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Knowledge on HIV testing indications and practice of requesting HIV tests by the intern medical officers in four tertiary care hospitals in Colombo; A descriptive cross sectional study

Authors:

P.S. Premadasa ,

Registrar in Venereology, National STD/AIDS Control Programme, LK
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D.A. Karawita,

Consultant Venereologist, Teaching Hospital Anuradhapura, LK
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A. Azran,

Registrar in Venereology, National STD/AIDS Control Programme, LK
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W.N. Widange,

Registrar in Venereology, National STD/AIDS Control Programme, LK
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H.G.A.K. Dayaratne,

Registrar in Venereology, National STD/AIDS Control Programme, LK
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N. Ediriwickrama

Registrar in Clinical Haematology National Hospital of Sri Lanka, LK
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Abstract

Introduction: Sri Lanka being an HIV low prevalent country (prevalence <0.1 % in the general population), the ward clinicians have less clinical experience and exposure to HIV patients and HIV is considered lower down in their differential diagnosis. Therefore over the years the majority of adults who are detected with HIV in the ward setting were significantly immunocompromised at the time of diagnosis and in 2012 the mean CD4 count of the inward diagnosed HIV cases was 92.1 cells/μl. Late diagnosis is associated with increased mortality, morbidity and impaired response to ART. HIV testing in all patients presenting with signs and symptoms or medical conditions indicative of HIV infection facilitate early case detection; it can also encourage 'normalisation' of HIV testing.

Objectives: To assess the knowledge on indications to request an HIV test and practice of requesting HIV test by the intern medical officers (IMO) attached to 4 tertiary care hospitals in Colombo.

Methods: A descriptive cross sectional study was carried out among 100 out of 104 IMO attached to 4 tertiary care hospitals in Colombo, using a self-administered questionnaire. Key outcomes included the knowledge on clinical indications for HIV testing, assessment of current practice of HIV testing, and knowledge and obstacles on routine testing procedure. Knowledge on clinical indications for HIV testing was assessed using the comprehensive list developed by the British HIV Association (BHIVA) which comprised of the conditions included in WHO clinical staging.

Results: Only 30 % of the respondents identified pulmonary TB, 46 % oral candidiasis, 44% CMV retinitis, 30 % cerebral abscess, 18% non-Hodgkin lymphoma and I 0% angular chelitis as indications for HIV testing. Only 57 % have ordered an HIV testing on their own for the last six months. Respondents with a good knowledge have requested tests less frequently than others (mean number of testing 2.25 per 6 months). Of the respondents who requested HIV tests 22.2% had difficulty in explaining the relevance of HIV testing. Of who have requested testing majority (72%) have requested considering the patients clinical findings. 17% have requested based on real or perceived high risk behaviour. The majority (26.6%) had encountered delay in receiving reports and 22.2% had problems in explaining the relevance of the test to the patient in getting consent. 76 % knew the correct volume of blood to be sent for testing and 31 % were unaware of the venue of HIV testing.

Conclusions: There is a missed opportunity for early detection of HIV in the ward setting as the understanding of common clinical indications in early disease is low. The practice of ordering HIV testing by IMO in the ward setting remain unsatisfactory. Report delay and difficulty in explaining the relevance of HIV testing to the patients, were the common problems encountered in testing. Reducing the high number of late diagnoses is a clinical and public health priority. To achieve this, it is recommended to improve policy dispersal coupled with education that targets barriers for HIV testing.

Sri Lanka Journal of Venereology Vol.5(1) 2014: 44-51

How to Cite: Premadasa, P.S. et al., (2015). Knowledge on HIV testing indications and practice of requesting HIV tests by the intern medical officers in four tertiary care hospitals in Colombo; A descriptive cross sectional study. Sri Lanka Journal of Venereology. 5(1), pp.44–51. DOI: http://doi.org/10.4038/sljv.v5i1.7352
Published on 26 Nov 2015.
Peer Reviewed

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