Newham Hivpoint of Care Testing (Poct) in GP Practices and Pharmacies

Newham HIVPoint of Care Testing (PoCT) in GP practices and Pharmacies

Pilot Service Specification

Pilot period - September 2010-June 2011

BACKGROUND

HIV/AIDS remains a Public Health concern in Newham. By the end of 2009, there were 1,359 people reported to be living with HIV/AIDS in the Newham, this represents a prevalence rate of 8.22per 1000 population. Majority of HIV cases are reported amongst the Black African communities who account for 72% of reported cases followed by Men who have sex with Men (MSM)who represent 21% of the total HIV cases in 2009 (HPA, 2010).

Advances in HIV/AIDS treatment and care have significantly improved health outcomes for people living with the virus. However, late diagnosis and undiagnosed HIV present a major problem for HIV related health outcomes. To address the problem of late and undiagnosed HIV, the Chief Medical Officer recommended in 2007 that HIV testing should be offered as routine in all health care settings. Following the CMO letter, in 2008, the British HIV Association (BHIVA) issued new guidelines recommending that HIV testing should be offered routinely to all men and women in general health care settings in places with high HIV prevalence of more than 2 people per 1,000.

SERVICE AIMS AND OBJECTIVES

All practices are expected to provide essential and those additional services they are contracted to provide to all their patients.

The aim of this service is to contribute to increasing the uptake of HIV testing and reduce late and undiagnosed HIV among Black African HIv communities, and MSM groups that are aged 18years and above by piloting HIV point of care testing(POCT), delivered through GP practices and Pharmacies.

OBJECTIVES

Recruit GPs and Pharmacies to offer POCT HIV testing
Strengthen the role and capacity of primary care providers in HIV prevention
To increase the availability and range of HIV testing.
Increase the number of people with HIV who are aware of their status
Increase access to HIV prevention and Sexual Health promotion services
Normalise HIV testing to reduce HIV related stigmas.
Ensure all HIV positive individuals have access to treatment and care
To assess the feasibility and affordability of the routine testing in GP practices and Pharmacies

TARGET GROUP

The HIV POCT activity should be proactively targeted at HIV at risk groups (i.e. Black Africans and MSM as well as Injecting Drug Users and Hepatitis B patients)aged 18 years or older who are unaware of their HIV status

PILOT PERIOD

The pilotperiodfor this service is September 2010 to June 2011 and would be delivered through 10 GP practices and 2 Pharmacies in Newham

SERVICES DELIVERY

Participating GP Practices and Pharmacists should offer the test to all new patient registrations and customers aged 18 – 59 years old proactively targeting at least 80% of HIV at risk groups.

The servicewill be availableto both old and new patients and/or customers through routine “opt out” HIV testing either by:

provider offering/initiating the test or
patients or customers initiates/requests test

The HIV test will be carried out through a finger prick blood test
The POC HIV test will be performed using the INSTI (1 minute) HIV-1/HIV-2 rapid antibody test.
TheRapid test Kit will be provided by NHS Newhamon completion of the Resources Request Form as set out in Appendix H
All test results will be give the same day (within 10mins)of the test being carried out
Patients must be able to engage in pre/ post test discussions and understand the information provided and consent to test.

GENERAL CONSULTATION PROCESS

Each participating GP Practice and Pharmacy will operate the HIV POCT service in accordance with the pathway set out in Appendices A and B respectively and shall implement and adapt protocols set out in BHIVAguidelines for HIV testing (

During the consultation with patient, it is recommended that the following should be discussed by the appropriate professional using relevant resources. Explain the following to patients:

The importance of HIV testing

What HIV and AIDS are and the difference between them
That test is confidential and will be appropriately documented
What the test involves
The accuracy of the testing kit
The possible outcomes of the test

Before performing the test, GP practices and pharmacists should check that:

The patient is within the age-range and target group
The relevant forms are completed correctly as set out in Appendices C and D
A record of each HIV test and result is kept
A record of each HIV test is recorded on the log sheet provided as set out in Appendix Eand on the EMIS data base using EMIS codes as set out in Appendix F

