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Doughty J, Tran C, Santella AJ, Fitzgerald R, Burns F, Porter S, Watt RG. Point of care HIV testing in dental settings in high-income countries: A mixed-methods systematic review. Community Dent Oral Epidemiol 2024. [PMID: 38822596 DOI: 10.1111/cdoe.12963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/27/2024] [Accepted: 04/12/2024] [Indexed: 06/03/2024]
Abstract
OBJECTIVES Expanding HIV testing beyond specialized services has been a key strategic approach to eliminating the transmission of HIV. In recent years, dental settings have been identified as offering an opportunity for delivering point of care HIV testing (POCT) interventions. Intervention components and implementation strategies have varied across studies and there is uncertainty about the prevalence of undiagnosed HIV in the dental patient population. Therefore, this systematic review aimed to synthesize the HIV testing outcomes of intervention studies, identify the core components of POCT interventions implemented in dental settings; and understand the barriers and facilitators to intervention implementation. METHODS A mixed-methods systematic review was undertaken. Two authors reviewed abstracts and full papers for inclusion and appraised the studies using the Mixed Methods Appraisal Tool. A convergent integrated mixed methods study design underpinned the synthesis. Outcomes were presented using descriptive statistics. Intervention components were mapped to the Template for Intervention Description and Replication (TIDieR) checklist. Barriers and facilitators were described using a narrative thematic analysis. RESULTS POCT was offered to 22 146 dental patients, 62.5% accepted POCT. Intervention studies that reported higher uptake of testing utilized a dedicated dental or researcher staff member to provide testing, integrated testing and provided results within the routine dental appointment and adopted a provider-initiated universal approach to offering testing. Six themes emerged that were pertinent to the barriers and facilitators to HIV testing in dental setting. CONCLUSIONS POCT uptake in dental settings was comparable with other non-specialized health settings. Key to the operationalization of the intervention were perceptions about its value and relevance to the dental patient population, attitudes toward the intervention, logistical barriers to its implementation, the risk of HIV testing stigma to the patient-practitioner relationship and maximising the fit of the intervention within the constraints of the dental setting.
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Affiliation(s)
- J Doughty
- Department of Epidemiology & Public Health, Faculty of Pop Health Sciences, University College London, London, UK
- School of Dentistry, University of Liverpool
| | - C Tran
- Oral and Maxillofacial Surgery department, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - A J Santella
- Marion Peckham Egan School of Nursing & Health Studies, Fairfield University, Fairfield, Connecticut, USA
| | - R Fitzgerald
- Department of Special Care Dentistry, Surrey and Sussex Healthcare Trust
| | - F Burns
- Institute for Global Health, University College London, London, UK
| | - Stephen Porter
- Eastman Dental Institute, Faculty of Medical Sciences, University College London, London, UK
| | - Richard G Watt
- Department of Epidemiology & Public Health, Faculty of Pop Health Sciences, University College London, London, UK
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Krause KD, Pérez-Figueroa RE, Halkitis PN. Barriers and facilitators related to COVID-19 vaccine acceptance and uptake among people living with HIV. Curr Opin HIV AIDS 2023; 18:142-147. [PMID: 36943471 DOI: 10.1097/coh.0000000000000788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
PURPOSE OF REVIEW This review reports on the myriad barriers and facilitators related to COVID-19 vaccine hesitancy and factors contribution to uptake among people living with HIV (PLWH) globally published over the past year (2021-2022). RECENT FINDINGS Across the literature, participants indicated concerns about the safety, efficacy and overall rapid development of the COVID-19 vaccine as a reason for delaying or not being vaccinated. Medical mistrust and perceptions about the risk of COVID-19 immune response and severity also played a role in COVID-19 vaccine hesitancy among PLWH. Almost every study examined different sociodemographic characteristics associated with COVID-19 vaccination acceptance and uptake, and although strong themes emerged around race/ethnicity, sex and educational attainment, the results were mixed across other characteristics, including age. Some studies also examined medical factors specifically related to PLWH including CD4 + cell count and adherence to antiretroviral therapy. SUMMARY The findings highlight individual, structural and social differences in COVID-19 vaccine acceptance and uptake among PLWH, which are varied throughout the world. We call on researchers and interventionists to not just consider the role of medical mistrust and disinformation, but also how emotional, financial and political vulnerability plays into making decisions around COVID-19 vaccine uptake and overall healthcare.
