Sciensano, Epidemiology of Infectious Diseases, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium.
Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.
BMC Public Health. 2018 Oct 22;18(1):1191. doi: 10.1186/s12889-018-6107-0.
Late diagnosis of HIV infection remains a key challenge in Europe. It is acknowledged that general practitioners (GPs) may contribute greatly to early case finding, yet there is evidence that many diagnostic opportunities are being missed. To further promote HIV testing in primary care and to increase the utility of available research, the existing evidence has been synthesised in a systematic review adhering to the PRISMA guidelines.
The databases PubMed, Scopus and Embase were searched for the period 2006-2017. Two authors judged independently on the eligibility of studies. Through a mixed-methods systematic review of 29 studies, we provide a description of HIV testing in general practices in Europe, including barriers and facilitators.
The findings of the study show that although various approaches to target patients are used by GPs, most tests are still carried out based on the patient's request. Several barriers obstruct HIV testing in general practice. Included are a lack of communication skills on sexual health, lack of knowledge about HIV testing recommendations and epidemic specificities, difficulties with using the complete list of clinical HIV indicator diseases and lack of experience in delivering and communicating test results. The findings also suggest that the provision of specific training, practical tools and promotion programmes has an impact on the testing performance of GPs.
GPs could have an increased role in provider-initiated HIV-testing for early case finding. To achieve this objective, solutions to the reported barriers should be identified and testing criteria adapted to primary healthcare defined. Providing guidance and training to better identify priority groups for HIV testing, as well as information on the HIV epidemic's characteristics, will be fundamental to increasing awareness and testing by GPs.
在欧洲，艾滋病病毒感染的晚期诊断仍然是一个主要挑战。人们承认，全科医生（GP）可以为早期发现病例做出重大贡献，但有证据表明，许多诊断机会都被错过了。为了进一步促进初级保健中的艾滋病毒检测，并提高现有研究的实用性，我们根据 PRISMA 指南对现有证据进行了系统评价。
我们在 2006 年至 2017 年期间在 PubMed、Scopus 和 Embase 数据库中搜索了研究。两位作者独立判断研究的资格。通过对 29 项研究进行混合方法系统评价，我们描述了欧洲普通实践中的艾滋病毒检测情况，包括障碍和促进因素。
研究结果表明，尽管全科医生采用了各种针对患者的方法，但大多数检测仍然是根据患者的要求进行的。普通实践中存在多种阻碍艾滋病毒检测的障碍。包括缺乏有关性健康的沟通技巧、缺乏有关艾滋病毒检测建议和流行特异性的知识、使用完整的临床艾滋病毒指标疾病清单存在困难以及在提供和沟通检测结果方面缺乏经验。研究结果还表明，提供特定的培训、实用工具和推广方案对全科医生的检测表现有影响。
全科医生可以在提供者发起的艾滋病毒检测中发挥更大的作用，以早期发现病例。为了实现这一目标，应该确定报告的障碍的解决方案，并调整检测标准以适应初级保健定义。提供指导和培训，以更好地确定艾滋病毒检测的优先群体，以及有关艾滋病毒流行特征的信息，对于提高全科医生的认识和检测至关重要。
