We were encouraged to read Clerk et al's. (2013) article on a nurse-led approach to. HIV testing in TB patients in Volume 22,. Issue 11 of the British Journal of ...
LETTER TO THE EDITOR
HIV diagnoses are in our hands In response to an article published in the BJN in June 2013, we received the letter below from readers who wanted to applaud the authors’ innovative nurse-led approach to HIV testing in TB patients, as well as share their own research which found similar results with lymphoma patients.
© 2014 MA Healthcare Ltd
Dear Editor, We were encouraged to read Clerk et al’s (2013) article on a nurse-led approach to HIV testing in TB patients in Volume 22, Issue 11 of the British Journal of Nursing. We agree that the importance of normalising HIV testing in modern-day medicine, especially within high-risk patient groups, is paramount and all health professionals have a role to play. We applaud the authors’ use of an innovative approach to HIV testing, which resulted in an increase in both offering and uptake of HIV tests.Their work is a proactive method of increasing HIV testing in a hospital setting. The article also emphasises that many members of the multidisciplinary team are capable of counselling for and taking an HIV test as recognised in recent guidance (British HIV Association (BHIVA), 2008). Despite encouraging advances such as those mentioned in Clerk et al’s (2013) article, other inpatient and outpatient groups must not be forgotten. For example, HIV testing is recommended as standard in other patient groups such as those with hepatitis C and lymphoma (BHIVA, 2008). Thus, awareness of HIV testing in non-HIV specialties such as gastroenterology, respiratory medicine and haematology is essential. However, there is evidence to suggest that such testing may be being overlooked. Non-Hodgkin’s lymphoma is an AIDSdefining illness and Hodgkin’s lymphoma is the most common malignant non-AIDS defining condition in HIV-positive people (D’Addario et al, 2003). Routine HIV testing is recommended in both cases. We recently audited a local acute trust in our region (which has an HIV prevalence of 5/1000 people) to establish frequency of HIV testing in people with Hodgkin’s and Non-Hodgkin’s lymphoma. We analysed the medical notes of 200 patients clinically coded as having nonHodgkins or Hodgkin’s lymphoma, and who were treated in one of the three hospital sites
British Journal of Nursing, 2014, Vol 23, No 1
comprising our Acute Healthcare Trust in 2010. Patients were excluded who were miscoded, principally treated at another site or died in the first 3 months following diagnosis. In addition to the medical notes, HIV testing and results were confirmed using the online virology results system. Of the notes analysed, 173 patients met inclusion criteria and were suitable for subsequent analysis. The average patient age was 61 years old (range 16–88 years old) and 92 patients (53%) were male. Despite non-Hodgkin and Hodgkin’s lymphoma being clinical indicator diseases and despite the national guidance recommending routine HIV testing in such patients, our audit showed an unacceptably low level of HIV testing in these patients.The rate of HIV testing was similar to that found by Clerk et al (2013) in the pre-intervention phase of their audit, with only 19% (33/173) having been HIV tested. Of the 140 patients who did not have an HIV test, there was no documentation in the medical notes about relevant discussion with the patient concerning testing nor a documented reason for not offering or performing an HIV test. Those tested for HIV were more likely to be younger (44 versus 65 years) and male (of those tested, 27% were male and 11% were female). This highlights the importance of indiscriminate testing to avoid missing potential diagnoses in groups who are incorrectly perceived to be ‘lower risk’ such as women, heterosexuals and older people. Differences in HIV testing rates were also noted between hospital sites within the Trust. Within the hospital site containing a dedicated infectious diseases tertiary referral unit, the rate of HIV testing of lymphoma patients was 30% whereas in the two hospital sites without a dedicated infectious diseases service, the rates were lower at 18% and 10% respectively. This may be a chance finding, or it may indicate that within hospital sites that have dedicated infectious disease services, the rates of HIV testing in non-infection specialties is higher. Our results suggest that
this may relate to better education and communication between the haematology and infectious diseases departments but further work would be required in order to corroborate this finding. HIV testing is no longer solely the realm of the HIV, GUM or ID health professional, nor does it require extensive counselling; the importance lies in actually offering the test. In order for HIV testing to become routine—like any other blood test—it must be adopted by all specialties and results must be easily obtainable and expediently reported. If recognised early, most HIV patients diagnosed in the modern day and initiated on Combined Antiretroviral Therapy appropriately, have dramatically improved morbidity and mortality and can look forward to near-normal life expectancy (Mocroft et al, 2003; Antiretroviral Therapy Cohort Collaboration, 2008). Education concerning HIV testing across all specialties is likely to be the key to improving HIV testing, especially in hospitals which do not have dedicated infectious diseases services.Wherever we carry out HIV testing, be it in a TB or lymphoma clinic, an acute medical admissions unit, or a GP surgery, the diagnosis of HIV is in our hands. Clerk N, Antunes G, Williams J, Dibble W (2013) Improving the uptake of HIV testing in patients with tuberculosis. Br J Nurs 22(11): 634-7 British HIV Association (2008) UK National Guidelines for HIV testing. http://tinyurl.com/pt8evoh (accessed 7 January 2014) D’Addario G, Dieterle A, Torhorst J et al (2003) HIVtesting and newly-diagnosed malignant lymphomas. The SAKK 96/90 registration study. Leuk Lymphoma 44(1): 133-8 Mocroft A, Ledergerber B, Katlama C et al (2003) Decline in the AIDS and death rates in the EuroSIDA study: an observational study. Lancet 362(9377): 22-9 Antiretroviral Therapy Cohort Collaboration (2008) Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet 372(9635): 293-9
Tom Wingfield, Imperial College London and North Manchester General Hospital; Joanna Cowan, Kay Scott, Annie Herbert and Andrew P Ustianowski; North Manchester General Hospital
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