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Affiliation(s)
- Kristen D Krause
- Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS)
- Department of Urban-Global Health
| | - Rafael E Pérez-Figueroa
- Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS)
- Department of Urban-Global Health
| | - Perry N Halkitis
- Center for Health, Identity, Behavior, and Prevention Studies (CHIBPS)
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Rutgers University, Piscataway, New Jersey, USA
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3
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Barbanotti D, Tincati C, Tavelli A, Santoro A, Sala M, Bini T, De Bona A, d’Arminio Monforte A, Marchetti GC. HIV-Indicator Condition Guided Testing in a Hospital Setting. Life (Basel) 2023; 13:1014. [PMID: 37109543 PMCID: PMC10145962 DOI: 10.3390/life13041014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Late diagnosis is still a major issue in HIV infection management, leading to important consequences for both patients and community. In this perspective, HIV screening targeted on some clinical conditions (HIV indicator conditions-HIVICs) emerged as a useful strategy, also involving patients not considered at high behavioral risk. We organized an in-hospital HIVICs guided screening campaign named ICEBERG in Milan, Italy, between 2019 and 2021. Among the 520 subjects enrolled, mainly presenting with viral hepatitis or mononucleosis-like syndrome, 20 resulted HIV positive (3.8% prevalence). A significant proportion of them had multiple conditions and advanced immunosuppression, with 40% being AIDS-presenters. As adherence to the screening campaign was modest for non-ID specialists, educational interventions to raise clinicians' sensitivity are urgently needed. HIV-ICs guided testing was confirmed as a useful tool, but a combined approach with other screening strategies seems to be essential for early HIV diagnosis.
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Affiliation(s)
- Diletta Barbanotti
- Unit of Infectious Diseases, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, 20122 Milan, Italy
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Association of Affirming Care with Chronic Disease and Preventive Care Outcomes among Lesbian, Gay, Bisexual, Transgender, and Queer Older Adults. Am J Prev Med 2023; 64:305-314. [PMID: 36460525 DOI: 10.1016/j.amepre.2022.09.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Experiences of discrimination and bias in healthcare contribute to health disparities for lesbian, gay, bisexual, transgender, and queer populations. To avoid discrimination, many go to great lengths to find healthcare providers who they trust and who are knowledgeable about their health needs. This study examines whether access to an affirming provider improves health outcomes for lesbian, gay, bisexual, transgender, and queer populations across a range of preventive health and chronic disease management outcomes. METHODS This cross-sectional study uses Poisson regression models to examine original survey data (n=1,120) from Wave 1 of the Vanderbilt University Social Networks, Aging, and Policy Study, a panel study examining older (aged 50-76 years) lesbian, gay, bisexual, transgender, and queer adults' health and aging, collected between April 2020 and September 2021. RESULTS Overall, access to an affirming provider is associated with greater uptake of preventive health screenings and improved management of mental health conditions. Participants with an affirming provider are more likely to have ever and recently received several types of preventive care than participants reporting a usual source of care that is not affirming, including past year provider visit, influenza vaccination, colorectal cancer screening, and HIV test. Access to an affirming provider is also associated with better management of mental health conditions. CONCLUSIONS Inclusive care is essential for reducing health disparities among lesbian, gay, bisexual, transgender, and queer populations. Health systems can reduce disparities by expanding continuing education opportunities; adopting nondiscrimination policies for patients and employees; and ensuring that necessary care is covered by health insurance.
