1
|
Saleem K, Ting EL, Loh AJW, Baggaley R, Mello MB, Jamil MS, Barr‐Dichiara M, Johnson C, Gottlieb SL, Fairley CK, Chow EPF, Ong JJ. Missed opportunities for HIV testing among those who accessed sexually transmitted infection (STI) services, tested for STIs and diagnosed with STIs: a systematic review and meta-analysis. J Int AIDS Soc 2023; 26:e26049. [PMID: 37186451 PMCID: PMC10131090 DOI: 10.1002/jia2.26049] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/16/2022] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Of 37.7 million people living with HIV in 2020, 6.1 million still do not know their HIV status. We synthesize evidence on concurrent HIV testing among people who tested for other sexually transmitted infections (STIs). METHODS We conducted a systematic review using five databases, HIV conferences and clinical trial registries. We included publications between 2010 and May 2021 that reported primary data on concurrent HIV/STI testing. We conducted a random-effects meta-analysis and meta-regression of the pooled proportion for concurrent HIV/STI testing. RESULTS We identified 96 eligible studies. Among those, 49 studies had relevant data for a meta-analysis. The remaining studies provided data on the acceptability, feasibility, barriers, facilitators, economic evaluation and social harms of concurrent HIV/STI testing. The pooled proportion of people tested for HIV among those attending an STI service (n = 18 studies) was 71.0% (95% confidence intervals: 61.0-80.1, I2 = 99.9%), people tested for HIV among those who were tested for STIs (n = 15) was 61.3% (53.9-68.4, I2 = 99.9%), people tested for HIV among those who were diagnosed with an STI (n = 13) was 35.3% (27.1-43.9, I2 = 99.9%) and people tested for HIV among those presenting with STI symptoms (n = 3) was 27.1% (20.5-34.3, I2 = 92.0%). The meta-regression analysis found that heterogeneity was driven mainly by identity as a sexual and gender minority, the latest year of study, country-income level and region of the world. DISCUSSION This review found poor concurrent HIV/STI testing among those already diagnosed with an STI (35.3%) or who had symptoms with STIs (27.1%). Additionally, concurrent HIV/STI testing among those tested for STIs varied significantly according to the testing location, country income level and region of the world. A few potential reasons for these observations include differences in national STI-related policies, lack of standard operation procedures, clinician-level factors, poor awareness and adherence to HIV indicator condition-guided HIV testing and stigma associated with HIV compared to other curable STIs. CONCLUSIONS Not testing for HIV among people using STI services presents a significant missed opportunity, particularly among those diagnosed with an STI. Stronger integration of HIV and STI services is urgently needed to improve prevention, early diagnosis and linkage to care services.
Collapse
Affiliation(s)
- Kanwal Saleem
- Melbourne Sexual Health CentreAlfred HealthMelbourneVictoriaAustralia
| | - Ee Lynn Ting
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Andre J. W. Loh
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Rachel Baggaley
- Global HIV, Hepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Maeve B. Mello
- Global HIV, Hepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Muhammad S. Jamil
- Global HIV, Hepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | | | - Cheryl Johnson
- Global HIV, Hepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Sami L. Gottlieb
- Global HIV, Hepatitis and STI ProgrammesWorld Health OrganizationGenevaSwitzerland
| | - Christopher K. Fairley
- Melbourne Sexual Health CentreAlfred HealthMelbourneVictoriaAustralia
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Eric P. F. Chow
- Melbourne Sexual Health CentreAlfred HealthMelbourneVictoriaAustralia
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Jason J. Ong
- Melbourne Sexual Health CentreAlfred HealthMelbourneVictoriaAustralia
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Faculty of Infectious and Tropical DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
| |
Collapse
|
2
|
Anderson S, Friedman EE, Eller D, Kerman J, Zhou J, Stanford KA, Ridgway JP, McNulty MC. HIV testing in a high prevalence urban area in the US: Identifying missed opportunities two ways. Int J STD AIDS 2022; 33:970-977. [DOI: 10.1177/09564624221118484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Routine opt-out HIV testing in healthcare settings is often not implemented to its fullest extent. We assessed factors contributing to missed HIV testing opportunities at an academic medical center in Chicago, Illinois, with a routine HIV screening program. Methods Retrospective analysis of HIV testing in clinical encounters was performed using multivariate regession models. Missed opportunities were defined as 1) an encounter during which an HIV test was not conducted on a patient later diagnosed with HIV, or 2) an encounter in which a bacterial STI test was performed without HIV testing. Results Of 122 people newly diagnosed with HIV from 2011-2018, 98 patients had 1215 prior encounters, of which 82.8% were missed opportunities. Female gender, persons not known to be men who have sex with men, and encounter location other than inpatient had higher odds of a missed opportunity. Nearly half (48.4%) of 104,678 bacterial STI testing encounters were missed opportunities. Female gender, older age, lack of syphilis testing, and location outside the emergency department had higher odds of a missed opportunity. Conclusions We found a high number of missed HIV testing opportunities, which could be reduced by strengthening routine screening and increasing targeted testing concurrent with STI screening.
