GPs who are under 35 and working in metropolitan areas are more likely to offer HIV tests, a study from Australia has found. Patients deemed to be at risk by their GP or who present for screening are most likely to be tested.

The study used data from a cross-sectional, national survey of GP activity called BEACH (Bettering the Evaluation and Care of Health).

This database has been running since 2000; each year, approximately 1,000 GPs from a national, rolling sample are recruited.

Each GP provides patient demographics and information for 100 consecutive anonymised, patient encounters.

The weighted BEACH encounter samples have repeatedly been shown to be representative of all encounters claimed through the universal insurance system.

The period of study between April 2000 and March 2010 focused on HIV testing encounters. The characteristics of patients coming for HIV testing and the GP who did the test were noted. The effect of GP, patient and encounter characteristics on HIV testing were measured using multiple logistic regression models.

Data were available for 984,200 encounters from 9,842 GPs. Of these, 2,588 from 1,796 GPs included an HIV test (18.2% of participating GPs). Just over half the patients being tested (54%) were aged 25-44, 30% were aged 15-24, and slightly more women (56%) were tested than men.

The likelihood of being tested was increased in men, patients aged 15-24, those new to the practice and where there was an opportunity to test i.e. those who were deemed at risk or who presented for screening.

The GPs more likely to test for HIV tended to be female, younger, in a group practice, in metropolitan areas, working only a few sessions a week, Australian graduates, those who conducted less than 50% of their consultations in a language other than English, and those working in an accredited practice.

From logistic regression, the strongest independent predictor for HIV testing being ordered was an opportunity to test when the patient presented for screening or was considered to be at risk by their GP.

GP factors independently associated with testing were younger age, working in a major city, being in a group practice and working in an accredited practice. Other studies have also found that younger GPs working in inner cities are more likely to manage patients with sexual health problems.

Although this study is based in Australia, there are several characteristics of the healthcare system that are similar to the UK.

First, GPs in Australia act as gatekeepers to the healthcare system and 85% of the population attends a general practice in a given year.

Second, their 2010-2013 National HIV/AIDS strategy is similar to the National Strategy for Sexual Health & HIV published in 2001 in England which identified primary care as having a key role in diagnosis and prevention.

Third, both Australia and the UK have a voluntary counselling and testing approach for HIV where individuals attend healthcare settings for testing, rather than population-wide screening.

There were 86,500 people estimated to be living with HIV in the UK at the end of 2009, of whom a quarter were unaware of their diagnosis. Half of the adults with a new diagnosis of HIV had been diagnosed late.

HIV testing guidelines in the UK state that HIV tests should be offered to all individuals aged 15-59 years registering in general practices in areas where the prevalence of HIV is greater than 2 in 1,000; this includes almost all urban areas in the UK.

It seems that despite both the Australian and UK governments issuing guidelines for HIV testing, similar barriers exist. The authors say lack of time, resources and concerns about follow-up care are often cited as barriers to wider HIV testing.

The same factors have been cited as reasons for low levels of HIV testing in the UK.

There are two messages in this paper which to me might suggest potential strategies to improve HIV testing. Working on the supply side by focusing on GPs who are less likely to offer tests, and on the demand side by encouraging more people to ask for HIV testing; the latter seems to be one of the reasons for testing being carried out.

Dr Richard Ma