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5
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Simmons R, Plunkett J, Cieply L, Ijaz S, Desai M, Mandal S. Blood-borne virus testing in emergency departments - a systematic review of seroprevalence, feasibility, acceptability and linkage to care. HIV Med 2023; 24:6-26. [PMID: 35702813 DOI: 10.1111/hiv.13328] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/09/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Blood-borne viruses (BBVs) cause significant morbidity and mortality worldwide. Emergency departments (EDs) offer a point of contact for groups at increased risk of BBVs who may be less likely to engage with primary care. We reviewed the literature to evaluate whether BBV testing in this setting might be a viable option to increase case finding and linkage to care. METHODS We searched PubMed database for English language articles published until June 2019 on BBV testing in EDs. Studies reporting seroprevalence surveys, feasibility, linkage to care, enablers and barriers to testing were included. Additional searches for grey literature were performed. RESULTS Eight-nine articles met inclusion criteria, of which 14 reported BBV seroprevalence surveys in EDs, 54 investigated feasibility and acceptability, and 36 investigated linkage to care. Most studies were HIV-focused and conducted in the USA. Seroprevalence rates were in the range 1.5-17% for HCV, 0.7-1.6% for HBV, and 0.8-13% for HIV. For studies that used an opt-in study design, testing uptake ranged from 2% to 98% and for opt-out it ranged from 16% to 91%. There was a wide range of yield: 13-100% of patients received their test result, 21-100% were linked to care, and 50-91% were retained in care. Compared with individuals diagnosed with HIV, linkage to and retention in care were lower for those diagnosed with hepatitis C. Predictors of linkage to care was associated with certain patient characteristics. CONCLUSIONS Universal opt-out BBV testing in EDs may be feasible and acceptable, but linkage to care needs to be improved by optimizing implementation. Further economic evaluations of hepatitis testing in EDs are needed.
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Affiliation(s)
- Ruth Simmons
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STIs) and HIV Division, UK Health Security Agency, London, UK.,The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College, London, UK
| | - James Plunkett
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STIs) and HIV Division, UK Health Security Agency, London, UK
| | - Lukasz Cieply
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STIs) and HIV Division, UK Health Security Agency, London, UK
| | - Samreen Ijaz
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College, London, UK.,Blood Borne Virus Unit, Virus Reference Department, UK Health Security Agency, London, UK
| | - Monica Desai
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STIs) and HIV Division, UK Health Security Agency, London, UK.,The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College, London, UK
| | - Sema Mandal
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STIs) and HIV Division, UK Health Security Agency, London, UK.,The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College, London, UK
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6
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Marchant R, Patterson A, Dragovic B, Kelly B, Hamzah L, Hempling M. High-level compliance to opt-out HIV testing in the emergency department (ED) of a large teaching hospital using the biochemistry sample as the sample type for HIV screening. HIV Med 2022; 23:1214-1218. [PMID: 36377075 DOI: 10.1111/hiv.13441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/19/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION HIV remains a key public health issue. National Institute for Health and Care Excellence and British HIV Association guidance recommends that patients should be offered HIV testing when admitted to hospital or attending emergency departments (EDs) in areas with a prevalence ≥ 2 per 1000. We report a novel method of testing and the first 3-year results from our HIV ED testing programme utilizing biochemistry samples for HIV testing, with the aim of improving uptake while ensuring no changes to clinical practice in EDs. METHODS Routine ED HIV testing was implemented on 1 October 2018; it was initially opt-in and was subsequently changed to opt-out on 1 February 2019. HIV testing was added to all ED blood test order sets and was performed on the biochemistry samples of those aged 18-59 years. The age range was extended to include those aged 16+ years on 1 March 2021 along with a move to notional consent. RESULTS A total of 78 333 HIV tests were performed from an estimated 110 683 attendees who had bloods taken in the same age range, demonstrating an overall 69.5% testing coverage. On implementation of opt-out testing after the first 4 months, the proportion of tests increased (from 57.9% to 69%). After increase in age range to 16+ years and a move to notional consent, the overall testing coverage improved to 74.2%. Of 1054 reactive results, 728 (69%) were known people living with HIV, eight (0.8%) were not contactable, two (0.2%) re-tested elsewhere and three (0.3%) declined a re-test. A total of 259 false-positives were determined by follow-up testing and 50 (4.8%) were newly diagnosed with HIV. An HIV diagnosis was suspected in only 22%, and 48% had never previously tested for HIV. CONCLUSIONS An opt-out HIV testing programme with notional consent and using biochemistry samples within the ED is feasible, acceptable and provides an excellent opportunity to diagnose patients who do not perceive themselves to be at risk or have never tested before.
