Development and Evaluation of an HIV-Testing Intervention for Primary Care: Protocol for a Mixed Methods Study.

Area of Science:

• Public Health
• Epidemiology
• Intervention Studies

Background:

• Late HIV diagnosis contributes to transmission and hidden epidemics, particularly among men who have sex with men of non-Belgian origin and sub-Saharan African migrants in Belgium.
• Primary care settings often miss opportunities for HIV diagnostic testing, despite its role in early detection.

Purpose of the Study:

• To develop, implement, and evaluate an intervention aimed at enhancing provider-initiated HIV testing by general practitioners (GPs) in Flanders.
• To support GPs in offering HIV testing to facilitate early diagnosis and reduce undiagnosed HIV infections.

Main Methods:

• A mixed-methods evaluation using a modified stepped-wedge design compared two intervention levels (online dissemination vs. dissemination with training) against a control group.
• An evidence-based tool, "HIV-testing advice for primary care," was developed to aid GPs in provider-initiated testing.
• Outcomes included the number of HIV diagnoses by GPs, diagnoses in at-risk groups, CD4 cell counts, and prescribed tests, analyzed using Poisson regression.

Main Results:

• The study was funded in 2016, with intervention implementation from January 2017 to December 2018. Data analysis was ongoing as of October 2019, with results anticipated in late 2020.
• Fidelity, feasibility, and acceptability of the intervention among GPs were assessed via surveys and interviews.

Conclusions:

• The intervention study is expected to provide valuable data on the effectiveness of enhanced HIV testing strategies among Flemish GPs.
• Findings will inform the development of official HIV testing guidelines, though limitations include potential spill-over effects and data access delays.