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• W1935667675 abstract "Riva and colleagues argue that HIV screening programmes should not just be limited to testing and delivery of results but rather be planned within medical and social care for HIV prevention. We agree and feel that we achieved this within the RHIVA2 trial. The RHIVA2 cluster-randomised trial1Leber W McMullen H Anderson J et al.Promotion of rapid testing for HIV in primary care (RHIVA2): a cluster-randomised controlled trial.Lancet HIV. 2015; 2: 229-235Summary Full Text Full Text PDF Scopus (35) Google Scholar was embedded with national sexual health prevention strategy2British HIV AssociationUK National Guidelines for HIV testing.http://www.bhiva.org/documents/guidelines/testing/glineshivtest08.pdfGoogle Scholar, 3National Institute for Health and Care ExcellenceIncreasing the uptake of HIV testing to reduce undiagnosed infection and prevent transmission among men who have sex with men, 2011.https://www.nice.org.uk/guidance/ph34Google Scholar, 4National Institute for Health and Care ExcellenceIncreasing the uptake of HIV testing to reduce undiagnosed infection and prevent transmission among black African communities living in England.https://www.nice.org.uk/guidance/ph33Date: 2011Google Scholar, 5Donaldson L Improving the detection and diagnosis of HIV in non-HIV specialties including primary care. 2007.http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_082338.pdfGoogle Scholar and developed against the background of a UK HIV epidemic that continued to increase despite large-scale screening in traditional settings, including sexual health and antenatal clinics.6Public Health EnglandHIV in the United Kingdom: 2014 report.https://www.gov.uk/government/statistics/hiv-in-the-united-kingdomDate: 2014Google Scholar RHIVA2 nurses and health-care assistants were trained in discussions before and after tests as well as in rapid testing. Patients were informed about benefits of HIV testing including the potential for early diagnosis of HIV and advised to use condoms and to test again in case of any recent risk exposure (for details, see the RHIVA2 supplement).1Leber W McMullen H Anderson J et al.Promotion of rapid testing for HIV in primary care (RHIVA2): a cluster-randomised controlled trial.Lancet HIV. 2015; 2: 229-235Summary Full Text Full Text PDF Scopus (35) Google Scholar Patients with a reactive rapid HIV test result, however, were seen by a general practitioner or senior nurse for immediate support and onward referral to a specialist clinic for comprehensive psychosocial care and antiretroviral treatment. Riva and colleagues also suggest that results should be given in medical consultations. We felt this was only necessary and practical in the case of confirmed positive results.We agree with Richard Ma's comment that the number of new diagnoses was lower than expected. Implementation of a successful HIV screening programme requires that the new registration check be fully integrated into general practice services. RHIVA2 was pragmatic in that all practices in the borough were invited to participate in the trial irrespective of their organisational circumstances: only about half of the practices offered a registration check, which in turn was attended by only about half of the newly registered patients, hampering access to testing. In terms of actual numbers, however, the proportion of patients diagnosed via rapid testing, 11 of 4978, was in line with the prevalence of undiagnosed HIV in the borough of two per 1000. Furthermore, an additional seven patients were newly diagnosed in the intervention practices compared with control, probably reflecting a so-called halo effect of the intervention on opportunistic testing. Finally, initial data from an ongoing implementation study looking at the long-term effect of RHIVA2 suggests that practices have continued to test and newly diagnose patients at levels similar to those seen during the trial (unpublished). We agree, evaluation of a multifaceted intervention is complex. However, as shown recently, innovation adoption may be influenced by the personal characteristics of individual practitioners, and depend on the type of the innovation, the dynamics within health-care teams, and the structural context of an organisation itself.7McMullen H Griffiths C Leber W et al.Explaining high and low performers in complex intervention trials: a new model based on diffusion of innovations theory.Trials. 2015; 16: 242Crossref PubMed Scopus (37) Google ScholarJA reports fees and non-fi nancial support from Bristol-Myers Squibb, grants and personal fees from Gilead Sciences, personal fees from ViiV, personal fees from Merck Sharp & Dohme, grants from Janssen, and personal fees from AbbVie, outside the submitted work. The other authors declare no competing interests. Riva and colleagues argue that HIV screening programmes should not just be limited to testing and delivery of results but rather be planned within medical and social care for HIV prevention. We agree and feel that we achieved this within the RHIVA2 trial. The RHIVA2 cluster-randomised trial1Leber W McMullen H Anderson J et al.Promotion of rapid testing for HIV in primary care (RHIVA2): a cluster-randomised controlled trial.Lancet HIV. 2015; 2: 229-235Summary Full Text Full Text PDF Scopus (35) Google Scholar was embedded with national sexual health prevention