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Affiliation(s)
| | - Anne Patterson
- St George's University Hospital NHS Foundation Trust, London, UK
| | - Bojana Dragovic
- St George's University Hospital NHS Foundation Trust, London, UK
| | - Bernard Kelly
- St George's University Hospital NHS Foundation Trust, London, UK
| | - Lisa Hamzah
- St George's University Hospital NHS Foundation Trust, London, UK
| | - Melissa Hempling
- St George's University Hospital NHS Foundation Trust, London, UK
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7
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Somerset S, Jones W, Evans C, Cirelli C, Mbang D, Blake H. Opt-in HIV testing in construction workplaces: an exploration of its suitability, using the socioecological framework. BMC Public Health 2022; 22:1409. [PMID: 35870921 PMCID: PMC9308504 DOI: 10.1186/s12889-022-13787-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background Late diagnosis of HIV remains a challenge, despite improved testing and treatment. Testing is often targeted at high-risk groups; workplace events might normalise testing and allow access to a wider population. The construction workforce has a number of risk factors for HIV. In the Test@Work study, HIV tests were delivered within general health checks to construction employees, with high uptake and acceptability. This paper reports on the experiences of construction managers and health professionals involved in Test@Work and explores the suitability of construction worksites as a venue for opt-in HIV testing. Methods Qualitative interviews (n = 24) were conducted with construction managers who had facilitated health check/HIV testing (n = 13), and delivery partners (n = 11) including i) healthcare volunteers who had delivered general health checks (n = 7) and, ii) HIV professionals who had conducted HIV testing (n = 4) at 21 Test@Work events held on construction sites. Interviews explored their experiences of these events and views towards HIV testing in the workplace. Exit questionnaires (n = 107) were completed by delivery partners after every event, providing qualitative data identifying facilitators and barriers to effective delivery. Thematic analysis identified themes that were mapped against a socioecological framework. Results Delivery partners reported high engagement of construction workers with workplace HIV testing, peer-to-peer encouragement for uptake, and value for accessibility of onsite testing. HIV professionals valued the opportunity to reach an untested population, many of whom had a poor understanding of their exposure to HIV risk. Managers valued the opportunity to offer workplace health checks to employees but some identified challenges with event planning, or provision of private facilities. Conclusions The construction sector is complex with a largely male workforce. Providing worksite HIV testing and education to an untested population who have poor knowledge about HIV risk helped to normalise testing, encourage uptake and reduce HIV-related stigma. However, there are practical barriers to testing in the construction environment. Rapid testing may not be the most suitable approach given the challenges of maintaining confidentiality on construction worksites and alternatives should be explored. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13787-5.
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8
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Smout E, Phyu K, Hughes GJ, Parker L, Rezai R, Evans A, McLaren J, Bush S, Davey S, Aldersley MA, Ruf M, Page EE. Real-world clinical effectiveness and sustainability of universal bloodborne virus testing in an urban emergency department in the UK. Sci Rep 2022; 12:19257. [PMID: 36357472 PMCID: PMC9648896 DOI: 10.1038/s41598-022-23602-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 11/02/2022] [Indexed: 11/12/2022] Open
Abstract
Innovative testing approaches and care pathways are required to meet HIV, hepatitis B (HBV) and hepatitis C (HCV) elimination goals. Routine testing for blood-borne viruses (BBVs) within emergency departments (EDs) is suggested by the European Centre for Disease Prevention and Control but there is a paucity of supporting evidence. We evaluated the introduction of routine BBV testing in EDs at a large teaching hospital in northern England. In October 2018, we modified the electronic laboratory ordering system to reflex opt-out HIV, HBV and HCV testing for all ED attendees aged 16-65 years who had a routine blood test for urea and electrolytes (U&Es). Linkage to care (LTC) was attempted for newly diagnosed patients, those never referred and those who had previously disengaged from care. The project operated for 18 months, here we present evaluation of the initial nine months (2 October 2018-1 July 2019). We analysed testing uptake, BBV seropositivity, LTC and treatment initiation within six months post-diagnosis. Over 9 months, 17,026/28,178 (60.4%) ED attendees who had U&Es performed were tested for ≥ 1 BBV. 299 active BBV infections were identified: 70 HIV Ab/Ag-positive (0.4% seroprevalence), 73 HBsAg-positive (0.4%) and 156 HCV RNA-positive (1.0%). Only 24.3% (17/70) HIV Ab/Ag-positive individuals required LTC, compared to 94.9% (148/156) HCV RNA-positive and 53.4% (39/73) HBsAg-positive individuals. LTC was successful in 94.1% (16/17) HIV Ab/Ag-positive and 69.3% (27/39) HBsAg-positive individuals. However, at 6 months LTC was just 39.2% (58/148) for HCV RNA-positive individuals, with 64% (37/58) of these commencing treatment. Universal opt-out ED BBV testing proved feasible and effective in identifying active BBV infections, especially among marginalised populations with reduced healthcare access. Our integrated approach achieved good LTC rates although further service development is necessary, particularly for HCV RNA-positive people who inject drugs.
