India, the second most populated country in the world, is home to an estimated 2.1 million people living with HIV (PLHIV) according to the HIV Estimates (2015 )Technical Report  National AIDS Control Organization (Ministry of Health and Family Welfare, Government of India. India ).

In moving towards ending this epidemic, early diagnosis and testing for HIV are important factors.

General practitioners are undoubtedly in an ideal position to support the drive for early diagnosis of HIV– many patients diagnosed with HIV will have come into contact with primary care services prior to their diagnosis. For all medical complaints, big and small, the general practitioner is the first level of medical consultation - the first medical caregiver to whom a patient reaches out when in need. Community research has confirmed that among different specialties of doctors, it is the general practitioners who enjoy the highest level of trust and confidence of the patients. This puts a huge responsibility and onus on the general practitioner. However, the clinical diagnosis of HIV-related conditions in primary care poses several challenges. Many problems associated with HIV,like seborrhoeic dermatitis, shingles, folliculitis or a glandular fever-like illness, are commonly seen in people without HIV infection. It barely seems feasible to consider HIV first – and then to raise it – whenever common conditions such as these present in the surgery.

Nevertheless, the general practitioners are skilled at the concept of considering rare but serious conditions when extremely common symptoms present and thus can vastly contribute to the improved chances of detecting HIV at the community level.

Effective and meticulous screening by general practitioners can alleviate the burden of HIV/AIDS

In the management of sexually transmitted infections like HIV, which are preventable, the general practitioner has a major role to play. Early identification of at-risk individuals and timely HIV testing among high risk subgroups can reveal early infection – which otherwise remains asymptomatic until it progresses in severity. Hence, those who begin treatment early can delay progression to AIDS and can have a better quality and longevity of life. In this context, the role of the general practitioner assumes tremendous importance. If HIV testing for suspected cases and at-risk individuals is performed earlier in the hierarchy of medical consultation, by the general practitioner, it can identify early asymptomatic HIV infection and early treatment can be started for better prognosis. In the long run, this can have a snowball effect by not only improving clinical outcomes at a community level, but also by reducing costs of treating HIV and AIDS and their associated complications.

Recent epidemiological research favors the instrumental role of the general practitioner in HIV control

Queen Mary University of London (QMUL) and the London School of Hygiene & Tropical Medicine, conducted a study in the UK spanning across 86,000 people from 40 GP surgeries. The study published in Lancet reveals that offering HIV testing to people at health checks when they register at a new GP surgery in high-prevalence areas is cost-effective and can save lives.

The study examined data from an earlier research trial in Hackney -- a socioeconomically deprived inner London borough with an HIV prevalence rate of 8 per 1000 adults. The trial involved 40 general practices, where they tested the effect of a rapid fingerpick HIV testing as part of the standard health check during registration and found it led to a fourfold higher HIV diagnosis rate.

India Needs HIV testing at the Level of Primary Care and Community Centres: NACO Guidelines (2016)

Dr. Werner Leber from QMUL believes that HIV screening in primary care is cost effective and potentially cost saving, which is contrary to the prevalent widespread belief.The findings of this study also seem applicable to resource poor settings like the third world countries, where majority of the population does not have access to basic medical care and specialized and super specialized medical consultation is a luxury; restricted mainly to urban pockets. Hence, if HIV testing gets proactively intensified in high risk areas and subgroups, at the level of general practice, in a country like India, several lives can be saved and healthcare expenses be reduced.

As per National Aids Control organization’s (NACO’s) HIV Counselling and testing Services (HTCS) guidelines – “Early testing and diagnosis, on a voluntary basis, is the gateway to HIV prevention, treatment, care and other support services. The challenge is to increase access to and uptake of HIV testing among priority populations. This warrants different innovative strategic approaches suitable for implementation across different states and union territories of India”.

National Health Portal of India stresses on community level testing of HIV under the National AIDS Control Program (NACP) III

The NACP III plans to invest extensively in community based local centres for HIV testing as identifying the infection at the level of the local general practitioner is key to control. Under the plan all HIV/AIDS linked services have been percolated down right to the sub-district and community level. Community health centres and primary care clinics have been integrated into the NACP III through counselling and testing services.