6 responses to “HIV in Family Practice: testing & diagnosis”

  1. nice summary.

  2. I offer HIV, HCV and syphilis testing every time I test for G & C but often the patient declines. The difficulty working in an ED setting is ensuring adequate follow up and counselling, which in our current system is sometimes difficult to do.

  3. This is a challenge for me. My 25 years of sporadic but not insignificant screening has yielded not a single positive result, my only case moved here after diagnosis, and as my practice ages the returns are unlikely to increase. I will try to screen more extensively but glucose, FIT, Mammo, Pap, depression, alcohol, and lipids seem more relevant in my catchment.

  4. Will definitely change practice but the resources are Vancouver Lower mainland centric and need to be expanded to include the rest of the province!

  5. I took the course on universal testing for HIV several months ago and was keen to start it at my Hospital the next day. (I am part of a large Hospitalist group in Fraser Health). However, I was asked not to do this as the sudden change in testing patterns would have overwhelmed our system. I am still waiting to be told that we can do universal testing; my threshold for testing is much lower than it used to be.

  6. Thank you for your feedback.
    As for the follow up in the ER, we recognized this could be a challenge in Vancouver when we implemented routine testing in Acute Care. A delegate follow-up process was created to avoid any concerns re: increased workload, or post testing follow-up. If you want to contact us, we can discuss this process with your MHO/Health authority etc.

    With respect to increasing testing in a population where HIV prevalence is assumed to be low, I have 2 comments.
    1. We will never know the true prevalence of HIV in a population of practice unless we test, and our current recommendations suggest we should test until we determine prevalence is below 0.1%. Within the doctors that have implemented routine testing, some never see 1 positive and others have unexpectedly found 2 or 3.
    2. With an increasingly mobile society, and increased social media based sexual networks, people that are at risk of acquiring HIV are very difficult to pin down geographically. People can easily move from areas of high prevalence to low, and many people are engaged in high risk activity that of which their practitioners are unaware.
    With respect to expansion to the rest of the province, resources are currently highest, in areas where prevalence is known to be high. However the “Hope to Health” initiative describes permanent funding which is being given to all the health authorities in the province to expand HIV testing, treatment and additional resources. Perhaps is you have an interest in this area, we can link you to some of this new work in your region.

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