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Affiliation(s)
- Elizabeth Smout
- grid.515304.60000 0005 0421 4601UK Field Epidemiology Training Programme, UK Health Security Agency, Leeds, UK ,grid.515304.60000 0005 0421 4601Field Service, UK Health Security Agency, Leeds, UK
| | - Khine Phyu
- grid.418161.b0000 0001 0097 2705Leeds Teaching Hospitals Trust, Leeds General Infirmary, Great George St, Leeds, LS1 3EX UK
| | - Gareth J. Hughes
- grid.515304.60000 0005 0421 4601Field Service, UK Health Security Agency, Leeds, UK
| | - Lee Parker
- grid.418161.b0000 0001 0097 2705Leeds Teaching Hospitals Trust, Leeds General Infirmary, Great George St, Leeds, LS1 3EX UK
| | - Roozbeh Rezai
- grid.418161.b0000 0001 0097 2705Leeds Teaching Hospitals Trust, Leeds General Infirmary, Great George St, Leeds, LS1 3EX UK
| | - Amy Evans
- grid.418161.b0000 0001 0097 2705Leeds Teaching Hospitals Trust, Leeds General Infirmary, Great George St, Leeds, LS1 3EX UK
| | - Joscelyne McLaren
- grid.418161.b0000 0001 0097 2705Leeds Teaching Hospitals Trust, Leeds General Infirmary, Great George St, Leeds, LS1 3EX UK
| | - Stephen Bush
- grid.418161.b0000 0001 0097 2705Leeds Teaching Hospitals Trust, Leeds General Infirmary, Great George St, Leeds, LS1 3EX UK
| | - Sarah Davey
- grid.418161.b0000 0001 0097 2705Leeds Teaching Hospitals Trust, Leeds General Infirmary, Great George St, Leeds, LS1 3EX UK
| | - Mark A. Aldersley
- grid.418161.b0000 0001 0097 2705Leeds Teaching Hospitals Trust, Leeds General Infirmary, Great George St, Leeds, LS1 3EX UK
| | - Murad Ruf
- grid.476328.c0000 0004 0383 8490Public Health, Medical Affairs, Gilead Sciences Ltd, London, UK
| | - Emma E. Page
- grid.418161.b0000 0001 0097 2705Leeds Teaching Hospitals Trust, Leeds General Infirmary, Great George St, Leeds, LS1 3EX UK
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Farmer S, Razin V, Peagler AF, Strickler S, Fain WB, Damhorst GL, Kempker RR, Pollock NR, Brand O, Seitter B, Heilman SS, Nehl EJ, Levy JM, Gottfried DS, Martin GS, Greenleaf M, Ku DN, Waggoner JJ, Iffrig E, Mannino RG, F. Wang Y, Ortlund E, Sullivan J, Rebolledo PA, Clavería V, Roback JD, Benoit M, Stone C, Esper A, Frank F, Lam WA. Don't forget about human factors: Lessons learned from COVID-19 point-of-care testing. CELL REPORTS METHODS 2022; 2:100222. [PMID: 35527805 PMCID: PMC9061138 DOI: 10.1016/j.crmeth.2022.100222] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
During the COVID-19 pandemic, the development of point-of-care (POC) diagnostic testing accelerated in an unparalleled fashion. As a result, there has been an increased need for accurate, robust, and easy-to-use POC testing in a variety of non-traditional settings (i.e., pharmacies, drive-thru sites, schools). While stakeholders often express the desire for POC technologies that are "as simple as digital pregnancy tests," there is little discussion of what this means in regards to device design, development, and assessment. The design of POC technologies and systems should take into account the capabilities and limitations of the users and their environments. Such "human factors" are important tenets that can help technology developers create POC technologies that are effective for end-users in a multitude of settings. Here, we review the core principles of human factors and discuss lessons learned during the evaluation process of SARS-CoV-2 POC testing.