6.1PRE-TEST DISCUSSION

As soon as the patient agrees to go ahead with the test, the professional should do the following:

Explain and emphasize confidentiality and reassure the patients that the records are kept secure.
Ensure that the patient understands what HIV and AIDS are
Explain the contents of the testing kit
Explain the meaning of a reactive and a non-reactive result
Explain the ‘window period’
Explain availability of other services that may be linked to care and support
Obtain informed consent
Discuss any immediate questions and concerns that the patient may have
Prepare and perform the test

6.2POST TEST DISCUSSION

6.21Post test discussion for a HIV non-reactive result

For a post test discussion involving a non-reactive result, the professional should do the following:

Clearly inform the patient of the result
Explain and emphasize the ‘window period’ and the need for re-testing

Discuss general sexual health promotion to reduce risk including the use of condom and assist patient to identify support for risk reduction.

End post test discussion session

6.22Post test discussion for a HIV reactive result

For a post test discussion involving a reactive result, the professional should do the following:

Clearly inform the patient of the result
Discuss and identify sources of support

Discuss general sexual health promotion to reduce risk including the use of condom and assist patients to identify support for risk reduction
Provide referrals to needed HIV-related services
Discuss disclosure and partner referral

End post test discussion session

After performing the test and informing patients of test results, GP practices and pharmacists should ensure that:

The relevant forms have been completed correctly
Referral forms for confirmatory tests have been completed as set out in Appendix G
Patients are referred to appropriate HIV-related services
A record of each HIV test, result and referral is recorded appropriately

ACTIVITY LEVELS AND PAYMENTS

The total expected activity for the pilot periodfor all participating GP Practices and Pharmacist is 2000 rapid tests. For each participating GP Practice and Pharmacy, the expected activity will be between 180-200 HIV rapid testsfor the pilot period.Any activity above target must be agreed with NHS Newham.

Payments will be made to participating GP Practices and Pharmacies on a monthly basis according to activity following submission of a log sheet and invoice (Appendix E& I))and subject to:

The patient being within the age range and who are within target group
The form being correctly completed to include the first part of postcode,

The pilot caries two payments based on test undertaken and an additional enhancement payment for a reactive result. Each participating GP Practise and Pharmacist will be paid £35.00 for each rapid test carried out and an additional £35.00 for a reactive result.

7.1 Information required on invoice:

Name of Project
Mailing address of the billing GP practice/ Pharmacy
Date of Service (invoice period)
Invoice date
Invoice number
Activity description (including number of tests with results)
Amount
VAT if indicated
Bank
Name of Bank
Account Number
Sort Code
Address to mail invoice(s)

All invoices should be sent to the following address, marked for the attention of: Wendy Hachmöller.NewhamPCT, 5C5 Payables 6735, Phoenix House, Topcliffe Lane, WakefieldWF3 1WE.

REPORTING AND MONITORING

The HIV community projects officer,(Frances Makinwa) will send out monthly reports to participating GP practices and pharmacists. This report will contain the number of tests that have been undertaken by the different participants under this pilot scheme and what the positivity rates are if appropriate.

EVALUATION/SUCCESS CRITERIA

The pilot will be monitored and evaluated in order to asses the feasibility and affordability of the routine testing in GP practices and Pharmacies. Using 2009 HIV testing figures as a baseline the success of the project will be measured by the following:

Increase in the number of HIV tests in GP practices
Number of people taking the HIV tests in Pharmacies
Increase in the number of patients referrals to HIV related services
Increase in the number of people re-testing after at least 3months

CLINICAL ASSURANCE

All interested GP Practices and Pharmacists who wish to participate in this HIV POCT pilot scheme must be able to demonstrate appropriate clinical competence by having undertaken suitable education and training.

All interested GP Practices and Pharmacists are required attend training sessions run by NHS Newham or an appointed agent before delivery of the service.

The pilot will comply with NHSNewham clinical governance requirements. Clinical support and supervisionwill be provided by NUHT specialist HIV clinical services (Greenway Centre).

All reactive tests should be confirmed using an approved confirmatory test at appropriate HIV care centres as set out in Appendix J.

