Pretest Discussion Procedure Points

The procedure can be modified depending on the assessment of the patient's previous knowledge and any documented discussion from previous testing. If the same person has previously undertaken pre-test counselling with the patient, it may not be necessary to go over all the points again, but it would be advisable to do so if some time has passed since the patient last attended.

The points that are relevant for discussion with the patient are the following and should generally follow a similar questioning order:

1. If the patient is requesting an HIV test, establish the reason for requesting the test and the possible risk of exposure to HIV. If offering an HIV test as part of an STI screen, explain the rationale for testing and establish the possible risk of exposure to HIV.

2. Establish the patient's knowledge about HIV and the difference between HIV and AIDS; about principles of transmission and prevention strategies and about risk factors.

3. Discuss the pros and cons of testing, including treatment options.

4. Explain the practicalities of taking the test.

5. Explain the relevance of the 3-month window period: i.e. antibody development and the need for repeat testing if the patient falls within this period.

6. Explain the confidentiality within the clinic and clinic records and that GPs are not routinely informed (unless this is requested by a patient). Notes in most GU clinics are kept within the clinic.

7. Explain the meaning of negative, positive and equivocal/ indeterminate results.

8. Discuss the legal, social and psychological implications of a positive result. Explain the issues around insurance companies and testing. The ABI (Association of British Insurers - has recently confirmed that having had an HIV test will not lead to penalties against individuals applying for life assurance or mortgages. However, failing to disclose a positive HIV test result when applying for a life insurance or mortgage constitutes fraud, and could result in the policy being terminated. Additionally, companies may ask if an HIV test result is pending.

9. Assess the patient's ability to cope with a positive result, including their social support networks. What would the patient do if the result were positive? Who would they tell? Who would be supportive? How do they usually handle bad news? Be aware of self-harm behaviours such as alcohol and drug abuse.

10. Enquire again if the patient is happy to have an HIV test done today.

11. Explain how HIV results are obtained in your clinic.

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