Introduction
Methods
Design and setting
Questionnaire recruitment and design
Interview recruitment and design
Data collection
Analysis
Results
Participant characteristics
Questionnaire participants (n = 101) | Interview participants (n = 8) | |
---|---|---|
n (%) | n (%) | |
Female sex | 63 (62%) | 3 (38%) |
Age categories | ||
30–44 years | 39 (37%) | 0 (0%) |
45–59 years | 40 (40%) | 6 (75%) |
60 + years | 22 (22%) | 2 (25%) |
Years work experience | ||
0–5 years | 13 (13%) | 0 (0%) |
6–10 years | 21 (21%) | 1 (13%) |
11–15 years | 12 (12%) | 0 (0%) |
> 15 years | 54 (54%) | 7 (88%) |
missing | 1 (1%) | n/a |
No. of days working per week | ||
< 3 days | 5 (5%) | n/a |
3–4 days | 84 (84%) | |
5 days (full-time) | 11 (11%) | |
missing | 1 (1%) | n/a |
Est. no. of PLHIV in the practice | ||
< 5 PLHIV | 7 (7%) | 0 (0%) |
5–10 PLHIV | 41 (41%) | 5 (63%) |
11–25 PLHIV | 27 (27%) | 1 (13%) |
> 25 PLHIV | 9 (9%) | 2 (25%) |
Don’t know | 14 (14%) | 0 (0%) |
missing | 3 (3%) | n/a |
Participated in the first session | 65 (64%) | 8 (100%) |
Additional HIV/STI related activities | n/a | 3 (38%) |
Questionnaire-reported effect of the programme
Theme |
---|
Motivation for more proactive extragenital STI testing (including oropharyngeal and anorectal) |
Motivation to improve STI testing based on risk assessment and the guidelines for STI testing |
Motivation for more proactive HIV testing |
Awareness of HIV indicator conditions |
Motivation for more HIV/STI testing in general |
Awareness of other STI (syphilis, hepatitis C, Mycoplasma genitalium) |
Awareness of the (undiagnosed) HIV prevalence |
Awareness of the clinical symptoms of acute HIV infection |
Less HIV test ordering in low-risk populations |
Awareness that too little HIV/STI testing is being done |
Theme |
---|
Improved STI consultation; better history taking, following the guidelines |
More extragenital STI testing when indicated |
More proactive HIV testing or addressing HIV |
More HIV/STI testing in general |
More hepatitis C testing |
More indicator condition-guided HIV testing |
Started prescribing pre-exposure prophylaxis for HIV |
Implementation of quality improvement plans
Theme |
---|
More HIV testing or focus on HIV during consultations |
More extragenital chlamydia/gonorrhoea testing including anorectal testing |
Further improve HIV/STI testing and consultations in general |
Start/expand prescribing of pre-exposure prophylaxis |
More indicator condition-guided testing for HIV (including in case of another STI) |
More testing or focus on hepatitis B/C during consultations |
Improved Mycoplasma genitalium testing strategies (i.e. usually less testing) |
More retesting for chlamydia after treatment for a chlamydia-infection |
Effects of the programme as reported by interviewees
Some patients that definitely have a low risk I now test less. Sometimes people want HIV testing done themselves, then it’s fine, but I’m less proactive (Female, 50 years, 17 years work-experience).
I was already proactive, but really exclusively in key groups and now I think, I should also test the low-risk groups. You kind of want to screen all of Amsterdam (Female, 54 years, 25 years work-experience).
I diagnosed someone with HIV recently. He had very severe eczema, one of those indicator conditions. You recognise this faster now (Female, 50 years, 17 years work-experience).
Interviewees’ reflection on trends in HIV testing
Barriers and facilitators
Patient-level
I used to test very proactively, but I’m less on top of it now. But that’s also because people get very frightened when I bring it up. Sometimes I’ll just let them mull it over for a while (Female, 52 years, 27 years work-experience).
When someone has non-specific symptoms, such as weight loss or malaise, then at some point you think about who is in front of you, could it be an HIV infection? (Male, 53 years, 18 years work-experience)
Provider-level
System-level
We are a group that pre-eminently works based on past experience. So naturally, training and guidelines are important, but the guidelines are so elaborate that you don’t know them by heart, and then experience is leading (Female, 52 years, 27 years work-experience).
Evaluation of the programme
You usually already attend continued medical education sessions with the same group of GPs, so you are allowed to be bewildered by other participants’ testing strategies, and to ask awkward questions, and to be vulnerable. So I think that’s very important (Male, 60 years, 25 years work-experience).
The funny thing is, GPs, however big-mouthed they are, they’re always a bit afraid that they are underperforming. I have that too. But then we get our audit and feedback and then it turns out we’re not doing too bad at all. That’s really motivating to see (Female, 52 years, 27 years work-experience).
You really get a big mirror held up to your own testing behaviour. So I think it really lasts, because it’s more than a quick fix, so it would really work in the long run (Male, 40 years, 10 years work-experience).
I think we have about fifty practice improvement plans in our practice currently. You have to be careful about all these plans that sort of hang around, they start and never finish. It’s better to ask the group what they need, or one or two real take home messages, and address those in follow-up sessions, then it can be really effective (Male, 53 years, 18 years work-experience).