Table 4 Studies included in the review that report on barriers and facilitators

Agusti, 2013 [50]

Spain

Cross-sectional questionnaire survey, 2012

1308 GPs^a from the two largest Spanish scientific medical societies for family and community medicine

Barriers to provide (rapid) HIV testing: lack of time; lack of training; cultural barriers.

Fraisse, 2015 [37]

France

Cross-sectional questionnaire survey, 2013

78 GPs working in a 150,000-population district in the south of France

Barriers to provide rapid HIV testing: time constraints.

Gauthier, 2012 [51]

France

Prospective interventional study offering rapid testing in primary care, 2010

62 GPs and 383 primary care patients, covering six French regions + 72 GPs participating in the evaluation post intervention

Barriers to provide rapid HIV testing: difficulties to perform the test; lack of time; window period; difficulties to screen for other STIs.

Gennotte, 2013 [52]

Belgium

Prospective interventional study offering rapid HIV testing in a Brussels area with a substantial African community, 2010–2011

10 GPs and 1087 consultation records, 217 primary care patients offered rapid HIV testing

Barriers to provide (rapid) HIV testing: lack of time; difficulties to propose the test

Joore, 2016 [42]

Netherlands

Qualitative study with FGDs^b and in depth-interviews, 2014

6 FGDs including 81 GPs and in- depth interviews with 9 key-informants

Barriers to provide HIV testing: difficulties in targeting the right group; lack of time; fear of stigmatizing patients.

Leber, 2015 [53]

UK

Cluster randomised controlled trial among general practices in a multi-ethnic, socioeconomically deprived inner London borough, 2010–2011. Practices were randomised to offer either opt-out rapid testing to newly registering adults or continue usual care.

20 general practices in the intervention group and 20 in the control group

HIV diagnosis rate was 0.30 [95%CI: 0.11–0.85] per 10,000 patients per year in intervention practices versus 0.07 [95%CI: 0.02–0.20] in control practices.

Loos, 2014 [48]

Belgium

Qualitative evaluation making use of focus group discussions and in-depth interviews, 2011–2012

65 GPs implementing a tool to proactively offer HIV testing to Sub-Saharan African migrants

Barriers to provide HIV testing: feelings of discomfort to offer the test, lack of counselling skills and time constraints.

GPs identified training needs on the specificities of the HIV epidemic

GPs requested a tool to proactively offer HIV testing to populations at increased risk improved the testing performance.

Mahendran, 2015 [54]

UK

A single-center observational cohort study in an outpatient HIV department in a secondary care UK hospital assessing the site of initial HIV diagnosis and stage of infection, 2000–2012

1359 diagnosed HIV patients

Increase in the proportion of HIV diagnoses made in primary care: from 2.7% in 2000 to 21.2% in 2012.

Decrease in the proportion of late diagnoses from 89.5% in 2000 to 42% in 2012.

Manirankunda, 2012 [49]

Belgium

Qualitative study making use of in-depth interviews, 2007–2008

20 GPs in the cities of Ghent and Antwerp

Barriers to provide HIV testing: time constraints, concerns about result management, concerns about lack of access to treatment for migrants in an illegal situation.

Pilay, 2014 [55]

UK

An interventional study consisting of a training in sexual health skills in a high HIV prevalence London area, 2010–2011

51 general practice settings

Testing rates of trained and untrained practices increased from 2.29 to 6.66 and 1.54 to 1.90/1000 registered patients/year.

16.7 positive diagnoses per 1000 tests in trained practices, corresponding to a rise from 9.5 to 22 new diagnoses per year.

Poirier, 2015 [38]

France

Multi-center observational and interventional study offering rapid HIV testing, 2012–2013

352 GPs participating in the questionnaire survey and 23 GPs volunteering to use rapid testing

Barriers to provide rapid HIV testing: difficulties to include preventive screening in GP consultation; low prevalence; immediacy of test results in case of rapid testing.

Rayment, 2012 [39]

UK

Multi-center cross-sectional questionnaire survey combined with and interventional study offering HIV testing, 2009–2010

144 primary care staff, 1320 primary care patients

72% of GPs identified a need for training to include HIV testing as a routine part of patient care.

Sicsic, 2016 [56]

France

Retrospective observational study making use of data from the French National health Insurance Fund database, 2006–2013

2.176,647 person-years corresponding to 329.748 different individuals aged between 15 and 70

Annual HIV screening rates increased from 4.2% [95% CI: 4.2–4.3] in 2006 to 5.8% [95% CI: 5.7–5.9] in 2013 with a significant trend after 2010 (p < 0.0001). The increase was stronger for those that regularly consulted a GP: the national screening policy led to a 20.4% increase [95% CI: 17%-23.8] in 2013 compared to a 4.5% increase [95% CI: 4.4–4.5] for those who did not consult a GP regularly in 2013.

Thornton, 2012 [36]

UK

Qualitative study with FGDs embedded within an interventional study offering routine testing in non-traditional settings including primary care, 2009–2010

6 FGDs in the pre-testing phase including 10 GPs; 7 FGDs in the post-testing phase including 8 GPs

Barriers to provide HIV testing: lack of time; concerns about results management.

Routine offer to HIV testing in general practice is feasible but requires training and support for staff.

Tong, 2012 [57]

UK

Prospective interventional study adding a standard comment to encourage inclusion of HIV testing to all Glandular fever screening reports, 2010–2011

871 glandular fever screening samples from 865 patients submitted from primary care

After the introduction of the standard comment, 19.6% had a concomitant HIV request as compared to 9.5% in the baseline period.