Four-Stage Audit Demonstrating Increased Uptake of HIV Testing in Acute Neurology Admissions Using Staged Practical Interventions

• Published in: PloS one Vol. 10; no. 9; p. e0134574
• Main Authors: Sokhi, Dilraj Singh, Oxenham, Chantal, Coates, Rebecca, Forbes, Mhairi, Gupta, Nadi K, Blackburn, Daniel J
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 03.09.2015; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adult; Aged; Aged, 80 and over; AIDS; AIDS Serodiagnosis - utilization; Audits; Cost control; Encephalitis; Female; HIV; HIV Infections - complications; Human immunodeficiency virus; Humans; Infections; Male; Medical Audit; Medical diagnosis; Medical personnel; Medical tests; Medicine; Middle Aged; Nervous system; Nervous System Diseases - complications; Nervous System Diseases - physiopathology; Neurology; Patient Admission; Patients; Physicians; Powell, Jerome; Young Adult; United Kingdom > UK; Europe
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0134574

UK National Guidelines (UKNG) advise HIV testing in clinically indicated neurological presentations. We audited the impact of our practical strategies to increase uptake of HIV testing at a regional acute neurology admissions unit. We audited HIV testing in 4 periods over 2 years: before we designed a UKNG-based "HIV testing in Neurology" protocol ("pre-protocol"); after dissemination of the protocol alone ("post-protocol"); post-protocol dissemination combined with both a tailored departmental admissions clerking proforma to prompt for HIV testing & consenting, and regular focussed tutorials to doctors on HIV testing in neurological patients ("post-proforma"); and finally one year after the post-proforma period ("+1 year"). We also looked at the total number of HIV tests sent from the unit during the two-year period. We assessed significance using Fisher's exact test. 47.8% of all acute neurology non-stroke admissions were eligible for HIV testing during all the audit periods. Testing rates were as follows: pre-protocol 21.9%; post-protocol 36.6%; post-proforma 83.3%; and at +1 year 65.4% (p<0.05 for both post-protocol and +1 year when compared to pre-protocol). Documentation of consent for HIV testing improved from 25% to 67.6% with the HIV-tailored clerking proforma. The total number of HIV tests requested from the unit doubled in the post-proforma period compared to pre-protocol (p<0.05). the combination of an HIV testing protocol, a tailored departmental clerking proforma and regular focussed teaching to doctors on indications for HIV testing led to a sustained increase in HIV testing uptake in our regional acute neurology admissions unit.