strategy2British HIV AssociationUK National Guidelines for HIV testing.http://www.bhiva.org/documents/guidelines/testing/glineshivtest08.pdfGoogle Scholar, 3National Institute for Health and Care ExcellenceIncreasing the uptake of HIV testing to reduce undiagnosed infection and prevent transmission among men who have sex with men, 2011.https://www.nice.org.uk/guidance/ph34Google Scholar, 4National Institute for Health and Care ExcellenceIncreasing the uptake of HIV testing to reduce undiagnosed infection and prevent transmission among black African communities living in England.https://www.nice.org.uk/guidance/ph33Date: 2011Google Scholar, 5Donaldson L Improving the detection and diagnosis of HIV in non-HIV specialties including primary care. 2007.http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_082338.pdfGoogle Scholar and developed against the background of a UK HIV epidemic that continued to increase despite large-scale screening in traditional settings, including sexual health and antenatal clinics.6Public Health EnglandHIV in the United Kingdom: 2014 report.https://www.gov.uk/government/statistics/hiv-in-the-united-kingdomDate: 2014Google Scholar RHIVA2 nurses and health-care assistants were trained in discussions before and after tests as well as in rapid testing. Patients were informed about benefits of HIV testing including the potential for early diagnosis of HIV and advised to use condoms and to test again in case of any recent risk exposure (for details, see the RHIVA2 supplement).1Leber W McMullen H Anderson J et al.Promotion of rapid testing for HIV in primary care (RHIVA2): a cluster-randomised controlled trial.Lancet HIV. 2015; 2: 229-235Summary Full Text Full Text PDF Scopus (35) Google Scholar Patients with a reactive rapid HIV test result, however, were seen by a general practitioner or senior nurse for immediate support and onward referral to a specialist clinic for comprehensive psychosocial care and antiretroviral treatment. Riva and colleagues also suggest that results should be given in medical consultations. We felt this was only necessary and practical in the case of confirmed positive results. We agree with Richard Ma's comment that the number of new diagnoses was lower than expected. Implementation of a successful HIV screening programme requires that the new registration check be fully integrated into general practice services. RHIVA2 was pragmatic in that all practices in the borough were invited to participate in the trial irrespective of their organisational circumstances: only about half of the practices offered a registration check, which in turn was attended by only about half of the newly registered patients, hampering access to testing. In terms of actual numbers, however, the proportion of patients diagnosed via rapid testing, 11 of 4978, was in line with the prevalence of undiagnosed HIV in the borough of two per 1000. Furthermore, an additional seven patients were newly diagnosed in the intervention practices compared with control, probably reflecting a so-called halo effect of the intervention on opportunistic testing. Finally, initial data from an ongoing implementation study looking at the long-term effect of RHIVA2 suggests that practices have continued to test and newly diagnose patients at levels similar to those seen during the trial (unpublished). We agree, evaluation of a multifaceted intervention is complex. However, as shown recently, innovation adoption may be influenced by the personal characteristics of individual practitioners, and depend on the type of the innovation, the dynamics within health-care teams, and the structural context of an organisation itself.7McMullen H Griffiths C Leber W et al.Explaining high and low performers in complex intervention trials: a new model based on diffusion of innovations theory.Trials. 2015; 16: 242Crossref PubMed Scopus (37) Google Scholar JA reports fees and non-fi nancial support from Bristol-Myers Squibb, grants and personal fees from Gilead Sciences, personal fees from ViiV, personal fees from Merck Sharp & Dohme, grants from Janssen, and personal fees from AbbVie, outside the submitted work. The other authors declare no competing interests. Promotion of rapid testing for HIV in primary care (RHIVA2): a cluster-randomised controlled trialPromotion of opt-out rapid testing in general practice led to increased rate of diagnosis, and might increase early detection, of HIV. We therefore recommend implementation of HIV screening in general practices in areas with high HIV prevalence. Full-Text PDF Light and shade behind the opt-out system for the HIV screeningWe believe critical thinking is needed about the introduction of opt-out testing to increase early identification of HIV infection, as recently discussed by Leber and colleagues.1 Full-Text PDF Light and shade behind the opt-out system for the HIV screeningLeber and colleagues1 have shown the ability of opt-out rapid testing to increase the rate of HIV diagnosis and early detection in general practice. However, despite a well designed, cluster-randomised controlled trial with an educational programme to promote testing, the number of new diagnoses was lower than expected. 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• W1935667675 title "Light and shade behind the opt-out system for the HIV screening – Authors' reply" @default.
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