. 2023 Sep 30;24(1):201.

doi: 10.1186/s12875-023-02161-y.

Understanding the effect of an educational intervention to optimize HIV testing strategies in primary care in Amsterdam - results of a mixed-methods study

Saskia Bogers^{1

2

3}, Pythia Nieuwkerk^{4

5

6}, Nynke van Dijk^{7

8}, Maarten Schim van der Loeff^{9

10}, Suzanne Geerlings^{9

4

11}, Jan van Bergen^{7

12}; HIV Transmission Elimination Amsterdam (H-TEAM) Consortium

Collaborators, Affiliations

Collaborators

HIV Transmission Elimination Amsterdam (H-TEAM) Consortium:
T van Benthem, D Bons, G J de Bree, P Brokx, U Davidovich, F Deug, M Heidenrijk, E Hoornenborg, M Prins, P Reiss, A van Sighem, M van der Valk, J de Wit, W Zuilhof, N Schat, D Smith, M van Agtmael, J Ananworanich, D van de Beek, G E L van den Berk, D Bezemer, A van Bijnen, J P Bil, W L Blok, M Bomers, A Boyd, W Brokking, D Burger, K Brinkman, M de Bruin, S Bruisten, L Coyer, R van Crevel, M Dijkstra, Y T van Duijnhoven, A van Eeden, L Elsenburg, M A M van den Elshout, E Ersan, P E V Felipa, T B H Geijtenbeek, J van Gool, A Goorhuis, M Groot, C A Hankins, A Heijnen, M M J Hillebregt, M Hommenga, J W Hovius, N Brinkman, Y Janssen, K de Jong, V Jongen, N A Kootstra, R A Koup, F P Kroon, T J W van de Laar, F Lauw, M M van Leeuwen, K Lettinga, I Linde, D S E Loomans, I M van der Lubben, J T van der Meer, T Mouhebati, B J Mulder, J Mulder, F J Nellen, A Nijsters, H Nobel, E L M Op de Coul, E Peters, I S Peters, T van der Poll, O Ratmann, C Rokx, W E M Schouten, J Schouten, J Veenstra, A Verbon, F Verdult, J de Vocht, H J de Vries, S Vrouenraets, M van Vugt, W J Wiersinga, F W Wit, L R Woittiez, S Zaheri, P Zantkuijl, A Żakowicz, M C van Zelm, H M L Zimmermann

Affiliations

¹ Department of Internal Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands. s.j.bogers@amsterdamumc.nl.
² Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands. s.j.bogers@amsterdamumc.nl.
³ Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands. s.j.bogers@amsterdamumc.nl.
⁴ Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands.
⁵ Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
⁶ Amsterdam Public Health Research Institute, Mental Health, Personalized Medicine, Amsterdam, the Netherlands.
⁷ Department of General Practice, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
⁸ Amsterdam University of Applied Sciences, Faculty of Health, Center of Expertise Urban Vitality Amsterdam, Amsterdam, The Netherlands.
⁹ Department of Internal Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
¹⁰ Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands.
¹¹ Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
¹² STI AIDS Netherlands, Amsterdam, the Netherlands.

PMID: 37777732
PMCID: PMC10541686
DOI: 10.1186/s12875-023-02161-y

Understanding the effect of an educational intervention to optimize HIV testing strategies in primary care in Amsterdam - results of a mixed-methods study

Saskia Bogers et al. BMC Prim Care. 2023.

. 2023 Sep 30;24(1):201.

doi: 10.1186/s12875-023-02161-y.

Authors

Collaborators

HIV Transmission Elimination Amsterdam (H-TEAM) Consortium:
T van Benthem, D Bons, G J de Bree, P Brokx, U Davidovich, F Deug, M Heidenrijk, E Hoornenborg, M Prins, P Reiss, A van Sighem, M van der Valk, J de Wit, W Zuilhof, N Schat, D Smith, M van Agtmael, J Ananworanich, D van de Beek, G E L van den Berk, D Bezemer, A van Bijnen, J P Bil, W L Blok, M Bomers, A Boyd, W Brokking, D Burger, K Brinkman, M de Bruin, S Bruisten, L Coyer, R van Crevel, M Dijkstra, Y T van Duijnhoven, A van Eeden, L Elsenburg, M A M van den Elshout, E Ersan, P E V Felipa, T B H Geijtenbeek, J van Gool, A Goorhuis, M Groot, C A Hankins, A Heijnen, M M J Hillebregt, M Hommenga, J W Hovius, N Brinkman, Y Janssen, K de Jong, V Jongen, N A Kootstra, R A Koup, F P Kroon, T J W van de Laar, F Lauw, M M van Leeuwen, K Lettinga, I Linde, D S E Loomans, I M van der Lubben, J T van der Meer, T Mouhebati, B J Mulder, J Mulder, F J Nellen, A Nijsters, H Nobel, E L M Op de Coul, E Peters, I S Peters, T van der Poll, O Ratmann, C Rokx, W E M Schouten, J Schouten, J Veenstra, A Verbon, F Verdult, J de Vocht, H J de Vries, S Vrouenraets, M van Vugt, W J Wiersinga, F W Wit, L R Woittiez, S Zaheri, P Zantkuijl, A Żakowicz, M C van Zelm, H M L Zimmermann

