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Bull L, Rayment M. HIV-indicator-condition-driven HIV testing: clinically effective but still rarely implemented. Clin Med (Lond) 2016; 16:175-9. [PMID: 27037389 PMCID: PMC4952973 DOI: 10.7861/clinmedicine.16-2-175] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In the UK, outcomes for people living with HIV are excellent. However, a quarter of those living with HIV do not know their status, and almost half are diagnosed late. Strategies to broaden HIV testing are needed. HIV indicator conditions are those thought to be associated with HIV infection because they share risk factors (eg viral hepatitis) or because they arise as a result of early or late immunodeficiency (eg bacterial pneumonia, Kaposi's sarcoma). They comprise all AIDS-defining conditions, but also many non-AIDS-defining conditions spanning the spectrum of medicine. Patients presenting with indicator conditions should routinely be offered an HIV test. This approach is likely to be clinically effective, because knowledge of HIV status is essential in the management of many conditions. It is cost effective if the prevalence of HIV infection is greater than 0.1%. The strategy removes the need for risk assessment, and is acceptable to patients and healthcare practitioners. If broadly implemented, it is likely to be effective at a public health level, and will help to reduce both undiagnosed HIV and late diagnoses of HIV. Here we review the emerging evidence base that supports the value of routine HIV testing in indicator conditions.
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Affiliation(s)
- Lauren Bull
- Directorate of HIV/GU Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Michael Rayment
- Directorate of HIV/GU Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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O’Connell S, Lillis D, Cotter A, O’Dea S, Tuite H, Fleming C, Crowley B, Fitzgerald I, Dalby L, Barry H, Shields D, Norris S, Plunkett PK, Bergin C. Opt-Out Panel Testing for HIV, Hepatitis B and Hepatitis C in an Urban Emergency Department: A Pilot Study. PLoS One 2016; 11:e0150546. [PMID: 26967517 PMCID: PMC4788349 DOI: 10.1371/journal.pone.0150546] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/15/2016] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Studies suggest 2 per 1000 people in Dublin are living with HIV, the level above which universal screening is advised. We aimed to assess the feasibility and acceptability of a universal opt-out HIV, Hepatitis B and Hepatitis C testing programme for Emergency Department patients and to describe the incidence and prevalence of blood-borne viruses in this population. METHODS An opt-out ED blood borne virus screening programme was piloted from March 2014 to January 2015. Patients undergoing blood sampling during routine clinical care were offered HIV 1&2 antibody/antigen assay, HBV surface antigen and HCV antibody tests. Linkage to care where necessary was co-ordinated by the study team. New diagnosis and prevalence rates were defined as the new cases per 1000 tested and number of positive tests per 1000 tested respectively. RESULTS Over 45 weeks of testing, of 10,000 patient visits, 8,839 individual patient samples were available for analysis following removal of duplicates. A sustained target uptake of >50% was obtained after week 3. 97(1.09%), 44(0.49%) and 447(5.05%) HIV, Hepatitis B and Hepatitis C tests were positive respectively. Of these, 7(0.08%), 20(0.22%) and 58(0.66%) were new diagnoses of HIV, Hepatitis B and Hepatitis C respectively. The new diagnosis rate for HIV, Hepatitis B and Hepatitis C was 0.8, 2.26 and 6.5 per 1000 and study prevalence for HIV, Hepatitis B and Hepatitis C was 11.0, 5.0 and 50.5 per 1000 respectively. CONCLUSIONS Opt-out blood borne viral screening was feasible and acceptable in an inner-city ED. Blood borne viral infections were prevalent in this population and newly diagnosed cases were diagnosed and linked to care. These results suggest widespread blood borne viral testing in differing clinical locations with differing population demographic risks may be warranted.
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Affiliation(s)
- Sarah O’Connell
- Department of Genito-Urinary Medicine and Infectious Disease, St James’s Hospital, Dublin, Ireland
| | - Darren Lillis
- Emergency Medicine Department, St James’s Hospital, Dublin, Ireland
| | - Aoife Cotter
- Department of Genito-Urinary Medicine and Infectious Disease, St James’s Hospital, Dublin, Ireland
| | - Siobhan O’Dea
- Department of Genito-Urinary Medicine and Infectious Disease, St James’s Hospital, Dublin, Ireland
| | - Helen Tuite
- Infectious Diseases Department, Galway University Hospital, Dublin, Ireland
| | - Catherine Fleming
- Infectious Diseases Department, Galway University Hospital, Dublin, Ireland
| | - Brendan Crowley
- Microbiology Department, St James’s Hospital, Dublin, Ireland
| | - Ian Fitzgerald
- Microbiology Department, St James’s Hospital, Dublin, Ireland
| | - Linda Dalby
- Microbiology Department, St James’s Hospital, Dublin, Ireland
| | - Helen Barry
- Microbiology Department, St James’s Hospital, Dublin, Ireland
| | - Darragh Shields
- Emergency Medicine Department, St James’s Hospital, Dublin, Ireland
| | - Suzanne Norris
- Hepatology Department, St James’s Hospital, Dublin, Ireland
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Colm Bergin
- Department of Genito-Urinary Medicine and Infectious Disease, St James’s Hospital, Dublin, Ireland
- Department of Clinical Medicine, Trinity College Dublin, Dublin, Ireland
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Leblanc J, Rousseau A, Hejblum G, Durand-Zaleski I, de Truchis P, Lert F, Costagliola D, Simon T, Crémieux AC. The impact of nurse-driven targeted HIV screening in 8 emergency departments: study protocol for the DICI-VIH cluster-randomized two-period crossover trial. BMC Infect Dis 2016; 16:51. [PMID: 26831332 PMCID: PMC4736610 DOI: 10.1186/s12879-016-1377-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2010, to reduce late HIV diagnosis, the French national health agency endorsed non-targeted HIV screening in health care settings. Despite these recommendations, non-targeted screening has not been implemented and only physician-directed diagnostic testing is currently performed. A survey conducted in 2010 in 29 French Emergency Departments (EDs) showed that non-targeted nurse-driven screening was feasible though only a few new HIV diagnoses were identified, predominantly among high-risk groups. A strategy targeting high-risk groups combined with current practice could be shown to be feasible, more efficient and cost-effective than current practice alone. METHODS/DESIGN DICI-VIH (acronym for nurse-driven targeted HIV screening) is a multicentre, cluster-randomized, two-period crossover trial. The primary objective is to compare the effectiveness of 2 strategies for diagnosing HIV among adult patients visiting EDs: nurse-driven targeted HIV screening combined with current practice (physician-directed diagnostic testing) versus current practice alone. Main secondary objectives are to compare access to specialist consultation and how early HIV diagnosis occurs in the course of the disease between the 2 groups, and to evaluate the implementation, acceptability and cost-effectiveness of nurse-driven targeted screening. The 2 strategies take place during 2 randomly assigned periods in 8 EDs of metropolitan Paris, where 42 % of France's new HIV patients are diagnosed every year. All patients aged 18 to 64, not presenting secondary to HIV exposure are included. During the intervention period, patients are invited to fill a 7-item questionnaire (country of birth, sexual partners and injection drug use) in order to select individuals who are offered a rapid test. If the rapid test is reactive, a follow-up visit with an infectious disease specialist is scheduled within 72 h. Assuming an 80 % statistical power and a 5 % type 1 error, with 1.04 and 3.38 new diagnoses per 10,000 patients in the control and targeted groups respectively, a sample size of 140,000 patients was estimated corresponding to 8,750 patients per ED and per period. Inclusions started in June 2014. Results are expected by mid-2016. DISCUSSION The DICI-VIH study is the first large randomized controlled trial designed to assess nurse-driven targeted HIV screening. This study can provide valuable information on HIV screening in health care settings. TRIAL REGISTRATION ClinicalTrials.gov: NCT02127424 (29 April 2014).
