Changing physician behaviour in low-prevalence countries to deliver comprehensive targeted testing to high-risk groups is a challenge and, even with the introduction of national guidelines, HIV testing rates have been slow to increase [6-8]. For these reasons, national guidelines advocate universal testing in healthcare settings serving populations with a higher HIV prevalence (2 per 1000 in the UK [9]; 1 per 100 in the USA [10]). Successful initiatives in antenatal and genitourinary medicine services, and US emergency departments [9,

11], have shown that point-of-care HIV testing (HIV POCT) reduces specific barriers for testing. These barriers include the need for

follow-up visits, venepuncture and the anxiety associated with waiting for a result [12, 13]. Thus, HIV POCT may be a critical tool for implementing universal testing selleck in many settings. New studies piloting HIV testing in hospital, primary care and community services suggest that HIV testing is feasible and acceptable in these settings [14]. A high HIV prevalence has previously been demonstrated in the Hospital for Tropical Diseases out-patient clinic [15, 16]. The aim was to establish nurse-delivered universal HIV POCT in an acute medical setting in an inner London hospital – the Hospital for Tropical Diseases selleckchem open-access emergency clinic. The Hospital for Tropical Diseases open-access emergency clinic offers a specialist service for acutely unwell patients who have a history of foreign travel in the last 6 months. Patients over 18 years of age may self-refer or attend with a referral from a primary care physician. We conducted a prospective study of all patients attending this clinic from the introduction of an Access database on 26 August 2008 until click here 31 December 2010. During this study period, we introduced a universal offer of an HIV test. A fast-track referral service to

the local genitourinary medicine clinic was established with designated health advisor appointments for patients who received a reactive result. Patient leaflets were generated to support the service, and included information on the potential for a false negative (as a result of a recent infection) and false reactive tests. Prior to universal testing, targeted HIV testing was offered to patients (phase 0), as part of clinical diagnosis and management, by the junior doctor who assessed the patient after triage by the tropical clinical nurse specialist. Doctors were aware of, and had received training that covered, the 2008 UK guidelines on testing patients from high-risk groups and with indicator diseases [British HIV Association (BHIVA) / British Association of Sexual Health and HIV (BASHH) / British Infection Society (BIS) 2008] [9].