Training GPs and practice nurses using a multifaceted educational intervention can improve HIV testing rates in general practice, a longitudinal study has found.

Sexual Health in Practice (SHIP) addresses the barriers to HIV testing and teaches a systematic clinical approach to testing. It covers four situations where HIV tests may be offered: patient request; opportunistic testing for those found to be high risk through history taking; diagnostic testing for those with relevant symptoms; and screening.

SHIP training, which aims to attract GPs and practice nurses irrespective of whether they have an interest in sexual health, was commissioned by Haringey PCT in North London.

The PCT covers an area with a high prevalence of HIV. Incentives to attend training included access to free condoms and pregnancy testing kits, and locum reimbursements. No financial incentives were given for HIV testing.

GP training comprised two afternoon sessions, one on clinical and communication skills in the area of sexual health, the other on HIV. Practice nurses attended three afternoon sessions on sexual health promotion skills.

Laboratory HIV testing rates were used as an outcome measure: 24 months (retrospectively) before training, prospectively during 19 months of training and 5 months after training; altogether 48 months of data. Equivocal results were deleted on the assumption that they would be repeated; repeat positives with same patient ID were also removed to reduce duplication.

Practices were classified as untrained if no clinical staff completed all relevant sessions or trained if at least one health professional had attended all relevant sessions. A total of 39 out of 51 practices had clinical staff that completed SHIP training; some practices had multiple attenders.

During the 24-month pre-training period, the number of HIV tests performed in Haringey was increasing slowly but not significantly.

After the introduction of SHIP, the number of HIV tests increased significantly among trained practices from 2.29 to 6.66 tests/1,000 registered patients/year (P = 0.0016). There was no evidence of an increase in HIV testing rates in the untrained group which changed from 1.54 to

1.90 tests/1,000 registered patients/year (P = 0.5195). However, there was already a significant difference in the testing rates between the trained and untrained practices before the SHIP training programme (P = 0.0137).

The total testing rate for Haringey PCT also increased significantly (P = 0.0014). More importantly, the number of positive HIV tests in trained practices increased from 19 over the two years before training to 39 in the two years after training began; the numbers were too small to detect a significant difference. General practice is accessed by much of the population, including those in key risk groups so it may be possible to expand HIV testing in this setting.

This study suggests that SHIP as an educational intervention led to changes in clinical practice and behaviour, and specifically increased the number of HIV tests among practices in Haringey.

The increase in the number of positive diagnoses per 1,000 tests seems to be diluted by the significant increase in the number of tests done. However, the increase in the number of positive HIV diagnoses means improved outcomes for patients assuming they get treated, resulting in better health outcomes and reduced transmission.

This study also demonstrates that financial incentives are not necessary to increase HIV testing in general practice.

Dr Richard Ma

• Pillay TD, Mullineux J, Smith CJ, Matthews P. Unlocking the potential: longitudinal audit finds multifaceted education for general practice increases HIV testing and diagnosis. Sex Transm Infect 2012;0:1-6.doi:10.1136/sextrans-2012-050655