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Affiliation(s)
- Judith Leblanc
- Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Center of East of Paris (CRC-Est), F75012, Paris, France. .,Université Paris Saclay - Université Versailles Saint-Quentin, Doctoral School of Public Health (EDSP), UMR 1173, F92380, Garches, France.
| | - Alexandra Rousseau
- AP-HP, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Unit of East of Paris (URC-Est), F75012, Paris, France.
| | - Gilles Hejblum
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France.
| | - Isabelle Durand-Zaleski
- AP-HP, Hôpital Hôtel-Dieu, URC Eco Île-de-France, F75004, Paris, France. .,Université Paris Diderot, Univ Paris 07, INSERM, ECEVE, UMR 1123, F75019, Paris, France. .,AP-HP, Hôpital Henri-Mondor, Santé publique, F94010, Créteil, France.
| | - Pierre de Truchis
- AP-HP, Hôpital Raymond-Poincaré, Infectious Disease Department, F92380, Garches, France.
| | - France Lert
- Université Paris Sud, Univ Paris 11, INSERM, Centre for research in Epidemiology and population health, U 1018, F94800, Villejuif, France.
| | - Dominique Costagliola
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France.
| | - Tabassome Simon
- AP-HP, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Department of clinical pharmacology and Clinical Research Center of East of Paris (CRC-Est), F75012, Paris, France. .,Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR 1148, F75018, Paris, France.
| | - Anne-Claude Crémieux
- AP-HP, Hôpital Raymond-Poincaré, Infectious Disease Department, F92380, Garches, France. .,Université Versailles Saint-Quentin, UMR 1173, F92380, Garches, France.
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Montoy JCC, Dow WH, Kaplan BC. Patient choice in opt-in, active choice, and opt-out HIV screening: randomized clinical trial. BMJ 2016; 532:h6895. [PMID: 26786744 PMCID: PMC4718971 DOI: 10.1136/bmj.h6895] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
STUDY QUESTION What is the effect of default test offers--opt-in, opt-out, and active choice--on the likelihood of acceptance of an HIV test among patients receiving care in an emergency department? METHODS This was a randomized clinical trial conducted in the emergency department of an urban teaching hospital and regional trauma center. Patients aged 13-64 years were randomized to opt-in, opt-out, and active choice HIV test offers. The primary outcome was HIV test acceptance percentage. The Denver Risk Score was used to categorize patients as being at low, intermediate, or high risk of HIV infection. STUDY ANSWER AND LIMITATIONS 38.0% (611/1607) of patients in the opt-in testing group accepted an HIV test, compared with 51.3% (815/1628) in the active choice arm (difference 13.3%, 95% confidence interval 9.8% to 16.7%) and 65.9% (1031/1565) in the opt-out arm (difference 27.9%, 24.4% to 31.3%). Compared with active choice testing, opt-out testing led to a 14.6 (11.1 to 18.1) percentage point increase in test acceptance. Patients identified as being at intermediate and high risk were more likely to accept testing than were those at low risk in all arms (difference 6.4% (3.4% to 9.3%) for intermediate and 8.3% (3.3% to 13.4%) for high risk). The opt-out effect was significantly smaller among those reporting high risk behaviors, but the active choice effect did not significantly vary by level of reported risk behavior. Patients consented to inclusion in the study after being offered an HIV test, and inclusion varied slightly by treatment assignment. The study took place at a single county hospital in a city that is somewhat unique with respect to HIV testing; although the test acceptance percentages themselves might vary, a different pattern for opt-in versus active choice versus opt-out test schemes would not be expected. WHAT THIS PAPER ADDS Active choice is a distinct test regimen, with test acceptance patterns that may best approximate patients' true preferences. Opt-out regimens can substantially increase HIV testing, and opt-in schemes may reduce testing, compared with active choice testing. FUNDING, COMPETING INTERESTS, DATA SHARING This study was supported by grant NIA 1RC4AG039078 from the National Institute on Aging. The full dataset is available from the corresponding author. Consent for data sharing was not obtained, but the data are anonymized and risk of identification is low.Trial registration Clinical trials NCT01377857.
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Affiliation(s)
- Juan Carlos C Montoy
- Department of Emergency Medicine, University of California, 505 Parnassus Ave, San Francisco, CA 94143, USA
| | - William H Dow
- School of Public Health, University of California, 239 University Hall #7360, University of California, Berkeley, CA 94720-7360, USA
| | - Beth C Kaplan
- Department of Emergency Medicine, University of California, 1001 Potrero Ave, San Francisco CA 94143, USA
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Evans C, Nalubega S, McLuskey J, Darlington N, Croston M, Bath-Hextall F. The views and experiences of nurses and midwives in the provision and management of provider-initiated HIV testing and counseling: a systematic review of qualitative evidence. ACTA ACUST UNITED AC 2016; 13:130-286. [PMID: 26767819 DOI: 10.11124/jbisrir-2015-2345] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 09/25/2015] [Accepted: 10/22/2015] [Indexed: 10/31/2022]
Abstract
BACKGROUND Global progress towards HIV prevention and care is contingent upon increasing the number of those aware of their status through HIV testing. Provider-initiated HIV testing and counseling is recommended globally as a strategy to enhance uptake of HIV testing and is primarily conducted by nurses and midwives. Research shows that provider-initiated HIV testing and counseling implementation is sub-optimal. The reasons for this are unclear. OBJECTIVES The review aimed to explore nurses' and midwives' views and experiences of the provision and management of provider-initiated HIV testing and counseling. INCLUSION CRITERIA TYPES OF PARTICIPANTS All cadres of nurses and midwives were considered, including those who undertake routine HIV testing as part of a diverse role and those who are specifically trained as HIV counselors. Types of phenomenon of interest: The review sought to understand the views and experiences of the provision and management of provider-initiated HIV testing and counseling (including perceptions, opinions, beliefs, practices and strategies related to HIV testing and its implementation in practice). CONTEXT The review included only provider-initiated HIV testing and counseling. It excluded all other models of HIV testing. The review included all countries and all healthcare settings. Types of studies: This review considered all forms of qualitative study design and methodology. Qualitative elements of a mixed method study were included if they were presented separately within the publication. SEARCH STRATEGY A three-step search strategy was utilized. Eight databases were searched for papers published from 1996 to October 2014, followed by hand searching of reference lists. Only studies published in the English language were considered. METHODOLOGICAL QUALITY Methodological quality was assessed using the Qualitative Assessment and Review Instrument developed by the Joanna Briggs Institute. DATA EXTRACTION Qualitative findings were extracted using the Joanna Briggs Institute Qualitative Assessment and Review Instrument. DATA SYNTHESIS Qualitative research findings were pooled using a pragmatic meta-aggregative approach and the Joanna Briggs Institute Qualitative Assessment and Review Instrument software. RESULTS This review included 21 publications from 18 research studies, representing a wide range of countries and healthcare settings. There were 245 findings which were aggregated into 12 categories and five synthesized findings. 1. Nurses/midwives are supportive of provider-initiated HIV testing and counseling if it is perceived to enhance patient care and to align with perceived professional roles. 2. Nurses'/midwives' ability to perform provider-initiated HIV testing and counseling well requires an appropriate infrastructure and adequate human and material resources. 3. At the organizational level, nurses'/midwives' engagement with provider-initiated HIV testing and counseling is facilitated by an inclusive management structure, alongside the provision of ongoing training and clinical supervision. Provider-initiated HIV testing and counseling is hindered by difficulties in fitting it into existing workloads and routines. 4. Nurses/midwives perceive that good quality care in provider-initiated HIV testing and counseling involves finding a balance between public health needs and individual patient needs. Good care requires time and the ability to apply a patient centred approach. 5. The emotional work involved in provider-initiated HIV testing and counseling can be stressful. Nurses/Midwives may require support to deal with complex moral and ethical issues. CONCLUSIONS This review shows that provider-initiated HIV testing and counseling is supported by nurses/midwives who strive to implement it according to principles of good care and a patient centered approach. Nurses/midwives face multiple operational, infra-structural, resource and ethical challenges in the implementation of provider-initiated HIV testing and counseling. IMPLICATIONS FOR PRACTICE The implementation process for provider-initiated HIV testing and counseling would benefit from using a quality improvement framework. Nurses/midwives undertaking provider-initiated HIV testing and counseling require management support, ongoing training and adequate infrastructure/resources. Additional guidance is required on legal/ethical issues in testing of children and in third party disclosure. IMPLICATIONS FOR RESEARCH Operational research is required to determine an optimal skill mix and optimal methods of integrating provider-initiated HIV testing and counseling into existing work routines.
