Background
Methods
Context
Content
Learning goals
Objective theme | Specific objective |
---|---|
Knowledge | GP trainers can explain the importance of early detection of HIV. |
GP trainers can explain the risk groups for HIV. | |
GP trainers can explain STI related complaints. | |
GP trainers have knowledge on how to perform a risk-assessment. | |
GP trainers have an understanding of the different test locations of STI. | |
GP trainers can explain the different questions asked in a sexual anamnesis. | |
GP trainers can explain the role of the STI clinic in prevention and control of STI. | |
Attitude | GP trainers can express the important role of GP trainers in early detection of HIV. |
GP trainers can express the relevance of a risk-assessment. | |
GP trainers acknowledge that an open attitude towards HIV and sexuality is important for prevention and control. | |
GP trainers express a positive attitude towards proactive HIV testing. | |
Skills | GP trainers possesses skills to discuss sexual risk behavior and treatment in STI related consultations. |
GP trainers possesses skills to discuss proactive HIV testing. | |
GP trainers are able to perform the right STI tests based on someone’s risk profile. | |
GP trainers are able to explain how STI tests are executed. | |
GP trainers possesses skills to refer to the STI clinic. |
Blended educational approach
Blended educational programme | |||
---|---|---|---|
Duration | Content | Teaching methods | |
Preparation of the programme | 90 min | GP trainers were asked to read the STI guideline and to do an e-learning before the start of the first meeting | |
Training day 1 | 10 min | Introduction | Lecture |
5 min | Pre-test | Questionnaire (on knowledge and attitude) | |
50 min | Information about the STI guideline and provider-initiated testing strategies | Interactive lecture with slides, videos and casuistry | |
10 min | Summary & quality improvement targets, explanation of the homework assignments, evaluation and reflection of the first meeting | Lecture, questionnaire (quality improvement targets and on satisfaction) | |
Learning conversation with their resident | |||
Training day 2 | 15 min | A reflection on the preceding training day, what they had learned in daily practice (quality improvement targets) and on the learning conversation they had with their resident | lecture, discussion |
50 min | Discussion of barriers and facilitators related to new provider-initiated HIV testing | Focus groups | |
10 min | Evaluation and reflection of the second meeting | Questionnaire | |
Post questionnaire | 3 months after the end of the programme | Questionnaire |
Preparation of the programme
The first meeting
Learning conversation
Discussion groups
Laboratory-documented HIV testing
Assessments and evaluation of the educational programme
Statistical analysis
Results
Study population
N | % | |
---|---|---|
Total | 90 | |
Male | 45 | 50.0 |
Age, (IOR) | 51 (46;57) | |
Location of practice | ||
City | 70 | 77.7 |
Country side | 20 | 22.2 |
Years of experience as GP | ||
< 10 years | 16 | 17.8 |
11–15 years | 25 | 27.8 |
16–20 years | 15 | 16.7 |
20–25 years | 14 | 15.6 |
26–30 years | 11 | 12.2 |
> 30 years | 9 | 10.0 |
Years of experience as GP trainer (quartiles) | 6 | |
Number of HIV patients in practice | ||
< 5 patients | 55 | 62.5 |
5–10 patients | 22 | 25.0 |
10–25 patients | 5 | 5.7 |
> 25 patients | 6 | 6.8 |
Missing | 1 | |
Number of patients diagnosed with HIV in the past year (quartiles) | 1 | [0,1] |
GP trainers’ laboratory-documented HIV testing
Self-reported HIV testing
Mean (sd) score at the start of the programme (n = 74) | Mean (sd) score after three months of the programme (n = 74) | p-value | |
---|---|---|---|
Self-reported HIV testing behaviour 6-point scale (scale 1–6: never - at least twice a week). | 3.3 (1.3) | 2.9 (1.1) | 0.004 |
HIV test initiated by the patient (scale 1–5; not-always) | 3.8 (0.9) | 3.3 (1.0) | 0.001 |
HIV test initiated by GP trainers (scale 1–5; not-always) | 2.1 (0.9) | 2.2 (0.7) | 0.568 |
HIV test initiated by symptoms or complaints (scale 1–5; not-always) | 1.5 (0.6) | 1.7 (0.7) | 0.017 |
Intended behavioural change
Categories | Number of quality improvement targets per category |
---|---|
Sexual history and techniques | 30 |
Ask more in-depth questions | 6 |
Talk more about sex | 6 |
Be aware of symptoms and conditions related to HIV/STI | 17 |
Be aware of new HIV/STI tests | 22 |
Different body-locations to test the patient | 16 |
More proactive HIV testing | 15 |
Awareness of HIV testing among patients from HIV endemic countries | 5 |
Awareness of HIV testing among MSM | 6 |
Give instruction to resident | 14 |
More often test the BIG five | 8 |
Awareness of window phase | 3 |
Make the e-learning of the STI guideline | 7 |
Awareness of not having sex after treatment | 3 |
Patient information about STI/HIV | 2 |
Applying of specific obtained knowledge | 10 |
Curation, Counselling and Contact sex partners | 7 |
Take into account own risk payments | 1 |
Prevention of STI/HIV among adolescents | 1 |
Scores on knowledge and attitude-related questions
Knowledge | Pre-training % of GP trainers with correct answer | Post-training % of GP trainers with correct answer | p-value |
---|---|---|---|
• ‘Is HIV testing required in high-risk groups?’ | 83.6 | 95.9 | 0.012 |
• ‘What is the percentage of people unaware of their HIV infection?’ | 41.1 | 78.1 | 0.000 |
• ‘What is the percentage of people diagnosed late for care?’ | 42.9 | 72.9 | 0.000 |
Attitude | |||
Mean (sd) score at the start of the programme (n = 74) | Mean (sd) score after three months of the programme (n = 74) | p-value | |
• Proactive HIV testing is a task of the GP | 3.9 (0.8) | 3.9 (0.6) | 0.744 |
• It is a task of the GP to be aware of the patients sexual orientation | 3.5 (0.9) | 3.5 (0.8) | 0.566 |
• Sexual history and techniques is an essential part of a STI consultation | 4.1 (0.6) | 4.3 (0.5) | 0.105 |
• Lack of time to discuss a sexual history and techniques in a STI consultation | 2.7 (0.9) | 2.9 (0.9) | 0.197 |
• I rather refer patients with STI symptoms to a STI clinic | 2.2 (0.9) | 2.0 (0.7) | 0.038 |
• It’s unacceptable to discuss an HIV test if patients visit their GP with no STI related questions | 2.4 (0.8) | 2.4 (0.7) | 0.902 |
• It’s a GP trainers task to register sexual orientation | 2.9 (1.0) | 2.7 (0.9) | 0.187 |