The National Strategy for Sexual Health and HIV (DH, 2001) recommends that all new patients attending a GUM clinic are offered an HIV test, with the goal of reducing newly acquired HIV infection by 25 per cent by 2007, as well as reducing waiting times for urgent appointments. This poses a real challenge to current GUM services; if more HIV testing is undertaken, it follows that increased counselling is necessary. This obviously lengthens clinic appointments, and may actually lead to further delays in seeing urgent appointments.
Some GUM clinics now operate a 'no news is good news' policy with patients. This is offered to patients who are deemed to be at low risk of a sexually transmitted infection. This means that within a defined time-period staff from the clinic will only contact the patients if any results come back as being positive, in order to cut down on unnecessary appointments for both patients and clinic staff. Before implementing this policy, it is obviously vital to have a thorough results administration procedure in place, with all test results being checked routinely on all patients that attend. HIV-positive results should never be given over the telephone or by post. Recall for patients who test positive for HIV, if they fail to attend for their results, should only be done by mail. A standardized letter should be sent informing the patient that they missed their appointment and requesting them to return to collect their results.
A clinic appointment should, however, be made for the following reasons:
• The patient is only having an HIV test done and no other screening tests. However, if a patient requests an HIV test only and they are at risk of other STIs, it is best practice to encourage them to have a full sexual health screen. If they still decline you should offer syphilis IgM/IgG, a hepatitis screen (if appropriate) and a Chlamydia urine test.
• The patient is a high-risk patient, and there is a strong likelihood that they will be positive.
• The patient is 'anxious' and wants to come back to the clinic to collect their results.
• The patient has limited understanding of English and needs to return to the clinic with an interpreter to discuss the results.
HIV PRE- AND POST-TEST DISCUSSION HIV POST-TEST DISCUSSION
When disclosing a negative test result, you should explain what the test result means, answer any questions, address the patient's emotional response, and discuss strategies for remaining HIV-negative. It is important not to add any emotional weight to giving a negative result, such as 'the good news is that your HIV result is negative', as you are unaware if this result is good news for the patient or not.
When giving negative test results, remind patients that the results may not be accurate if the client has engaged in behaviours that put him or her at risk during the three months before testing or since the test was done. If appropriate, clients should be offered a repeat test at an appropriate time in the future.
An equivocal or indeterminate result is where laboratory testing from a patient's first blood sample is neither positive nor negative. The tests have differing 'cut off' points, and the virologist performing the test may comment on the likely outcome of the test. In this case, communication with the virology department is important, and it may be helpful to impart to the virologist the patient's current health status (any recent seroconversion-type illnesses, risk factors, etc.). You should then document the outcome of this discussion in the patient's notes.
An equivocal HIV result is an uncommon outcome from a serum antibody test, and can be a difficult result to give to a patient. It can be complicated for the result-giver to explain and difficult for the patient to understand. It may be especially complicated if the patient has heightened anxiety levels regarding the result of their HIV blood test. It is usually necessary that extra time during the consultation should be allocated for the result-giver to answer questions and explain the meaning of this test result.
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