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Affiliation(s)
- Catrin Evans
- University of Nottingham Center for Evidence Based Healthcare: a Collaborating Center of the Joanna Briggs Institute, United Kingdom
| | - Sylivia Nalubega
- University of Nottingham Center for Evidence Based Healthcare: a Collaborating Center of the Joanna Briggs Institute, United Kingdom
| | - John McLuskey
- University of Nottingham Center for Evidence Based Healthcare: a Collaborating Center of the Joanna Briggs Institute, United Kingdom
| | - Nicola Darlington
- University of Nottingham Center for Evidence Based Healthcare: a Collaborating Center of the Joanna Briggs Institute, United Kingdom
| | | | - Fiona Bath-Hextall
- University of Nottingham Center for Evidence Based Healthcare: a Collaborating Center of the Joanna Briggs Institute, United Kingdom
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Raben D, Mocroft A, Rayment M, Mitsura VM, Hadziosmanovic V, Sthoeger ZM, Palfreeman A, Morris S, Kutsyna G, Vassilenko A, Minton J, Necsoi C, Estrada VP, Grzeszczuk A, Johansson VS, Begovac J, Ong ELC, Cabié A, Ajana F, Celesia BM, Maltez F, Kitchen M, Comi L, Dragsted UB, Clumeck N, Gatell J, Gazzard B, d’Arminio Monforte A, Rockstroh J, Yazdanpanah Y, Champenois K, Jakobsen ML, Sullivan A, Lundgren JD. Auditing HIV Testing Rates across Europe: Results from the HIDES 2 Study. PLoS One 2015; 10:e0140845. [PMID: 26560105 PMCID: PMC4641587 DOI: 10.1371/journal.pone.0140845] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 10/01/2015] [Indexed: 12/15/2022] Open
Abstract
European guidelines recommend the routine offer of an HIV test in patients with a number of AIDS-defining and non-AIDS conditions believed to share an association with HIV; so called indicator conditions (IC). Adherence with this guidance across Europe is not known. We audited HIV testing behaviour in patients accessing care for a number of ICs. Participating centres reviewed the case notes of either 100 patients or of all consecutive patients in one year, presenting for each of the following ICs: tuberculosis, non-Hodgkins lymphoma, anal and cervical cancer, hepatitis B and C and oesophageal candidiasis. Observed HIV-positive rates were applied by region and IC to estimate the number of HIV diagnoses potentially missed. Outcomes examined were: HIV test rate (% of total patients with IC), HIV test accepted (% of tests performed/% of tests offered) and new HIV diagnosis rate (%). There were 49 audits from 23 centres, representing 7037 patients. The median test rate across audits was 72% (IQR 32–97), lowest in Northern Europe (median 44%, IQR 22–68%) and highest in Eastern Europe (median 99%, IQR 86–100). Uptake of testing was close to 100% in all regions. The median HIV+ rate was 0.9% (IQR 0.0–4.9), with 29 audits (60.4%) having an HIV+ rate >0.1%. After adjustment, there were no differences between regions of Europe in the proportion with >0.1% testing positive (global p = 0.14). A total of 113 patients tested HIV+. Applying the observed rates of testing HIV+ within individual ICs and regions to all persons presenting with an IC suggested that 105 diagnoses were potentially missed. Testing rates in well-established HIV ICs remained low across Europe, despite high prevalence rates, reflecting missed opportunities for earlier HIV diagnosis and care. Significant numbers may have had an opportunity for HIV diagnosis if all persons included in IC audits had been tested.
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Affiliation(s)
- D. Raben
- CHIP, Rigshospitalet, Copenhagen, Denmark
- * E-mail:
| | - A. Mocroft
- University College London, London, United Kingdom
| | - M. Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | | | - V. Hadziosmanovic
- Clinical Center University of Sarajevo, Infectious Diseases Clinic, Sarajevo, Bosnia
| | - Z. M. Sthoeger
- Ben Ari Institute of Clinical Immunology, Rehovot, Israel
| | - A. Palfreeman
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - S. Morris
- Western General Hospital, Edinburgh, United Kingdom
| | | | | | - J. Minton
- St James’s University Hospital, Leeds, United Kingdom
| | - C. Necsoi
- Saint-Pierre University Hospital, Brussels, Belgium
| | | | - A. Grzeszczuk
- Medical University of Bialystok, Department of Infectious Diseases and Hepatology, Bialystok, Poland
| | - V. Svedhem Johansson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - J. Begovac
- University Hospital of Infectious Diseases, Zagreb, Croatia
| | - E. L. C. Ong
- The Newcastle upon Tyne Hospital, Newcastle, United Kingdom
| | - A. Cabié
- Centre Hospitalier Universitaire de Fort de France, Fort de France, Martinique
| | - F. Ajana
- Centre Hospitalier de Tourcoing, Tourcoing, France
| | - B. M. Celesia
- Unit of Infectious Diseases University of Catania, ARNAS Garibaldi, Catania, Italy
| | - F. Maltez
- Hospital Curry Cabral, Lisbon, Portugal
| | - M. Kitchen
- Medical University of Innsbruck Innsbruck, Austria
| | - L. Comi
- Unit of Infectious Diseases, San Paolo Hospital, Milan, Italy
| | | | - N. Clumeck
- Saint-Pierre University Hospital, Brussels, Belgium
| | - J. Gatell
- Hospital Clinic de Barcelona, Barcelona, Spain
| | - B. Gazzard
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | | | | | - Y. Yazdanpanah
- IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
- IAME, UMR 1137, INSERM, Paris, France
- AP-HP, Hôpital Bichat, Service de Biostatistique, Paris, France
| | | | | | - A. Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
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Hempling MC, Zielicka-Hardy A, Ellis JP, Majewska W, Fida G. Routine HIV testing in the Emergency Department: feasible and acceptable? Int J STD AIDS 2015; 27:1267-1274. [PMID: 26503556 DOI: 10.1177/0956462415613727] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/30/2015] [Indexed: 11/15/2022]
Abstract
Routine HIV testing in non-specialist settings has the potential to significantly reduce late diagnosis and delay in treatment. The objective was to determine the feasibility and acceptability of HIV testing in an Emergency Department (ED) at a busy London teaching hospital. We conducted an observational cross sectional study between March-May 2012 where patients aged between 18-65 years attending St George's ED having serological tests were offered HIV testing by ED clinical staff. Patients were given an information leaflet on HIV, including how to obtain results. Data detailing whether the test was offered (feasibility) and whether the patient consented to the test (acceptability) were documented. Information regarding reasons for not offering HIV testing and reasons why the test was declined was also recorded. During the study period, 24,171 patients aged 18-65 were seen in the ED. Data were collected from 5657 patients. The mean age was 38 years, 57% were female and 27% identified themselves as white. 48% were offered HIV testing, of which 65% accepted. Incapacity to consent to testing was cited by clinicians as the commonest reason for not offering an HIV test (76%). 'Recent HIV test' was the commonest reason for declining a test (38%). One new HIV diagnosis was made. Our experience demonstrates that routine HIV testing in the ED is feasible and acceptable. However, to make HIV testing effective and part of routine clinical care, considerable clinical leadership, staff training and additional resources are required.
