2020 BHIVA/BASHH/BIA adult HIV testing guidelines: Time to revisit the window period discussion

Background: Since March 2020, our clinic has used remote self-sampling for asymptomatic HIV testing as a means of delivering COVID-secure care whilst symptomatic patients attend face to face. In 2014, BASHH/EAGA guidelines recommended re-screening for HIV at 8 weeks following events deemed high risk of transmission. The updated 2020 guidelines recommend a window period (WP) of 45 days to detect 99% of infections for fourth-generation serological HIV tests. We aimed to audit practice against the 2014 recommendations, implement the 2020 guidelines and re-assess HIV WP discussion outcomes. Method: Using a plan-do- study- act (PDSA) model, case notes of all patients tested for HIV in a face-to- face appointment between 01/08/20 and 15/08/20 were reviewed (cycle 1, audit standard 2014 guidelines). Data on eligibility for HIV re-screen, WP discussion and follow-up testing were extracted from our electronic patient record. Eligibility for a HIV re-screen at the end of the WP was defined as having a sexual risk within that time or a regular partner for less than the WP duration. An intervention to improve clinician knowledge of HIV testing guidelines was delivered via online group teaching, alongside updates to our website and patient information leaflets. Practice was re-audited against the 2020 guidelines between 31/10/20 and 14/11/20 (cycle 2). Results: Eligibility for end of WP screening was similar in both PDSA cycles (Table 1). Following the intervention, the proportion of cases where an appropriate WP discussion was documented increased, with a higher percentage having specific follow-up testing. Conclusion: Empowering patients to consider HIV re-screening at the end of the WP facilitates best use of available resources. Amidst multiple competing demands and evolving clinical practices designed to mitigate COVID-19 risk, finding time to deliver appropriate WP advice is difficult. Whilst there were improved HIV WP discussion outcomes following an intervention, further work is required so that national standards are fully met. (Table Presented).