Affiliations

¹ Department of Internal Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands. s.j.bogers@amsterdamumc.nl.
² Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands. s.j.bogers@amsterdamumc.nl.
³ Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands. s.j.bogers@amsterdamumc.nl.
⁴ Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands.
⁵ Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
⁶ Amsterdam Public Health Research Institute, Mental Health, Personalized Medicine, Amsterdam, the Netherlands.
⁷ Department of General Practice, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
⁸ Amsterdam University of Applied Sciences, Faculty of Health, Center of Expertise Urban Vitality Amsterdam, Amsterdam, The Netherlands.
⁹ Department of Internal Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
¹⁰ Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands.
¹¹ Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
¹² STI AIDS Netherlands, Amsterdam, the Netherlands.

PMID: 37777732
PMCID: PMC10541686
DOI: 10.1186/s12875-023-02161-y

Abstract

Background: In the Netherlands, general practitioners (GPs) play a key role in provider-initiated HIV testing, but opportunities for timely diagnosis are regularly missed. We implemented an educational intervention to improve HIV testing by GPs from 2015 to 2020, and observed a 7% increase in testing in an evaluation using laboratory data. The objective for the current study was to gain a deeper understanding of whether and how practices and perceptions of GPs' HIV/sexually transmitted infection (STI) testing behaviour changed following the intervention.

Methods: We performed a mixed-methods study using questionnaires and semi-structured interviews to assess self-reported changes in HIV/STI testing by participating GPs. Questionnaires were completed by participants at the end of the final educational sessions from 2017 through 2020, and participating GPs were interviewed from January through March 2020. Questionnaire data were analysed descriptively, and open question responses were categorised thematically. Interview data were analysed following thematic analysis methods.

Results: In total, 101/103 participants completed questionnaires. Of 65 participants that were included in analyses on the self-reported effect of the programme, forty-seven (72%) reported it had changed their HIV/STI testing, including improved STI consultations, adherence to the STI consultation guideline, more proactive HIV testing, and more extragenital STI testing. Patients' risk factors, patients' requests and costs were most important in selecting STI tests ordered. Eight participants were interviewed and 15 themes on improved testing were identified, including improved HIV risk-assessment, more proactive testing for HIV/STI, more focus on HIV indicator conditions and extragenital STI testing, and tools to address HIV during consultations. However, several persistent barriers for optimal HIV/STI testing by GPs were identified, including HIV-related stigma and low perceived risk.

Conclusions: Most GPs reported improved HIV/STI knowledge, attitude and testing, but there was a discrepancy between reported changes in HIV testing and observed increases using laboratory data. Our findings highlight challenges in implementation of effective interventions, and in their evaluation. Lessons learned from this intervention may inform follow-up initiatives to keep GPs actively engaged in HIV testing and care, on our way to zero new HIV infections.

Keywords: General practitioner; HIV testing; Medical education; Mixed-methods; Primary care; Sexually transmitted infections.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

**Fig. 1**
Themes identified in the interviews with eight GPs in Amsterdam regarding their reflections on trends in HIV testing, 2020. GP: general practitioner. MSM: men who have sex with men. PrEP: Pre-exposure prophylaxis. SHC: sexual health centre. STI: sexually transmitted infection

**Fig. 2**
Themes identified in the interviews with eight GPs in Amsterdam on the evaluation and recommendations for improvement of the educational intervention, 2020. GP: general practitioner. STI: sexually transmitted infection

See this image and copyright information in PMC

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Jordans CCE, Niemantsverdriet-Rokx L, Struik JL, van der Waal EC, van der Voorn PVJM, Bakker N, Verbon A, Bindels PJE, Rokx C. Jordans CCE, et al. BMC Prim Care. 2024 Dec 27;25(1):440. doi: 10.1186/s12875-024-02666-0. BMC Prim Care. 2024. PMID: 39731054 Free PMC article.

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Understanding the effect of an educational intervention to optimize HIV testing strategies in primary care in Amsterdam - results of a mixed-methods study

Collaborators

Affiliations

Understanding the effect of an educational intervention to optimize HIV testing strategies in primary care in Amsterdam - results of a mixed-methods study

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

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