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Affiliation(s)
| | | | - Jayne P Ellis
- Emergency Department, St George's Healthcare NHS Trust, London, UK
| | - Wendy Majewska
- Courtyard Clinic, St George's Healthcare, NHS Trust, London, UK
| | - Gosaye Fida
- Public Health Department, NHS Wandsworth, London, UK
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Ong KJ, Thornton AC, Fisher M, Hutt R, Nicholson S, Palfreeman A, Perry N, Stedman-Bryce G, Wilkinson P, Delpech V, Nardone A. Estimated cost per HIV infection diagnosed through routine HIV testing offered in acute general medical admission units and general practice settings in England. HIV Med 2015; 17:247-54. [PMID: 26394818 DOI: 10.1111/hiv.12293] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Following national guidelines to expand HIV testing in high-prevalence areas in England, a number of pilot studies were conducted in acute general medical admission units (ACUs) and general practices (GPs) to assess the feasibility and acceptability of testing in these settings. The aim of this study was to estimate the cost per HIV infection diagnosed through routine HIV testing in these settings. METHODS Resource use data from four 2009/2010 Department of Health pilot studies (two ACUs; two GPs) were analysed. Data from the pilots were validated and supplemented with information from other sources. We constructed possible scenarios to estimate the cost per test carried out through expanded HIV testing in ACUs and GPs, and the cost per diagnosis. RESULTS In the pilots, cost per test ranged from £8.55 to £13.50, and offer time and patient uptake were 2 minutes and 90% in ACUs, and 5 minutes and 60% in GPs, respectively. In scenario analyses we fixed offer time, diagnostic test cost and uptake rate at 2 minutes, £6 and 80% for ACUs, and 5 minutes, £9.60 and 40% for GPs, respectively. The cost per new HIV diagnosis at a positivity of 2/1000 tests conducted was £3230 in ACUs and £7930 in GPs for tests performed by a Band 3 staff member, and £5940 in ACUs and £18 800 in GPs for tests performed by either hospital consultants or GPs. CONCLUSIONS Expanded HIV testing may be more cost-efficient in ACUs than in GPs as a consequence of a shorter offer time, higher patient uptake, higher HIV positivity and lower diagnostic test costs. As cost per new HIV diagnosis reduces at higher HIV positivity, expanded HIV testing should be promoted in high HIV prevalence areas.
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Affiliation(s)
- K J Ong
- Centre for Infectious Disease Surveillance and Control, Public Health England, UK
| | - A C Thornton
- Department of Infection and Population Health, University College London, London, UK
| | - M Fisher
- Brighton and Sussex University Hospital, Brighton, UK
| | - R Hutt
- NHS South East London, Public Health Lewisham, London, UK
| | - S Nicholson
- Brighton and Hove City Council, Brighton, UK
| | | | - N Perry
- Brighton and Sussex University Hospital, Brighton, UK
| | | | - P Wilkinson
- Brighton and Hove City Council, Brighton, UK
| | - V Delpech
- Centre for Infectious Disease Surveillance and Control, Public Health England, UK
| | - A Nardone
- Centre for Infectious Disease Surveillance and Control, Public Health England, UK
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Four-Stage Audit Demonstrating Increased Uptake of HIV Testing in Acute Neurology Admissions Using Staged Practical Interventions. PLoS One 2015; 10:e0134574. [PMID: 26335351 PMCID: PMC4559461 DOI: 10.1371/journal.pone.0134574] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 07/13/2015] [Indexed: 11/30/2022] Open
Abstract
Background UK National Guidelines (UKNG) advise HIV testing in clinically indicated neurological presentations. We audited the impact of our practical strategies to increase uptake of HIV testing at a regional acute neurology admissions unit. Methods We audited HIV testing in 4 periods over 2 years: before we designed a UKNG-based “HIV testing in Neurology” protocol (“pre-protocol”); after dissemination of the protocol alone (“post-protocol”); post-protocol dissemination combined with both a tailored departmental admissions clerking proforma to prompt for HIV testing & consenting, and regular focussed tutorials to doctors on HIV testing in neurological patients (“post-proforma”); and finally one year after the post-proforma period (“+1 year”). We also looked at the total number of HIV tests sent from the unit during the two-year period. We assessed significance using Fisher’s exact test. Results 47.8% of all acute neurology non-stroke admissions were eligible for HIV testing during all the audit periods. Testing rates were as follows: pre-protocol 21.9%; post-protocol 36.6%; post-proforma 83.3%; and at +1 year 65.4% (p<0.05 for both post-protocol and +1 year when compared to pre-protocol). Documentation of consent for HIV testing improved from 25% to 67.6% with the HIV-tailored clerking proforma. The total number of HIV tests requested from the unit doubled in the post-proforma period compared to pre-protocol (p<0.05). Conclusion In conclusion: the combination of an HIV testing protocol, a tailored departmental clerking proforma and regular focussed teaching to doctors on indications for HIV testing led to a sustained increase in HIV testing uptake in our regional acute neurology admissions unit.
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Kok S, Rutherford AR, Gustafson R, Barrios R, Montaner JSG, Vasarhelyi K. Optimizing an HIV testing program using a system dynamics model of the continuum of care. Health Care Manag Sci 2015; 18:334-62. [PMID: 25595433 PMCID: PMC4543429 DOI: 10.1007/s10729-014-9312-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 11/26/2014] [Indexed: 12/01/2022]
Abstract
Realizing the full individual and population-wide benefits of antiretroviral therapy for human immunodeficiency virus (HIV) infection requires an efficient mechanism of HIV-related health service delivery. We developed a system dynamics model of the continuum of HIV care in Vancouver, Canada, which reflects key activities and decisions in the delivery of antiretroviral therapy, including HIV testing, linkage to care, and long-term retention in care and treatment. To measure the influence of operational interventions on population health outcomes, we incorporated an HIV transmission component into the model. We determined optimal resource allocations among targeted and routine testing programs to minimize new HIV infections over five years in Vancouver. Simulation scenarios assumed various constraints informed by the local health policy. The project was conducted in close collaboration with the local health care providers, Vancouver Coastal Health Authority and Providence Health Care.
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Affiliation(s)
- Sarah Kok
- />The IRMACS Centre, Simon Fraser University, Burnaby, British Columbia Canada
| | - Alexander R. Rutherford
- />The IRMACS Centre and Department of Mathematics, Simon Fraser University, Burnaby, British Columbia Canada
| | - Reka Gustafson
- />Vancouver Coastal Health, Vancouver, British Columbia Canada
| | - Rolando Barrios
- />British Columbia Centre for Excellence in HIV/AIDS and Vancouver Coastal Health, Vancouver, British Columbia Canada
| | - Julio S. G. Montaner
- />British Columbia Centre for Excellence in HIV/AIDS and Faculty of Medicine, University of British Columbia, Vancouver, British Columbia Canada
| | - Krisztina Vasarhelyi
- />Faculty of Health Sciences and The IRMACS Centre, Simon Fraser University, Burnaby, British Columbia Canada
| | - on behalf of the Vancouver HIV Testing Program Modelling Group
- />The IRMACS Centre, Simon Fraser University, Burnaby, British Columbia Canada
- />The IRMACS Centre and Department of Mathematics, Simon Fraser University, Burnaby, British Columbia Canada
- />Vancouver Coastal Health, Vancouver, British Columbia Canada
- />British Columbia Centre for Excellence in HIV/AIDS and Vancouver Coastal Health, Vancouver, British Columbia Canada
- />British Columbia Centre for Excellence in HIV/AIDS and Faculty of Medicine, University of British Columbia, Vancouver, British Columbia Canada
- />Faculty of Health Sciences and The IRMACS Centre, Simon Fraser University, Burnaby, British Columbia Canada
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Reyes-Urueña J, Fernàndez-López L, Force L, Daza M, Agustí C, Casabona J. Level of impact on the public health of universal human immunodeficiency virus screening in an Emergency Department. Enferm Infecc Microbiol Clin 2015; 35:434-437. [PMID: 26341042 DOI: 10.1016/j.eimc.2015.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/29/2015] [Accepted: 06/30/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The aim of this study was to determine the prevalence of HIV and the acceptability of rapid testing in an emergency department (ED), Barcelona (6/07/2011 to 8/03/2013). METHOD A convenience sample was used, depending on nurse availability in the ED. Participants signed an informed consent. Results were confirmed by conventional methods. RESULT A total of 2,140 individuals were offered testing, and 5% rejected taking part (107/2,140). Three subjects (3/2,033 [0.15%]) had confirmed reactive test. Individuals with a higher education were more likely to perform a rapid HIV test in ED (P<.005). CONCLUSION A low prevalence of new HIV diagnoses was found among participants, although there was a high acceptability rate to perform rapid testing in the ED.