The pilot will be accountable to:

NHS Newham ( Board/PEC)
Newham Sexual Health Strategy Group
Pilot Steering group
North East London HIV and Sexual Health Clinical Network (NELNET)
Inner North East London HIV prevention Group

TRAINING AND SUPPORT

Initial training will be provided by the GUM service, Public Health and Clinical nurse specialist (CNS) with support from the HIV testing provider (INSTI)

Regular training updates will also be provided and individual support will be provided to GPs and Pharmacies as required.

TRANSFER AND SUBCONTRACTING

The service provider will not assign the whole or any part of the Agreement or sub-contract the supply of services without the consent of NHS Newham

VARIATION

The services may be varied if:

Proposals to vary the service may be initiated by either party. A variation to the service will require three month’s written notice unless both parties agree otherwise.

Under the terms of this agreement the PCT will suspend the contract if for any reason service provision or patient safety is compromised in any way. The contract will be suspended pending the outcome of a full and transparent investigation, following which the agreement will either terminate or be reinstated.

CONCILIATION AND ARBITRATION

It is the wish of both parties that this Agreement shall not interfere with or impede the goodwill that has existed between the parties prior to the Agreement.

In the event or any disagreement or dispute between the parties they will use their best endeavour to reach a resolution without resort to conciliation or arbitration.

In the event or the parties being unable to reach a resolution jointly they will jointly agree the name of a conciliator. Only in the event of conciliation proving unsuccessful will they resort to arbitration. In such event either party may give notice that they wish to refer the disagreement or dispute to an Arbitrator. Should the parties fail to agree the nomination of a named individual or individuals as Arbitrator either party may apply to FHSAA to determine the dispute or settle the difference. Any reference to arbitration under this clause shall be deemed to be a reference to arbitration within the meaning of the Arbitration Acts 1950 and 1979.

FORCE MAJEURE

Neither the Contractor nor NHS Newham will be liable for delay or failure to perform the obligations of this Agreement if this delay or failure results from circumstances beyond their reasonable control including but not limited to: Acts of God, Government Act or Direction, Explosion or Civil Commotion or Industrial Dispute.

SIGNING OF THE AGREEMENT

This document comprise the agreement to provide HIV Point of Care Testing Service concluded between NHS Newham and

Named Practice/ Pharmacy: ......

Signed: ……………………………………………….. On behalf of the Practice/ Pharmacy

Please print Name:………………………………… Position: ...... …

Signed: ……………………………………………….. On behalf of the NHS Newham

Please print Name:………………………………… Position: ...... …

Appendix A

REFERRAL PATHWAY TO GREENWAY CENTRE

(OR OTHER APPROPRIATE HIV CARE CENTRE)

Appendix B

REFERRAL PATHWAY TO GREENWAY CENTRE FOR PHARMACIES/ DENTISTS

(OR OTHER APPROPRIATE HIV CARE CENTRE)

Appendix C

RAPID HIV TEST - PRE TEST DISCUSSION PROFORMA

Date of attendance:
Patient Sticker:
Y/N
Is patient happy to have venous sample and wait 2-3d for result?
If yes then consider not proceeding with rapid test
Reason for test: MSM with high risk activity (and partners of)
IVDU who have shared equipment (and partners of)
From endemic area (and partners of)
UPSI with known HIV+
CSW with high risk activity
Pre PEP in those with previous high risk exposure
Very anxious
Patient wants test
Patient understands what HIV is
Patient understands confidentiality of test
Patient is aware of the benefits of testing (access to treatment, better prognosis if earlier diagnosis, prevention of transmission to others)
Patient is aware that a venous sample is best if there is a risk of recent infection
Patient is aware that a venous sample also allows us to check for syphilis, hep b/c
Patient is aware that the test is very accurate
Patient is aware that a false positive/reactive result is most likely in those at low risk of HIV
Procedure for testing discussed
Patient is aware that a result will be available during the next minute after blood sampling
Patient understands that a reactive result will need to be confirmed with a venous sample- and that this result will be available within 2-3days
Patient has been recommended to have STI screening at this visit pre rapid test
Patient gives verbal consent to proceed with rapid test
Staff signature / Print Name / Designation / Date

Appendix D

Point-of-care testing Pilot – Patient Information

Please fill in this form so that we can make up a set of notes for you. If you have any difficulties completing this form, we will be happy to assist.

