Slow increase in HIV testing in general practice
Requests for HIV testing from general practice have increased gradually since 1988. GPs are also taking the initiative more often to discuss the risk of HIV and testing, according to a publication by researchers from the Netherlands Institute for Health Services Research (NIVEL), the National Institute for Public Health and the Environment (RIVM) and STI AIDS Netherlands (Soa Aids Nederland) in the scientific journal BMJ Open.
The World Health Organisation and the Health Council have been making the case since 1999 for more active HIV and AIDS testing, so that treatment can be commenced as early as possible and the risk of transmission is reduced. It is estimated that 30 to 40% of HIV-positive individuals in the Netherlands have not been diagnosed and 43% are diagnosed too late, as a result of which the infection is less easy to treat. According to the HIV Monitoring Foundation, 16,167 HIV patients were being treated in the Netherlands in 2012, of whom 67% were homosexual males, the main risk group. Fifty-nine percent of registered HIV patients are Dutch nationals and 15% are from sub-Saharan Africa. Over recent years, some 1,100 new patients are added to that every year.
Going to the GP with an STI
It is estimated that two thirds of consultations for sexually transmitted infections (STI) take place in general practice. GPs can therefore play an important role in identifying HIV infections. Patients generally express their anxiety about HIV themselves or ask for an HIV test (between 77 and 93%). However, more and more often GPs are taking the initiative to discuss the issues, for example, if a patient asks to be tested for chlamydia. The number of consultations in which HIV was discussed on the GP’s initiative increased from 11% in 1988 to 23% in 2009. In 1988, GPs discussed the risk of HIV with an average of 7 patients per 10,000; this has now increased to 13 per 10,000. This figure ranges from 2 in rural areas to 31 in practices in large cities.
Open communication and more active testing
Since 2004, everyone attending an STI clinic has been tested for HIV as standard procedure. In general practice, the GP can request a test. Gé Donker is a researcher and epidemiologist at NIVEL, and a GP. “Over the years, we’ve seen more testing in general practices and more discussion of HIV issues,” she says. “Even so, there’s a lot of room for improvement, for example, more active testing and open communication about sexual health are points that need more attention. GPs must be alert and ensure that patients from risk groups are tested regularly. Particularly now that HIV can be treated effectively and early treatment minimises the transfer to others. That does require excellent communication skills, as well as an open attitude and knowledge of HIV and the early symptoms. There should be more attention paid to this in GP training and in refresher courses for GPs and other care providers.”
CMR
NIVEL has been recording data about the ‘fear of AIDS’ since 1988 in its Continuous Morbidity Registration Centres (CMR sentinel stations). The CMR sentinel stations have been around since 1970. They are a representative sample of 59 Dutch GPs in 42 general practices. Their patients comprise about 0.8% of the Dutch population and are representative of the country in terms of regional distribution and population density. The GPs involved provide weekly or annual reports about the prevention of a number of diseases, events and procedures that are missing from routine registration and are therefore awkward to include in the records.
Funding
- STI AIDS Netherlands (Soa Aids Nederland)
Cooperating partners
- STI AIDS Netherlands (Soa Aids Nederland)
- National Institute for Public Health and the Environment (RIVM)