Collapse
Affiliation(s)
- Sean Anderson
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Eleanor E Friedman
- Section of Infectious Diseases, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Dylan Eller
- Section of Infectious Diseases, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Jared Kerman
- Section of Infectious Diseases, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Junlan Zhou
- Section of Infectious Diseases, University of Chicago, Chicago, IL, USA
| | - Kimberly A Stanford
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Section of Emergency Medicine, University of Chicago, Chicago, IL, USA
| | - Jessica P Ridgway
- Section of Infectious Diseases, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Moira C McNulty
- Section of Infectious Diseases, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| |
Collapse
|
3
|
Lindley LL, Sharif AM, Chowdhury T. College students' comfort with and intention to use self-collection services for STI testing. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1768-1777. [PMID: 33048627 DOI: 10.1080/07448481.2020.1820511] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/10/2020] [Accepted: 08/28/2020] [Indexed: 06/11/2023]
Abstract
Objective: Sexually transmitted infections (STIs) are at unprecedented levels; yet most college students have never been tested. Offering asymptomatic individuals the option to collect their own samples for STI testing is an effective strategy to increase testing coverage. This study explores students' perceptions of self-collection services. Participants: Four hundred and thirty-four (434) students from a large public university completed an online survey in February 2018. Methods: The cross-sectional survey assessed students' human immunodeficiency virus (HIV)/STI testing behaviors, comfort with self-collection procedures, and intention to use self-collection services if offered on campus. Results: Most students (88%) said they would use self-collection test kits they could take home, followed by self-collection in a private room at student health services (59%). Students were most comfortable with testing procedures involving less human interaction and collecting specimens themselves. Cost, accuracy, confidentiality of tests, and provision of clear "how to" instructions, topped students' concerns. Conclusion: Offering self-collection options may increase STI testing among asymptomatic college students.
Collapse
Affiliation(s)
- Lisa L Lindley
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, Virginia, USA
| | - A'isha M Sharif
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Tasnuva Chowdhury
- UCSD COVID Team, Department of Medicine, University of California San Diego, San Diego, California, USA
| |
Collapse
|
4
|
Weller KG, Evans LK, Shinagawa A, Murtagh A, Moseman K, Oberbillig M, Larson T. Missed Testing Opportunities Among HIV-Positive Adults in a Community Emergency Department. AIDS Res Hum Retroviruses 2022; 38:300-305. [PMID: 34314244 DOI: 10.1089/aid.2020.0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Northern Nevada's most utilized emergency department (ED) could represent a locale of missed opportunity for human immunodeficiency virus (HIV) detection, as the ED serves as a source of primary care for many patients at risk for HIV infection. The authors conducted a retrospective chart review, through the electronic health record, evaluating new diagnoses of HIV between 2012 and 2017 within a single hospital system. An opportunity for prior detection of HIV in the hospital's adult ED, within the past 5 years, was recorded as a missed testing opportunity (MTO). Out of 46 new HIV diagnoses at this hospital for a 5-year period, 19 patients with at least one MTO were identified. Eight of these patients with an MTO were diagnosed with acquired immunodeficiency syndrome (AIDS) concomitant with detection of their HIV status. Encouraging earlier HIV detection in the ED could reduce transmission, mortality, and health care expenditures.