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Affiliation(s)
- Juliana Reyes-Urueña
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Barcelona, España
| | - Laura Fernàndez-López
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Barcelona, España; Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública (CIBERESP), Madrid, España; Fundació Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Barcelona, España.
| | - Luis Force
- Unidad Funcional de Enfermedades Infecciosas, Hospital de Mataró, Consorci Sanitari del Maresme (CSdM), Mataró, Barcelona, España
| | - Manel Daza
- Servei d'Urgències, Hospital de Mataró, Mataró, Barcelona, España
| | - Cristina Agustí
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Barcelona, España; Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública (CIBERESP), Madrid, España; Fundació Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Barcelona, España
| | - Jordi Casabona
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Barcelona, España; Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública (CIBERESP), Madrid, España; Fundació Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Barcelona, España; Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Pública, Universidad Autónoma de Barcelona, Bellaterra, Cerdanyola, Barcelona, España
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Town K, Ricketts EJ, Hartney T, Dunbar JK, Nardone A, Folkard KA, Charlett A, McNulty CAM. Supporting general practices to provide sexual and reproductive health services: protocol for the 3Cs & HIV programme. Public Health 2015; 129:1244-50. [PMID: 26278476 DOI: 10.1016/j.puhe.2015.07.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 04/02/2015] [Accepted: 07/13/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Sexually transmitted infections, HIV and unplanned pregnancies continue to be a major public health problem in England, especially in young adults. Strengthening the provision of free condoms, HIV testing, chlamydia screening and contraception within primary care will contribute to reducing poor sexual and reproductive health outcomes. Recent research demonstrated the benefit for general practices of educational support visits based on behaviour change theory. Public Health England (PHE) has piloted an educational training programme to improve the delivery of sexual health services and HIV testing within general practice. STUDY DESIGN & METHODS The 3Cs & HIV programme used practice based workshops to improve staffs' awareness and skills in order to increase opportunistic offers of chlamydia testing, provision of contraceptive service information and free condoms (the '3Cs') to 15-24 year olds and HIV testing according to national guidelines. The programme was based on the theory of planned behaviour and has been implemented using a stepped wedge design. Process evaluation, testing and diagnosis data, plus qualitative interviews were all used in the evaluation. The primary outcome measures were chlamydia testing and diagnosis rates. Secondary outcome measures were HIV testing and diagnoses rates within each practice and rates of consultations where long acting reversible contraceptives had been discussed. CONCLUSION A key strength of the 3Cs & HIV programme has been the evidence base underpinning the development of the resources and the formal process evaluation of its implementation. The programme was designed to encourage sustainable relationships between general practice staff and local sexual health services as well as the knowledge, awareness and behaviours cultivated during the programme.
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Affiliation(s)
- K Town
- HIV/STI Department, Centre for Infectious Disease Control and Surveillance, Public Health England, London, UK.
| | - E J Ricketts
- Public Health England Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, UK
| | - T Hartney
- HIV/STI Department, Centre for Infectious Disease Control and Surveillance, Public Health England, London, UK
| | - J K Dunbar
- HIV/STI Department, Centre for Infectious Disease Control and Surveillance, Public Health England, London, UK
| | - A Nardone
- HIV/STI Department, Centre for Infectious Disease Control and Surveillance, Public Health England, London, UK
| | - K A Folkard
- HIV/STI Department, Centre for Infectious Disease Control and Surveillance, Public Health England, London, UK
| | - A Charlett
- Statistics, Modelling and Economics Department, Public Health England, London, UK
| | - C A M McNulty
- Public Health England Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, UK
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Leber W, McMullen H, Anderson J, Marlin N, Santos AC, Bremner S, Boomla K, Kerry S, Millett D, Mguni S, Creighton S, Figueroa J, Ashcroft R, Hart G, Delpech V, Brown A, Rooney G, Sampson M, Martineau A, Terris-Prestholt F, Griffiths C. Promotion of rapid testing for HIV in primary care (RHIVA2): a cluster-randomised controlled trial. Lancet HIV 2015; 2:e229-35. [PMID: 26423195 DOI: 10.1016/s2352-3018(15)00059-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/02/2015] [Accepted: 04/02/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Many people with HIV are undiagnosed. Early diagnosis saves lives and reduces onward transmission. We assessed whether an education programme promoting rapid HIV testing in general practice would lead to increased and earlier HIV diagnosis. METHODS In this cluster randomised controlled trial in Hackney (London, UK), general practices were randomly assigned (1:1) to offer either opt-out rapid HIV testing to newly registering adults or continue usual care. All practices were invited to take part. Practices were randomised by an independent clinical trials unit statistician with a minimisation program, maintaining allocation concealment. Neither patients nor investigators were masked to treatment allocation. The primary outcome was CD4 count at diagnosis. Secondary outcomes were rate of diagnosis, proportion with CD4 count less than 350 cells per μL, and proportion with CD4 count less than 200 cells per μL. This study is registered with ClinicalTrials.gov, number ISRCTN63473710. FINDINGS 40 of 45 (89%) general practices agreed to participate: 20 were assigned to the intervention group (44 971 newly registered adult patients) and 20 to the control group (38 464 newly registered adult patients), between April 19, 2010, and Aug 31, 2012. Intervention practices diagnosed 32 people with HIV versus 14 in control practices. Mean CD4 count at diagnosis was 356 cells per μL (SD 254) intervention practices versus 270 (SD 257) in control practices (adjusted difference of square root CD4 count 3·1, 95% CI -1·2 to 7·4; p=0·16);); in a pre-planned sensitivity analysis excluding patients diagnosed via antenatal care, the difference was 6·4 (95% CI, 1·2 to 11·6; p=0·017). Rate of HIV diagnosis was 0·30 (95% CI 0·11 to 0·85) per 10 000 patients per year in intervention practices versus 0·07 (0·02 to 0·20) in control practices (adjusted ratio of geometric means 4·51, 95% CI 1·27 to 16·05; p=0·021). 55% of patients in intervention practices versus 73% in control practices had CD4 count less than 350 cells per μL (risk ratio 0·75, 95% CI 0·53 to 1·07). 28% versus 46% had CD4 count less than 200 cells per μL (0·60, 0·32 to 1·13). All patients diagnosed by rapid testing were successfully transferred into specialist care. No adverse events occurred. INTERPRETATION Promotion of opt-out rapid testing in general practice led to increased rate of diagnosis, and might increase early detection, of HIV. We therefore recommend implementation of HIV screening in general practices in areas with high HIV prevalence. FUNDING UK Department of Health, NHS City and Hackney.
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Affiliation(s)
- Werner Leber
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK.
| | - Heather McMullen
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Jane Anderson
- Homerton Sexual Health Services, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Nadine Marlin
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Andreia C Santos
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephen Bremner
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Kambiz Boomla
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Sally Kerry
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Danna Millett
- Homerton Sexual Health Services, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Sifiso Mguni
- Homerton Sexual Health Services, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Sarah Creighton
- Homerton Sexual Health Services, Homerton University Hospital NHS Foundation Trust, London, UK
| | | | | | - Graham Hart
- Faculty of Population Health Sciences, University College London, London, UK
| | - Valerie Delpech
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Alison Brown
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Graeme Rooney
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Maria Sampson
- Department of Virology, Barts Health NHS Trust, London, UK
| | - Adrian Martineau
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Chris Griffiths
- Centre for Primary Care and Public Health, Queen Mary University of London, London, UK
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Leblanc J, Burnet E, D'Almeida KW, Lert F, Simon T, Crémieux AC. The role of nurses in HIV screening in health care facilities: A systematic review. Int J Nurs Stud 2015; 52:1495-513. [PMID: 25979185 DOI: 10.1016/j.ijnurstu.2015.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 03/26/2015] [Accepted: 04/03/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine nurse-driven HIV screening in various health care settings in terms of its impact on test offering, acceptance and delivery rates, nursing responsibilities, staff perceptions and long-term implementation. DESIGN Systematic review. REVIEW METHODS The systematic review conducted in September 2014 adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Two independent reviewers extracted and summarised the eligible studies using a standardised form. STUDY ELIGIBILITY CRITERIA All studies published from 2004 to 2014 that explored nurse-driven HIV screening practice in health care facilities in countries with comparable concentrated HIV epidemics were included. DATA SOURCES MEDLINE, EBSCO CINAHL. RESULTS Overall, 30 quantitative, qualitative and mixed methods studies fulfilled the eligibility criteria. The studies showed a trend in higher test offering, better acceptance and higher delivery rates with the implementation of nurse-driven HIV screening. However, among the 23 studies (77%) that evaluated these aims, only 13 studies (56%) had a control group, and 4 studies (17%) were randomised controlled trials (RCT) in few centres (i.e., 1 or 2). In 2 studies that compared nurse-driven HIV test offering to physician intervention, the participation of nurses was higher than that of physicians (85% vs. 54%, p<0.001; 47% vs. 28%, p<0.05). In a third study, the intervention of a dedicated nurse increased the test offering from 96.5% to 99.5% (OR=7.27, 95% CI=1.02-316.9). Acceptance rates increased with the nurse intervention in 2 RCTs (75% vs. 71%, p=0.025; 45% vs. 19%, p<0.05) and in a cohort study (74.8% vs. 84.3%, OR=1.82, 95% CI=1.14-2.88), whereas it decreased in 2 other studies. The testing rates increased in 7 out of 10 studies, with a maximum absolute increase of 65.9%. Nurse-driven HIV screening was evaluated at the time of routine HIV screening implementation in 27 studies (90%) and provided nurses with new responsibilities in 9 studies (30%). The few studies (23%) that explored how health care professionals, including nurses, perceived the strategy showed that this approach was well received. However, several operational barriers, such as lack of time, prevented its long-term implementation. CONCLUSION The review supports the implementation of nurse-driven HIV screening. However, the evaluation of the impact of the nurse approach by RCTs was scarce, calling for additional research to better evaluate the impact of the nursing profession's contribution to HIV screening. Moreover, the perceptions of nurses and health care staff were seldom evaluated and require further exploration to improve nurse-driven HIV screening implementation.
