Hoyos Miller Juan, Clarke Emily, Patel Raj, Kell Philip, Desai Monica, Nardone Anthony
1 Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Spain.
2 Solent NHS Trust, Southampton, UK.
Int J STD AIDS. 2017 Nov;28(13):1305-1310. doi: 10.1177/0956462417704343. Epub 2017 Apr 29.
The aim of this study was to ascertain the existence of written policies and common clinical practices in sexual health clinics in England for the management of men who have sex with men who refuse to test for HIV. All sexual health clinics in England ( n = 223) were invited to complete an online questionnaire in August-September 2014. The questionnaire covered the four domains of clinic policies, management practices, training and monitoring. We assess differences by region. Overall, 92 clinics participated. Only three clinics reported having a written policy. In contrast, most reported having a common agreed practice (94% in London vs. 71.6% elsewhere). When encountering a refusal, 72.2% of the London clinics and 53.4% of the clinics from elsewhere offered a less invasive option. Few clinics (17.4%) provided information on home sampling kits and 74.4% informed about other testing options. Eighty-seven per cent of the clinics recorded the occurrence of refusals, but only 37.8% reviewed the collected data. Providing staff with training was more common in London (94.1% vs. 73.8%). Clear policies should be developed to guide professionals when encountering men who have sex with men who refuse an HIV test. Offering less invasive testing options and information on alternative testing options could be easily introduced into routine practice. Efforts should be made to review monitoring data in order to identify implications of test refusals and introduce improvements in management of refusals.
本研究的目的是确定英格兰性健康诊所针对拒绝进行艾滋病毒检测的男男性行为者是否存在书面政策和常见临床实践。2014年8月至9月，邀请了英格兰所有性健康诊所（n = 223）填写一份在线问卷。问卷涵盖诊所政策、管理实践、培训和监测这四个领域。我们按地区评估差异。总体而言，92家诊所参与了调查。只有三家诊所报告有书面政策。相比之下，大多数诊所报告有共同认可的做法（伦敦为94%，其他地区为71.6%）。遇到拒绝检测的情况时，72.2%的伦敦诊所和53.4%的其他地区诊所提供了侵入性较小的检测选项。很少有诊所（17.4%）提供家庭采样试剂盒的信息，74.4%的诊所告知了其他检测选项。87%的诊所记录了拒绝检测的情况，但只有37.8%的诊所对收集的数据进行了审查。在伦敦，为工作人员提供培训更为普遍（94.1%对73.8%）。应制定明确的政策，以指导专业人员在遇到拒绝艾滋病毒检测的男男性行为者时如何应对。提供侵入性较小的检测选项和替代检测选项的信息可以很容易地纳入常规实践。应努力审查监测数据，以确定检测拒绝的影响，并改进对拒绝情况的管理。
