Background: Human immunodeficiency virus (HIV) prevalence in
Switzerland is 0.4% and 30% of HIV patients are diagnosed with CD4
counts <200 cells/microliter. In 2010, the Swiss Federal Office of Public
Health (SFOP) published updated guidelines regarding Physician-
Initiated Counseling and Testing (PICT) for HIV. In the new guidelines,
when acute HIV infection is suspected or HIV is among the differential
diagnoses, an HIV test is performed without risk assessment nor prior
counseling, unless the patient specifically refuses it. Counseling and
verbal consent are still required when the patient asks for an HIV test
or belongs to a high risk group. Whist HIV testing in the emergency
departments (ED) is recommended, only 1% of patients are currently
screened. Lack of awareness among physicians has been cited in the
literature as the first barrier to guideline implementation.
Objectives: To test if physicians working in EDs of 5 large teaching
hospitals in western Switzerland, admitting 175,000 patients / year,
were aware of the updated SFOP guidelines.
Methods: A survey was delivered to 167 ED physicians in the summer
of 2011. The survey consisted of 26 vignettes designed to test whether
physicians would request an HIV test according to the new guidelines
and if they knew when the PICT strategy was allowed or counseling
required. Finally, physicians were asked the number of HIV tests they
had requested in the previous 4 weeks, and if they were aware of the
new HIV guidelines. Results are presented as mean and standard
deviation, median and interquartile range (IQR), or as proportions;
Student's t test was used to compare continuous variables;
Results: 143 physicians returned the survey (86%); mean age was 32
± 8 years, and median postgraduate experience of 6 years (IQR 3-12);
52% were male and 17% were attendings. The percentage of correct
responses was 60 ± 13% with no difference between attendings and
residents (p = 0.31); 2 of the 3 questions with the lowest scores were
failure to recognize situations in which HIV testing was indicated, and
the third one a failure to recognize acute HIV infection. 82% of
physicians were not aware of the new guidelines. The median number
of test requests was 1 (IQR 0-2, range 1-10).
Conclusion: ED physicians are not aware of current HIV screening
guidelines published by the SFOP, and rarely perform HIV tests. An
information campaign is required if ED physicians are expected to play
a significant role in the reduction of undiagnosed HIV patients.