Use of a leaflet to replace verbal pretest discussion for HIV: effects and acceptability

Objective: To determine the effect of using a leaflet to replace formal verbal pretest discussion and assess its acceptability to patients. Setting and methods: A leaflet was developed which gave information on all routine tests undertaken at a genitourinary medicine clinic. Information normally given during verbal pretest discussion for HIV was included. The leaflet was given to all new attenders at routine STI clinics. The proportion of patients accepting tests in the 6 weeks before and 4 weeks after the introduction of the leaflet was elicited by case note review. The acceptability of the leaflet was determined by means of a questionnaire given to patients. Results: The use of the leaflet increased the number of patients offered an HIV test from 654 of 1004 (65%) patients to 371 of 397 (94%), p<0.001. It also increased the number tested from 325 (32%) of 1004 patients to 210 of 397 (53%, p<0.001). Men were more likely to be offered an HIV test than women at baseline (342 of 500 men, 68%, v 312 of 504 women, 62%, p=0.036) but after the intervention there was no longer a difference (men 217, 93%, female 154, 94%). The number of men accepting a test increased more than the number of women (139 of 233 men, 60%, 71 of 164 women, 43%, p <0.005). The 79 questionnaires suitable for analysis showed patient views on the leaflet were mainly favourable: easy to understand 73 (92%), clear 70 (89%), absence of difficult words 73 (91%), and right balance of information 68 (86%). Conclusions: The routine use of a leaflet to replace verbal pretest discussion (PTD) increased the proportion of patients undergoing testing. Part of the increased testing was because physicians were more likely to offer the test, possibly because the time constraints of pretest discussion were removed. This appears to be an acceptable and effective way of increasing HIV testing in GUM clinics but further work is needed to elicit information on non-responders to the questionnaire.