Universal-offer HIV testing in primary care: A mixed-methods evaluation of a pilot study

Background: Offering HIV tests to all patients undergoing blood tests in primary care has been recommended by the National Institute for Health and Care Excellence (NICE) in the UK since 2016 but has not been fully adopted. We sought to evaluate the acceptability and feasibility of such a service in primary care. Methods: A 3-weeks pilot of offering HIV tests to all patients undergoing blood tests was conducted in a general practice in the UK and evaluated using a mixed- methods approach. Whether patients were offered and accepted tests was recorded and any differences by patient's age and gender assessed. All patients and HCPs offering testing were approached for semistructured interviews. Results: Two-hundred-and-51 patients (mean [range] 57.5 years [18 to 97], 58% female) attended blood test appointments with 117 being offered a HIV test (46.6%). 78.6% (n = 92) accepted testing with 91 negative results. The proportion of patients offered testing was associated with the HCP offering the test. No associations between the age or gender of the patient and their odds of being offered or accepting a test were observed. Patient semi- structured interviews (n = 13) revealed a range of previous HIV testing experiences, patients felt the "offer" of a test to be routine and nonjudgemental and felt that receiving negative results via SMS was appropriate. Several participants reported not fully considering the implications of a positive result when they accepted the test. Interviews with HCPs (n = 3) identified no significant service-level barriers. Conclusions: Offering HIV tests to patients undergoing blood tests in primary care is feasible and acceptable. The principal barrier to uptake was HCPs not offering testing.