Delivery of HIV test results has traditionally been done in person to allow for post-test counselling. Over the past 4 years, the BC Centre for Disease Control (BCCDC) has been offering notification of HIV results over the phone, saving time for clients and nurses. Notification of positive HIV test results, when done in a timely fashion, can significantly impact the HIV epidemic as research has shown that when people become aware of a HIV-positive status, decreased risk taking and increased safer sex practices result.(1;2) International guidelines for HIV testing and counselling (3;4) have underscored the importance of early knowledge of HIV status and the need to decrease the number of people who do not receive their HIV test results. However, the vast majority of clients testing for HIV will be negative and in-person notification is generally not required.
We conducted an evaluation to examine the impact of offering HIV results over the phone. All clients undergoing HIV testing at the BCCDC STI Clinic were offered the choice of face-to-face or telephone result notification. The proportion of clients notified of their test results, and the number of clinic appointments dedicated solely to the delivery of HIV test results, were compared among clients testing six months before and after the change in practice.
Results showed that 7% more clients received their HIV test results during the study period. In addition, the average number of clinic visits per month dedicated to delivering HIV results decreased from 410 to 160 after the change. These results illustrate that delivering HIV results over the phone is a feasible and acceptable avenue for clients attending an urban STI clinic to receive their results; a clinic where the volume of HIV testing is high but the incidence of HIV is relatively small.
Post-test counselling for all clients testing for HIV remains important. However, in a setting where the vast majority of test results are negative, offering post-test counselling to clients who have a negative HIV result can be done over the phone without incident. In this era of fiscal restraint, it is reasonable to routinely offer delivery of HIV results over the phone for low-risk clients, freeing up nursing time for clients who require physical assessments or treatment.
Our study does not intend to undermine the need to deliver emotional support and counsel to clients with a positive test result. Face-to-face notification is still preferred for HIV positive clients. However, our results (and the results from other jurisdictions (5-7)) show that delivery of results over the phone is preferred by the majority of clients and can be done safely without compromising client confidentiality.(8)
- Johnson WD, Diaz RM, Flanders WD, et al. Behavioral interventions to reduce risk for sexual transmission of HIV among men who have sex with men. Cochrane Database Syst Rev 2008;(3):CD001230.
- Marks G, Crepaz N, Senterfitt J, et al. Meta-analysis of high-risk sexual behaviour in persons aware and unaware they are infected. Journal of Acquired Immune Deficiency Syndrome 2005;39:446-53.
- June 2004 Joint United Nations Programme on HIV/AIDS. UNAIDSUNAIDS/WHO policy statement on HIV testing. http://data.unaids.org/una-docs/hivtestingpolicy_en.pdf2004
- World Health Organization. Guidance on provider-initiated HIV testing and counselling in health facilities. Geneva: World Health Organization; 2007.
- New Zealand Ministry of Health. Recommendations for HIV Testing of Adults in Health Care Settings – 2008. http://www moh govt nz/moh nsf/indexmh/hivaids-testingadultsinhealthcare 2008 [cited 9 A.D. Jun 20];Available from: URL: http://www.moh.govt.nz/moh.nsf/indexmh/hivaids-testingadultsinhealthcare
- Branson BM, Handsfield H, Lampe M, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health care settings. MMWR Recommendations and Reports 2006;55(RR14):1-17.
- Branson B, Ballenger A, Olthoff G. HIV test results and post-test counseling by telephone. International Conference on AIDS. 1994. 5-15-2009.
- Mendez J. Giving positive HIV test results over the phone: Essentials for success. 2008 National STD Prevention Conference. 2008. 3-10-0200.