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Affiliation(s)
- Judith Leblanc
- Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Center of East of Paris (CRC-Est), 184, rue du Faubourg Saint Antoine, 75012 Paris, France; Doctoral School of Public Health 420, Versailles Saint-Quentin University, Versailles, France; EA 3647, Versailles Saint-Quentin University, Versailles, France.
| | - Espérie Burnet
- AP-HP, Groupe Hospitalier des Hôpitaux Universitaires Centre Parisien, Paris, France.
| | | | - France Lert
- Epidemiology and Population Health Research Center, Team 11 Inserm U1018, Villejuif, France.
| | - Tabassome Simon
- AP-HP, Hôpital St Antoine, Department of Clinical Pharmacology, Clinical Research Center of East of Paris (CRC-Est), Paris, France; INSERM U-698, Paris, France; University Pierre et Marie Curie, Paris 6, Paris, France.
| | - Anne-Claude Crémieux
- AP-HP, Hôpital Raymond-Poincaré, Infectious disease department, Garches, France; EA 3647, Versailles Saint-Quentin University, Versailles, France.
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Leidel S, McConigley R, Boldy D, Girdler S, Wilson S. Should Australia consider opt-out HIV testing? Australas Med J 2015; 8:30-2. [PMID: 25848406 DOI: 10.4066/amj.2015.2290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Stacy Leidel
- School of Nursing & Midwifery, Curtin University, Perth, WA, Australia
| | - Ruth McConigley
- School of Nursing & Midwifery, Curtin University, Perth, WA, Australia
| | - Duncan Boldy
- School of Nursing & Midwifery, Curtin University, Perth, WA, Australia
| | - Sonya Girdler
- School of Occupational Therapy & Social Work, Curtin University, Perth, WA, Australia
| | - Sally Wilson
- School of Nursing & Midwifery, Curtin University, Perth, WA, Australia
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Delpech V, Lundgren J. Death from AIDS is preventable, so why are people still dying of AIDS in Europe? ACTA ACUST UNITED AC 2014; 19:20973. [PMID: 25443033 DOI: 10.2807/1560-7917.es2014.19.47.20973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- V Delpech
- Public Health England, London, United Kingdom
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Wallis E, Thornhill J, Saunders J, Orkin C. Introducing opt-out HIV testing in an acute medical admissions unit: does it improve testing uptake in those with lobar pneumonia? Sex Transm Infect 2014; 91:153. [DOI: 10.1136/sextrans-2014-051723] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 09/08/2014] [Indexed: 11/04/2022] Open
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Gökengin D, Geretti AM, Begovac J, Palfreeman A, Stevanovic M, Tarasenko O, Radcliffe K. 2014 European Guideline on HIV testing. Int J STD AIDS 2014; 25:695-704. [PMID: 24759563 DOI: 10.1177/0956462414531244] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Testing for HIV is one of the cornerstones in the fight against HIV spread. The 2014 European Guideline on HIV Testing provides advice on testing for HIV infection in individuals aged 16 years and older who present to sexually transmitted infection, genito-urinary or dermato-venereology clinics across Europe. It may also be applied in other clinical settings where HIV testing is required, particularly in primary care settings. The aim of the guideline is to provide practical guidance to clinicians and laboratories that within these settings undertake HIV testing, and to indicate standards for best practice.
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Affiliation(s)
- Deniz Gökengin
- Department of Infectious Diseases and Clinical Microbiology, Ege University Faculty of Medicine, Bornova, İzmir, Turkey
| | - Anna Maria Geretti
- Department of Clinical Infection, Microbiology & Immunology, Institute of Infection & Global Health, University of Liverpool, Liverpool, UK
| | - Josip Begovac
- Department of Infectious Diseases, University Hospital for Infectious Diseases, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Adrian Palfreeman
- Department of Sexual Health and HIV Medicine, University Hospitals Leicester Infirmary Close, Leicester, UK
| | - Milena Stevanovic
- Clinic for Infectious Diseases and Febrile Conditions, Skopje, Republic of Macedonia
| | - Olga Tarasenko
- Head Center of Hygiene and Epidemiology, Federal Medical-Biological Agency (FMBA) of Russia, Moscow, Russia
| | - Keith Radcliffe
- Department of Sexual Health and HIV Medicine, University Hospitals Birmingham, Birmingham, UK
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Rayment M, Doku E, Thornton A, Pearn M, Sudhanva M, Jones R, Nardone A, Roberts P, Tenant-Flowers M, Anderson J, Sullivan AK, Atkins M. Automatic oral fluid-based HIV testing in HIV screening programmes: automatic for the people. HIV Med 2014; 14 Suppl 3:49-52. [PMID: 24033905 DOI: 10.1111/hiv.12063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES UK guidelines recommend routine HIV testing in general clinical settings when the local HIV prevalence is > 0.2%. During pilot programmes evaluating the guidelines, we used laboratory-based testing of oral fluid from patients accepting tests. Samples (n = 3721) were tested manually using the Bio-Rad Genscreen Ultra HIV Ag-Ab test (Bio-Rad Laboratories Ltd, Hemel Hempstead, UK). This was a methodologically robust method, but handling of samples was labour intensive. We performed a validation study to ascertain whether automation of oral fluid HIV testing using the fourth-generation HIV test on the Abbott Architect (Abbott Diagnostics, Maidenhead, UK) platform was possible. METHODS Oral fluid was collected from 143 patients (56 known HIV-positive volunteers and 87 others having contemporaneous HIV serological tests) using the Oracol+ device (Malvern Medicals, Worcester, UK). Samples were tested concurrently: manually using the Genscreen Ultra test and automatically on the Abbott Architect. RESULTS For oral fluid, the level of agreement of results between the platforms was 100%. All results agreed with HIV serology. The use of the Oracol+ device produced high-quality samples. Subsequent field use of the test has shown a specificity of 99.97% after nearly 3000 tests. CONCLUSIONS Laboratory-based HIV testing of oral fluid requires less training of local staff, with fewer demands on clinical time and space than near-patient testing. It is acceptable to patients. The validation exercise and subsequent clinical experience support automation, with test performance preserved. Automation reduces laboratory workload and speeds up the release of results. Automated oral fluid testing is thus a viable option for large-scale HIV screening programmes.
