi-structured interviews with GPs, working in urban communities in Flanders. Findings: GPs use various types of patient information to estimate patients’ risk of HIV. The way in which sexual health information is collected and registered, depends on the type of information under discussion. General patient information and medical history data are often automatically collected and registered. Proactively collecting sexual health information is uncommon. Moreover, the registration of the latter is not obvious, mostly owing to insufficient space in the electronic medical record (EMR). Conclusions: GPs seem willing to systematically collect and register sexual health information, in particular about HIV-risk factors. They expressed a need for guidance together with practical adjustments of the EMR to adequately capture and share this information

Registration of sexual orientation in the electronic medical record in family practice: opinions of general practitioners (GPs) in Flanders

Background: Discussing sexual health is a sensitive issue in family practice, these data are often unknown and it is unclear if GP’s know the sexual orientation of patients[1]. Although homosexuals are a minority, they are prominently present in the HIV-population in Belgium[2]. Sexual culture among gay men is not only an individual matter, but embedded in a broader gay community. GP’s, as leading medical actor of community care, may support the continuity of (primary) health care by identifying patients at risk and develop targeted interventions. Aim: Exploring the view of GP’s in Flanders regarding a systematic registration of the sexual orientation and other risk factors for HIV. Methodology: An interview guide got drawn up through literature review, group conversations among the authors and feedback from experts. Data were collected and analysed from 13 semi structured interviews of GP’s, living in urban communities in Flanders. Results: Most GP’s see the Electronic Medical Record (EMR) as a valuable tool and communicator. However, there is no appropriate place to record patients' sexual information or –orientation. Currently GP’s acquire this information from signals of the patient, collecting this information actively outside a clinical context is uncommon. Yet it seems that with appropriate support, GP’s are willing to systematically collect information about HIV risk factors. Conclusion: GP’s underline the relevance of knowing the sexual orientation of patients; some of them even favour systematic registration in the EMR to organize optimal care and prevention. GP’s are of the opinion they have an important role to play in this matter

HIV testing within general practices in Europe : A mixed-methods systematic review

Funding Information: This work was supported by IWT (Belgium) and the ANRS (France) through the framework of HIVERA JTC 2014. Publisher Copyright: © 2018 The Author(s).Background: Late diagnosis of HIV infection remains a key challenge in Europe. It is acknowledged that general practitioners (GPs) may contribute greatly to early case finding, yet there is evidence that many diagnostic opportunities are being missed. To further promote HIV testing in primary care and to increase the utility of available research, the existing evidence has been synthesised in a systematic review adhering to the PRISMA guidelines. Methods: The databases PubMed, Scopus and Embase were searched for the period 2006-2017. Two authors judged independently on the eligibility of studies. Through a mixed-methods systematic review of 29 studies, we provide a description of HIV testing in general practices in Europe, including barriers and facilitators. Results: The findings of the study show that although various approaches to target patients are used by GPs, most tests are still carried out based on the patient's request. Several barriers obstruct HIV testing in general practice. Included are a lack of communication skills on sexual health, lack of knowledge about HIV testing recommendations and epidemic specificities, difficulties with using the complete list of clinical HIV indicator diseases and lack of experience in delivering and communicating test results. The findings also suggest that the provision of specific training, practical tools and promotion programmes has an impact on the testing performance of GPs. Conclusions: GPs could have an increased role in provider-initiated HIV-testing for early case finding. To achieve this objective, solutions to the reported barriers should be identified and testing criteria adapted to primary healthcare defined. Providing guidance and training to better identify priority groups for HIV testing, as well as information on the HIV epidemic's characteristics, will be fundamental to increasing awareness and testing by GPs.publishersversionPeer reviewe

HIV testing in Europe : mapping policies and exploring practices in the era of increased treatment availability

Summary When the HIV antibody test became available in 1985, it was mired in controversy: who should be tested, for what purpose, and under what conditions? In the absence of treatment and in the context of discrimination, HIV testing was embedded within exceptional procedures. With increasing treatment effectiveness, early HIV diagnosis became important, calling for normalisation of testing. With the objective to contribute to the understanding of how national HIV testing policies and practices are evolving in the context of a changing HIV testing paradigm, a health policy analysis has been undertaken. The core of the analysis concerned a multi-country study aimed at mapping national HIV testing policies in EU/EEA countries. The mapping study was complemented with an implementation study to investigate practices and barriers with regard to HIV testing. Current HIV testing policies exhibited a high level of exceptionalism, with informed consent and counselling constituting the normative base. Meanwhile, HIV testing practices are moving ahead faster than policies to accommodate changing contexts and practical needs. The study results showed that HIV testing is done in a wide variety of settings and that HIV testing is being normalised. In practice, there is less focus on pre-test counselling, yet more emphasis on post-test follow-up. However, there are barriers to testing which could cause a deficit in the normalisation since they are based on denial of risk and fear on the patients’ side and a certain embarrassment or awkwardness to address sexual health and HIV more actively on the providers’ side. The challenge lies now in the further accomplishment of the normalisation of HIV testing, with a clear focus on an efficient testing service delivery as being the starting-point of the HIV treatment cascade. For this, an improved understanding of the epidemic will provide a foundation for the development of an HIV testing model, considering the best mix of HIV testing approaches to achieve full coverage. However, for all HIV testing, the chief reason for testing must always be to benefit the individuals tested. Sufficient information should be provided to make an informed and voluntary decision to get tested whilst ensuring confidentiality and referral to appropriate follow-up services. To assure access to high-quality testing services which adhere to the guiding principles of HIV testing, the different testing approaches should be integrated within a national HIV testing policy framework. Finally, political commitment will be needed to reduce barriers to HIV testing, to support stakeholders at all levels in consolidating best practices and to expand targeted efforts within an enabling and supportive environment

Antenatal HIV screening in Europe: a review of policies

Background: The increased prevalence of HIV infection in women is leading to a rising number of children born to HIV-infected mothers. As therapeutic possibilities for HIV/AIDS increase, the detection of undiagnosed HIV infections in pregnant women, followed by adequate management, is of crucial interest. Therapeutic protocols are being updated and increasingly applied in most European countries, but there is no structured information on policies and strategies with regard to antenatal HIV screening as such. Methods: In order to identify national policies with regard to antenatal HIV screening, a structured questionnaire was sent to key-informants within the ministries of health and national institutes for public health in each of the 25 EU Member States. Results: Information was obtained from all EU Member States with the exception of Cyprus and Luxembourg. Eighteen countries issued a national policy with regard to antenatal HIV screening, 16 opted for a system in which HIV testing is offered to all women attending antenatal services while only two opted for selective screening. None of the 18 countries with a national policy supports a mandatory screening strategy. The voluntary testing strategies are of two types: opting in versus opting out. In almost all EU countries with antenatal HIV screening policies, screening conditions are defined. Conclusion: Policies are in place in most EU countries. Nevertheless, there is a need for more integrated European policies and region-specific recommendations on the performance of antenatal HIV screening as an opportunity for comprehensive HIV/AIDS service delivery. This would enable the different aspects of prevention to be linked and also address both the needs of pregnant women and mothers as well as that of their infants