Collapse
Affiliation(s)
| | - Lauran K. Evans
- Department of Head and Neck Surgery, Los Angeles David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Austin Shinagawa
- Reno School of Medicine, University of Nevada, Reno, Nevada, USA
| | - Ariel Murtagh
- Department of Family Medicine, University of California, Irvine, California, USA
| | - Kerry Moseman
- Internal Medicine Residency, St. Mary Medical Center, Long Beach, California, USA
| | - Megan Oberbillig
- Stead Family Department of Pediatrics, University of Iowa Healthcare, Iowa City, Iowa, USA
| | - Trudy Larson
- Department of Head and Neck Surgery, Los Angeles David Geffen School of Medicine, University of California, Los Angeles, California, USA
| |
Collapse
|
5
|
Rüütel K, Lemsalu L, Lätt S, Epštein J, On Behalf Of OptTEST By HiE. Missed opportunities for HIV testing in people diagnosed with HIV, Estonia, 2014 to 2015. ACTA ACUST UNITED AC 2020; 24. [PMID: 30994106 PMCID: PMC6470370 DOI: 10.2807/1560-7917.es.2019.24.15.1800382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Studies of missed opportunities for earlier diagnosis of HIV have shown that patients with undiagnosed HIV often present to healthcare settings numerous times before eventually receiving their diagnosis. Aim The aim of the study was to assess missed opportunities for HIV testing among people newly diagnosed with HIV. Methods In this observational retrospective study, we collected data from the Estonian Health Board on new HIV cases in people aged 16–49 years diagnosed in 2014–15 and from the Estonian Health Insurance Fund database for treatment invoices on their contacts with healthcare services in the 2 years preceding diagnosis. Diagnoses on treatment invoices were categorised as HIV indicator conditions using ICD-10 codes. Results Of 538 newly diagnosed HIV cases (62.5%; 336 men), 82% had visited healthcare services at least once during the 2 years before HIV diagnosis; the mean number of visits was 9.1. Of these, 16% had been tested for HIV and 31% had at least one ICD-10 code for an HIV indicator condition on at least one of their treatment invoices. In 390 cases of HIV indicator conditions, only 5% were tested for HIV. Of all new HIV cases aged 20–49 years from high-incidence regions (defined as priority groups in national testing guidance), 18% had been tested. Conclusions The HIV testing rate in the 2 years before an HIV diagnosis was very low, even in the presence of an HIV indicator condition. This emphasises the importance of implementing the Estonian HIV testing guidelines.
Collapse
Affiliation(s)
- Kristi Rüütel
- National Institute for Health Development, Tallinn, Estonia
| | - Liis Lemsalu
- National Institute for Health Development, Tallinn, Estonia
| | - Sirly Lätt
- Estonian Health Insurance Fund, Tallinn, Estonia
| | | | | |
Collapse
|
6
|
Argenyi M, Kushalnagar P. Social Media Use and HIV Screening Uptake Among Deaf Adults in the United States: Cross-Sectional Survey Study. JMIR Public Health Surveill 2019; 5:e13658. [PMID: 31579021 PMCID: PMC6777274 DOI: 10.2196/13658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 07/05/2019] [Accepted: 08/23/2019] [Indexed: 01/04/2023] Open
Abstract
Background About 46% of US adults obtain recommended HIV screening at least once during their lifetime. There is little knowledge of screening rates among deaf and hard-of-hearing adults who primarily use American Sign Language (ASL), or of social media as a potentially efficacious route for HIV prevention outreach, despite lower HIV/AIDS-specific health literacy and potentially higher HIV seropositivity rates than hearing peers. Objective We investigated both the likelihood of HIV screening uptake among deaf adults in the past year and over one year ago, and the relationship between social media use and HIV screening uptake among deaf adult ASL users. Methods The Health Information National Trends Survey in ASL was administered to 1340 deaf US adults between 2015-2018. Modified Poisson with robust standard errors was used to assess the relationship between social media usage as a predictor and HIV screening as an outcome (screened more than one year ago, screened within the past year, and never been screened), after adjusting for sociodemographics and sexually transmitted disease (STD) covariates. Results The estimated lifetime prevalence of HIV screening uptake among our sample was 54% (719/1340), with 32% (429/1340) in the past year. Being of younger age, male gender, black, lesbian, gay, bisexual, or queer, or having some college education or a prior STD were associated with HIV screening uptake. Adjusting for correlates, social media use was significantly associated with HIV screening in the past year, compared to either lifetime or never. Conclusions Screening falls well short of universal screening targets, with gaps among heterosexual, female, Caucasian, or older deaf adults. HIV screening outreach may not be effective because of technological or linguistic inaccessibility, rendering ASL users an underrecognized minority group. However, social media is still a powerful tool, particularly among younger deaf adults at risk for HIV.
Collapse
Affiliation(s)
| | - Poorna Kushalnagar
- University of Massachusetts Medical School, Worchester, MA, United States
| |
Collapse
|