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Affiliation(s)
- M Rayment
- Directorate of HIV/GU Medicine, Chelsea and Westminster Hospital NHS Foundation Trust
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Rayment M, Rae C, Ghooloo F, Doku E, Hardie J, Finlay S, Gidwani S, Atkins M, Roberts P, Sullivan AK. Routine HIV testing in the emergency department: tough lessons in sustainability. HIV Med 2014; 14 Suppl 3:6-9. [PMID: 24033895 DOI: 10.1111/hiv.12069] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Routine HIV testing in nonspecialist settings has been shown to be acceptable to patients and staff in pilot studies. The question of how to embed routine HIV testing, and make it sustainable, remains to be answered. METHODS We established a service of routine HIV testing in an emergency department (ED) in London, delivered by ED staff as part of routine clinical care. All patients aged 16 to 65 years were offered an HIV test (latterly the upper age limit was removed). Meetings were held weekly and two outcome measures examined: test offer rate (coverage) and test uptake. Sustainability methodology (process mapping; plan-do-study-act (PDSA) cycles) was applied to maximize these outcome measures. RESULTS Over 30 months, 44,582 eligible patients attended the ED. The mean proportion offered an HIV test was 14%, varying from 6% to 54% per month over the testing period. The mean proportion accepting a test was 63% (range 33-100%). A total of 4327 HIV tests have been performed. Thirteen patients have been diagnosed with HIV infection (0.30%). PDSA cycles having the most positive and sustained effects on the outcome measures include the expansion to offer blood-based HIV tests in addition to the original oral fluid tests, and the engagement of ED nursing staff in the programme. CONCLUSIONS HIV testing can be delivered in the ED, but constant innovation and attention have been required to maintain it over 30 months. Patient uptake remains high, suggesting acceptability, but time will be required before true embedding in routine clinical practice is achieved.
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Affiliation(s)
- M Rayment
- Directorate of HIV/GU Medicine, Chelsea and Westminster Hospital NHS Foundation Trust
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Elmahdi R, Gerver SM, Gomez Guillen G, Fidler S, Cooke G, Ward H. Low levels of HIV test coverage in clinical settings in the U.K.: a systematic review of adherence to 2008 guidelines. Sex Transm Infect 2014; 90:119-24. [PMID: 24412996 PMCID: PMC3945742 DOI: 10.1136/sextrans-2013-051312] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives To quantify the extent to which guideline recommendations for routine testing for HIV are adhered to outside of genitourinary medicine (GUM), sexual health (SH) and antenatal clinics. Methods A systematic review of published data on testing levels following publication of 2008 guidelines was undertaken. Medline, Embase and conference abstracts were searched according to a predefined protocol. We included studies reporting the number of HIV tests administered in those eligible for guideline recommended testing. We excluded reports of testing in settings with established testing surveillance (GUM/SH and antenatal clinics). A random effects meta-analysis was carried out to summarise level of HIV testing across the studies identified. Results Thirty studies were identified, most of which were retrospective studies or audits of testing practice. Results were heterogeneous. The overall pooled estimate of HIV test coverage was 27.2% (95% CI 22.4% to 32%). Test coverage was marginally higher in patients tested in settings where routine testing is recommended (29.5%) than in those with clinical indicator diseases (22.4%). Provider test offer was found to be lower (40.4%) than patient acceptance of testing (71.5%). Conclusions Adherence to 2008 national guidelines for HIV testing in the UK is poor outside of GUM/SH and antenatal clinics. Low levels of provider test offer appear to be a major contributor to this. Failure to adhere to testing guidelines is likely to be contributing to late diagnosis with implications for poorer clinical outcomes and continued onwards transmission of HIV. Improved surveillance of HIV testing outside of specialist settings may be useful in increasing adherence testing guidelines.
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Affiliation(s)
- Rahma Elmahdi
- Department of Infectious Disease Epidemiology, Imperial College London, , London, UK
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Hartney T, Kennedy I, Crook P, Nardone A. Expanded HIV testing in high-prevalence areas in England: results of a 2012 audit of sexual health commissioners. HIV Med 2013; 15:251-4. [PMID: 24581335 DOI: 10.1111/hiv.12099] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of the study was to examine whether UK HIV testing guidelines which recommend the expansion of HIV testing in high HIV prevalence areas have been implemented in England. METHODS An online survey tool was used to conduct an audit of sexual health commissioners in 40 high HIV prevalence areas (diagnosed prevalence > 2 per 1000) between May and June 2012. Responders were asked to provide details of expanded HIV testing programmes that they had commissioned in nontraditional settings and perceived barriers and facilitators involved in introducing expanded testing. RESULTS The response rate was 88% (35 of 40). Against the key audit standards, 31% (11 of 35) of areas had commissioned routine testing of new registrants in general practice, and 14% (five of 35) routine testing of general medical admissions. The majority of responders (80%; 28 of 35) had commissioned some form of expanded testing, often targeted at risk groups. The most common setting for commissioning of testing was the community (51%; 18 of 35), followed by general practice (49%; 17 of 35) and hospital departments (36%; 13 of 35). A minority (11%; four of 35) of responders had commissioned testing in all three settings. Where testing in general practice took place this was typically in a minority of practices (median 10-20%). Most (77%; 27 of 35) expected the rate of HIV testing to increase over the next year, but lack of resources was cited as a barrier to testing by 94% (33 of 35) of responders. CONCLUSIONS Not all high HIV prevalence areas in England have fully implemented testing guidelines. Scale-up of existing programmes and continued expansion of testing into new settings will be necessary to achieve this.
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Affiliation(s)
- T Hartney
- Centre for Infectious Disease Control and Surveillance, Public Health England, London, UK
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Scognamiglio P, Chiaradia G, De Carli G, Giuliani M, Mastroianni CM, Aviani Barbacci S, Buonomini AR, Grisetti S, Sampaolesi A, Corpolongo A, Orchi N, Puro V, Ippolito G, Girardi E. The potential impact of routine testing of individuals with HIV indicator diseases in order to prevent late HIV diagnosis. BMC Infect Dis 2013; 13:473. [PMID: 24112129 PMCID: PMC3852490 DOI: 10.1186/1471-2334-13-473] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 09/19/2013] [Indexed: 01/25/2023] Open
Abstract
Background The aim of our work was to evaluate the potential impact of the European policy of testing for HIV all individuals presenting with an indicator disease, to prevent late diagnosis of HIV. We report on a retrospective analysis among individuals diagnosed with HIV to assess whether a history of certain diseases prior to HIV diagnosis was associated with the chance of presenting late for care, and to estimate the proportion of individuals presenting late who could have been diagnosed earlier if tested when the indicator disease was diagnosed. Methods We studied a large cohort of individuals newly diagnosed with HIV infection in 13 counselling and testing sites in the Lazio Region, Italy (01/01/2004-30/04/2009). Considered indicator diseases were: viral hepatitis infection (HBV/HCV), sexually transmitted infections, seborrhoeic dermatitis and tuberculosis. Logistic regression analysis was performed to estimate association of occurrence of at least one indicator disease with late HIV diagnosis. Results In our analysis, the prevalence of late HIV diagnosis was 51.3% (890/1735). Individuals reporting at least one indicator disease before HIV diagnosis (29% of the study population) had a lower risk of late diagnosis (OR = 0.7; 95%CI: 0.5-0.8) compared to those who did not report a previous indicator disease. 52/890 (5.8%) late presenters were probably already infected at the time the indicator disease was diagnosed, a median of 22.6 months before HIV diagnosis. Conclusions Our data suggest that testing for HIV following diagnosis of an indicator disease significantly decreases the probability of late HIV diagnosis. Moreover, for 5.5% of late HIV presenters, diagnosis could have been anticipated if they had been tested when an HIV indicator disease was diagnosed. However, this strategy for enhancing early HIV diagnosis needs to be complemented by client-centred interventions that aim to increase awareness in people who do not perceive themselves as being at risk for HIV.
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Affiliation(s)
- Paola Scognamiglio
- National Institute for Infectious Diseases "L, Spallanzani" (IRCCS), Via Portuense 292, Rome 00149, Italy.
