HIV Testing Practices by Clinical Service before and after Revised Testing Guidelines in a Swiss University Hospital

OBJECTIVES: To determine 1) HIV testing practices in a 1400-bed university hospital where local HIV prevalence is 0.4% and 2) the effect on testing practices of national HIV testing guidelines, revised in March 2010, recommending Physician-Initiated Counselling and Testing (PICT). METHODS: Using 2 hospital databases, we determined the number of HIV tests performed by selected clinical services, and the number of patients tested as a percentage of the number seen per service ('testing rate'). To explore the effect of the revised national guidelines, we examined testing rates for two years pre- and two years post-PICT guideline publication. RESULTS: Combining the clinical services, 253,178 patients were seen and 9,183 tests were performed (of which 80 tested positive, 0.9%) in the four-year study period. The emergency department (ED) performed the second highest number of tests, but had the lowest testing rates (0.9-1.1%). Of inpatient services, neurology and psychiatry had higher testing rates than internal medicine (19.7% and 9.6% versus 8%, respectively). There was no significant increase in testing rates, either globally or in the majority of the clinical services examined, and no increase in new HIV diagnoses post-PICT recommendations. CONCLUSIONS: Using a simple two-database tool, we observe no global improvement in HIV testing rates in our hospital following new national guidelines but do identify services where testing practices merit improvement. This study may show the limit of PICT strategies based on physician risk assessment, compared to the opt-out approach

HIV testing practices by clinical service and year.

<p>Figure shows the numbers of tests performed (A) and the testing rates (B) in each clinical service during each of the four twelve-month periods studied. Abbreviations: OP, outpatients; IP, inpatients; ICU, intensive care units; ED, emergency departments.</p

Percentage of tests performed with positive result, median duration of inpatient stay, mean age of all patients seen and mean age of patients tested, for each clinical service.

<p>As data were not significantly different between 2008–2009 and 2010–2011, they have been pooled for clarity.</p><p>Abbreviations: IQR, interquartile range; SD, standard deviation; N/A, not applicable; OP, outpatients; IP, inpatients; ED, emergency department.</p

Numbers of patients seen in each clinical service during the four twelve-month periods studied.

<p>Abbreviations: OP, outpatients; IP, inpatients; ICU, intensive care units; ED, emergency departments.</p