Date………………/…………….../……………
Details  Male  Female
Date of Birth………………………………………………
Age………………………..
Post Code (optional) …………………………………….
Would you like to have :
An HIV Test  Yes  No
Please sign below to give consent for the HIV test.
Patient’s Signature………………………………….…..
Date……………………………………………………... / Country of birth......
Please tick the group which you feel describes your ethnic group best
Ethnic Origin / Description / Please tick one
A / English, Scottish, Welsh
B / Irish
C1 / Greek/Greek Cypriot
C2 / Turkish/Turkish Cypriot
C3 / Eastern European
C4 / Other White European
C5 / Orthodox Jewish
C6 / Jewish
CX / Other White/Mixed White
D / White & Mixed Caribbean
E / White & Black African
F / White & Asian
G / Other Mixed
H / Indian (incl British)
J / Pakistani (incl British)
K / Bangladeshi ( incl British)
L / Other Asian
M / Caribbean
N1 / Somali
N2 / African (except Somali)
P1 / Black British
PX / Other Black
R / Chinese
S1 / Arab or Middle East
S2 / Kurdish
S3 / Vietnamese
S4 / Traveller
SX / Any Other Group

All information that you give us will be treated in the strictest confidence.

If you have a query, please ask. Thank you.

GP Pilot HIV testWH/April/2010

Appendix E

HIV POCT RESULT SHEET/ LOG

Sex F/M / Age / Ethnic Origin
(codes) / Patient demonstrated understanding
Y/N / Consent given
Y/N / Kit reference / Test Result / Venous Sample Y/N / Referral
Y/N / Date & Time / Staff Name

Result = Negative, Reactive, Void or Indeterminate

If Void, retest with a different kit number

GP Pilot HIV testWH/April/2010

Appendix F

EMIS CODING

ACTIVITY / CODING
Rapid HIV Antibody Test / EMISNQRA5
Reactive Rapid HIV Antibody Test / EMISNQRE117
Non-reactive Rapid HIV Antibody Test / EMISNQNO26
Indeterminate Rapid HIV Antibody Test / EMISNQIN61
Invalid Rapid HIV Antibody Test / EMISNQIN62
HIV prevention Advice / EMISHI1

Appendix G

REFERRAL FORM

REFERRAL TO THE GREENWAY CENTRE

Please complete and fax to 020 7363 8316 (voice: 020 7363 8400)

PATIENT DETAILS:

DATE: ………………………. GENDER: Male Female (is the patient pregnant YES / NO)

SURNAME...... FIRST NAME(S)......

DATE OF BIRTH...... AGE….……

FULL ADDRESS...... ………………………………………………………………………………

...... ……………………………………………………………………………….

FULL POSTCODE......

TELEPHONE

HOME:...... MOBILE:......

PREFERRED METHOD OF CONTACT:………………………………………………………………………………………………….

REFERRER INFORMATION:

REFERRED BY:…………………………………………………. ROLE:………………………………………………….

ADDRESS:…………………………………………………………………………………………………………………….

…………………………………………………………………………………………POST CODE:……………………….

CONTACT NUMBER OF REFERRER:……………………………………………………………………………………...

FAX NUMBER OF REFERRER: ......

DATE OF HIV POSITIVE TEST RESULT (if not today): …………………………………………………………………..

DATE PATIENT WAS INFORMED OF REACTIVE HIV TEST RESULT: ………………………………………………...

ANY RELEVANT INFORMATION:……………………………………………………………………………………………

…………………………………………………………………………………………………………………………………….

Please advise the patient that they will be contacted within 24 hours (or by end of next working day if referred on Friday) by clinic staff. If they have not been contacted, please ask them to call 020 7363 8008 or 020 7363 8474.

For any referral queries, call one of the above numbers or bleep the HIV Clinical Nurse Specialist on

020 7476 4000, bleep 297.

GP Pilot HIV testWH/April/2010