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Raben D, Delpech V, de Wit J, Sullivan A, Lazarus JV, Dedes N, Coenen T, Lundgren J. Conclusions from the HIV in Europe Copenhagen 2012 Conference and ways forward: working together for optimal HIV testing and earlier care. HIV Med 2013; 14 Suppl 3:1-5. [DOI: 10.1111/hiv.12062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 11/29/2022]
Affiliation(s)
- D Raben
- Copenhagen HIV Programme; University of Copenhagen; Copenhagen; Denmark
| | - V Delpech
- Public Health England; Colindale; UK
| | - J de Wit
- National Centre in HIV Social Research; The University of New South Wales; Sydney; New South Wales; Australia
| | - A Sullivan
- Directorate of Sexual Health and HIV Medicine; Chelsea and Westminster NHS Foundation Trust; London; UK
| | - JV Lazarus
- Copenhagen HIV Programme; University of Copenhagen; Copenhagen; Denmark
| | - N Dedes
- European AIDS Treatment Group (EATG); Athens; Greece
| | - T Coenen
- AIDS Action Europe; Aids Fonds & Soa Aids Nederland; Amsterdam; the Netherlands
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Socías ME, Hermida L, Singman M, Kulgis G, Díaz Armas A, Cando O, Sued O, Pérez H, Hermes R, Presas JL, Cahn P. Routine HIV testing among hospitalized patients in Argentina. is it time for a policy change? PLoS One 2013; 8:e69517. [PMID: 23936034 PMCID: PMC3729969 DOI: 10.1371/journal.pone.0069517] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 06/10/2013] [Indexed: 12/05/2022] Open
Abstract
Introduction The Argentinean AIDS Program estimates that 110,000 persons are living with HIV/AIDS in Argentina. Of those, approximately 40% are unaware of their status, and 30% are diagnosed in advanced stages of immunosuppression. Though studies show that universal HIV screening is cost-effective in settings with HIV prevalence greater than 0.1%, in Argentina, with the exception of antenatal care, HIV testing is always client-initiated. Objective We performed a pilot study to assess the acceptability of a universal HIV screening program among inpatients of an urban public hospital in Buenos Aires. Methods Over a six-month period, all eligible adult patients admitted to the internal medicine ward were offered HIV testing. Demographics, uptake rates, reasons for refusal and new HIV diagnoses were analyzed. Results Of the 350 admissions during this period, 249 were eligible and subsequently enrolled. The enrolled population was relatively old compared to the general population, was balanced on gender, and did not report traditional high risk factors for HIV infection. Only 88 (39%) reported prior HIV testing. One hundred and ninety (76%) patients accepted HIV testing. In multivariable analysis only younger age (OR 1.02; 95%CI 1.003-1.05) was independently associated with test uptake. Three new HIV diagnoses were made (undiagnosed HIV prevalence: 1.58%); none belonged to a most-at-risk population. Conclusions Our findings suggest that universal HIV screening in this setting is acceptable and potentially effective in identifying undiagnosed HIV-infected individuals. If confirmed in a larger study, our findings may inform changes in the Argentinean HIV testing policy.
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Affiliation(s)
- María Eugenia Socías
- Infectious Diseases Division, Hospital J. A. Fernández, Buenos Aires, Argentina.
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Ellis S, Curtis H, Ong E. A survey of HIV care in the UK: results of British HIV association (BHIVA) national audit 2010. Int J STD AIDS 2013; 24:329-31. [PMID: 23970666 DOI: 10.1177/0956462412472828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of the 2010 BHIVA audit was to assess the impact of the 2008 UK HIV testing guidelines on clinical practice. Here, we report one aspect of the audit comprising a survey of local testing policy and practice at centres providing adult HIV services across the UK. Selected recommendations from the 2008 national HIV testing guidelines were assessed as target outcomes and the percentages of sites and subjects meeting these recommendations were calculated. One hundred and thirty-two sites responded to the survey and many are actively promoting HIV testing locally. Sites report HIV testing is routine in genitourinary (GU) medicine and antenatal services but offered selectively in other clinical areas. Encouragingly, 21 (16%) report some local general practitioner practices are offering testing routinely to new patients at registration. However, the time to receive non-urgent HIV test results exceeds 72 hours in 29% of sites. In conclusion, HIV testing needs to continue to expand across clinical settings to reduce the number of patients living with undiagnosed infection. Laboratory turnaround time needs to improve to ensure non-urgent HIV test results are available within 72 hours.
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Affiliation(s)
- S Ellis
- Department of Infection and Tropical Medicine, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE3 1UL.
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Sullivan AK, Raben D, Reekie J, Rayment M, Mocroft A, Esser S, Leon A, Begovac J, Brinkman K, Zangerle R, Grzeszczuk A, Vassilenko A, Hadziosmanovic V, Krasnov M, Sönnerborg A, Clumeck N, Gatell J, Gazzard B, Monforte AD, Rockstroh J, Lundgren JD. Feasibility and effectiveness of indicator condition-guided testing for HIV: results from HIDES I (HIV indicator diseases across Europe study). PLoS One 2013; 8:e52845. [PMID: 23341910 PMCID: PMC3546115 DOI: 10.1371/journal.pone.0052845] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 11/21/2012] [Indexed: 11/23/2022] Open
Abstract
Improved methods for targeting HIV testing among patients most likely to be infected are required; HIDES I aimed to define the methodology of a European wide study of HIV prevalence in individuals presenting with one of eight indicator conditions/diseases (ID); sexually transmitted infection, lymphoma, cervical or anal cancer/dysplasia, herpes zoster, hepatitis B/C, mononucleosis-like illness, unexplained leukocytopenia/thrombocytopenia and seborrheic dermatitis/exanthema, and to identify those with an HIV prevalence of >0.1%, a level determined to be cost effective. A staff questionnaire was performed. From October 2009– February 2011, individuals, not known to be HIV positive, presenting with one of the ID were offered an HIV test; additional information was collected on previous HIV testing behaviour and recent medical history. A total of 3588 individuals from 16 centres were included. Sixty-six tested positive for HIV, giving an HIV prevalence of 1.8% [95% CI: 1.42–2.34]; all eight ID exceeded 0.1% prevalence. Of those testing HIV positive, 83% were male, 58% identified as MSM and 9% were injecting drug users. Twenty percent reported previously having potentially HIV-related symptoms and 52% had previously tested HIV negative (median time since last test: 1.58 years); which together with the median CD4 count at diagnosis (400 cell/uL) adds weight to this strategy being effective in diagnosing HIV at an earlier stage. A positive test was more likely for non-white individuals, MSM, injecting drug users and those testing in non-Northern regions. HIDES I describes an effective strategy to detect undiagnosed HIV infection. All eight ID fulfilled the >0.1% criterion for cost effectiveness. All individuals presenting to any health care setting with one of these ID should be strongly recommended an HIV test. A strategy is being developed in collaboration with ECDC and WHO Europe to guide the implementation of this novel public health initiative across Europe.
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Affiliation(s)
- Ann K. Sullivan
- Directorate of Sexual Health and HIV Medicine, Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
| | - Dorthe Raben
- Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Joanne Reekie
- Department Infection of Population Health, University College London, London, United Kingdom
| | - Michael Rayment
- Directorate of Sexual Health and HIV Medicine, Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
| | - Amanda Mocroft
- Department Infection of Population Health, University College London, London, United Kingdom
| | - Stefan Esser
- Clinic of Dermatology and Venerology, University Hospital Essen, Essen, Germany
| | - Agathe Leon
- Department of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Josip Begovac
- University Hospital of Infectious Diseases, Zagreb, Croatia
| | - Kees Brinkman
- Department Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Robert Zangerle
- Department of Dermatology and Venereology, Innsbruck Medical University, Innsbruck, Austria
| | - Anna Grzeszczuk
- Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Bialystok, Poland
| | - Anna Vassilenko
- Department of Infectious Diseases, Belorussian State Medical University, Minsk, Belarus
| | - Vesna Hadziosmanovic
- Clinical Center, Infectious Diseases Clinic, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Maksym Krasnov
- Kharkov Regional Clinic of Infectious Diseases, Kharkov, Ukraine
| | - Anders Sönnerborg
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Nathan Clumeck
- Department of Infectious Diseases, Saint-Pierre University Hospital, Brussels, Belgium
| | - José Gatell
- Department of Infectious Diseases, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Brian Gazzard
- Directorate of Sexual Health and HIV Medicine, Chelsea and Westminster NHS Foundation Trust, London, United Kingdom
| | | | | | - Jens D. Lundgren
- Copenhagen HIV Programme, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
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