title: Nurse-delivered universal point-of-care testing for HIV in an open-access returning traveller clinic.
abstract: BACKGROUND
  Early diagnosis of HIV infection reduces morbidity and mortality associated with late presentation. Despite UK guidelines, the HIV testing rate has not increased. We have introduced universal HIV screening in an open-access returning traveller clinic.
  
  
  METHODS
  Data were prospectively recorded for all patients attending the open-access returning traveller clinic between August 2008 and December 2010. HIV testing was offered to all patients from May 2009; initially testing with laboratory samples (phase 1) and subsequently a point-of-care test (POCT) (phase 2).
  
  
  RESULTS
  A total of 4965 patients attended the clinic; 1342 in phase 0, 792 in phase 1 and 2831 in phase 2. Testing rates for HIV increased significantly from 2% (38 of 1342) in phase 0 to 23.1% (183 of 792) in phase 1 and further increased to 44.5% (1261 of 2831) during phase 2 (P < 0.0001). Two new diagnoses of HIV-1 were identified in phase 1 (1.1% of tested); seven patients had a reactive POCT test in phase 2, of whom five (0.4% of those tested) were confirmed in a 4th generation assay. The patients with false reactive tests had a concurrent Plasmodium falciparum infection. Patients travelling to the Middle East and Europe were less likely to accept an HIV test with POCT.
  
  
  CONCLUSIONS
  A nurse-delivered universal point-of-care HIV testing service has been successfully introduced and sustained in an acute medical clinic in a low-prevalence country. Caution is required in communicating reactive results in low-prevalence settings where there may be alternative diagnoses or a low population prevalence of HIV infection.
authors.affiliation: Hospital for Tropical Diseases, UCLH NHS Foundation Trust, London, UK. rherbert@nhs.net
authors.forename: R
authors.initials: R
authors.lastname: Herbert
authors.forename: A N
authors.initials: AN
authors.lastname: Ashraf
authors.forename: T A
authors.initials: TA
authors.lastname: Yates
authors.forename: K
authors.initials: K
authors.lastname: Spriggs
authors.forename: M
authors.initials: M
authors.lastname: Malinnag
authors.forename: E
authors.initials: E
authors.lastname: Durward-Brown
authors.forename: D
authors.initials: D
authors.lastname: Phillips
authors.forename: E
authors.initials: E
authors.lastname: Mewse
authors.forename: A
authors.initials: A
authors.lastname: Daniel
authors.forename: M
authors.initials: M
authors.lastname: Armstrong
authors.forename: I M
authors.initials: IM
authors.lastname: Kidd
authors.forename: J
authors.initials: J
authors.lastname: Waite
authors.forename: P
authors.initials: P
authors.lastname: Wilks
authors.forename: F
authors.initials: F
authors.lastname: Burns
authors.forename: R
authors.initials: R
authors.lastname: Bailey
authors.forename: M
authors.initials: M
authors.lastname: Brown
mesh_terms: D015492:AIDS Serodiagnosis / Q000379:methods*; D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000451:nursing; D006782:Hospitals, Special / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D024802:Nurse's Role; D010342:Patient Acceptance of Health Care; D019095:Point-of-Care Systems; D057184:Practice Patterns, Nurses'; D011446:Prospective Studies; D057236:Travel Medicine / Q000458:organization & administration*; D014330:Tropical Medicine; D006113:United Kingdom