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Affiliation(s)
- Sarah Farmer
- Center for Advanced Communications Policy, Georgia Institute of Technology, Atlanta, GA, USA
- Georgia Tech Research Institute, Georgia Institute of Technology, Atlanta, GA, USA
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
| | - Victoria Razin
- Georgia Tech Research Institute, Georgia Institute of Technology, Atlanta, GA, USA
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
| | - Amanda Foster Peagler
- Center for Advanced Communications Policy, Georgia Institute of Technology, Atlanta, GA, USA
- Georgia Tech Research Institute, Georgia Institute of Technology, Atlanta, GA, USA
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
| | - Samantha Strickler
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Emergency Medicine and Department of Anesthesia, Division of Critical Care, Emory University School of Medicine, Atlanta, GA, USA
| | - W. Bradley Fain
- Center for Advanced Communications Policy, Georgia Institute of Technology, Atlanta, GA, USA
- Georgia Tech Research Institute, Georgia Institute of Technology, Atlanta, GA, USA
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
| | - Gregory L. Damhorst
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Russell R. Kempker
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Nira R. Pollock
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Laboratory Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Oliver Brand
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
| | - Brooke Seitter
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Stacy S. Heilman
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Eric J. Nehl
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Joshua M. Levy
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - David S. Gottfried
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
| | - Greg S. Martin
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Morgan Greenleaf
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
| | - David N. Ku
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Jesse J. Waggoner
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Elizabeth Iffrig
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Robert G. Mannino
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Yun F. Wang
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Eric Ortlund
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
| | - Julie Sullivan
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Paulina A. Rebolledo
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Viviana Clavería
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - John D. Roback
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - MacArthur Benoit
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Cheryl Stone
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - Annette Esper
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Filipp Frank
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Department of Biochemistry, Emory University School of Medicine, Atlanta, GA, USA
| | - Wilbur A. Lam
- The Atlanta Center for Microsystems-Engineered Point-of-Care Technologies, Atlanta, GA, USA
- Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
- Children’s Healthcare of Atlanta, Atlanta, GA, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, USA
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10
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Rao A, Chen VH, Hill S, Reynolds SJ, Redd AD, Stead D, Hoffmann C, Quinn TC, Hansoti B. Changing HCW attitudes: a case study of normalizing HIV service delivery in emergency departments. BMC Health Serv Res 2022; 22:629. [PMID: 35546234 PMCID: PMC9097323 DOI: 10.1186/s12913-022-07942-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 04/12/2022] [Indexed: 11/18/2022] Open
Abstract
Background Delays in the implementation of evidence-based practices are significant and ubiquitous, compromising health outcomes. Resistance to change is a key factor in hindering adoption and integration of new evidence-based interventions. This study seeks to understand the impact of exposure to HIV testing within a research context on provider attitudes towards HIV counselling and testing (HCT) in emergency departments (ED). Methods This is a pre-and-post study design measuring the effect of a new ED-based HCT intervention, conducted by lay counsellors, on provider attitudes in Eastern Cape, South Africa. A validated, anonymized, 7-item survey was self-completed by routine care providers (physicians, nurses, and case managers). Questions were scored on a 5-point Likert scale with 5 consistently reflecting a positive attitude. Mean scores were calculated for each question and compared using a two-sample t-test to assess change in sample means for attitudes among providers surveyed before and after the intervention. Results A total of 132 surveys were completed across three EDs. Majority of respondents were female (70.5%), 20–29 years old (37.9%), of African race (81.1%), nurses (39.4%), and practicing medicine for 0–4 years (37.9%). Pre-intervention, providers displayed a positive attitude towards ‘the benefit of offering ED-based HCT to patients’ (4.33), ‘the ED offering HCT’ (3.53), ‘all ED patients receiving HCT’ (3.42), ‘concern about patient reaction to HCT’ (3.26), and ‘comfort with disclosing HCT results’ (3.21); and a mildly negative attitude towards ‘only high-risk ED patients receiving HCT’ (2.68), and ‘the burden of offering HCT in a clinical environment’ (2.80). Post-intervention, provider attitudes improved significantly towards ‘all ED patients receiving HCT’ (3.86, p < 0.05), ‘only high-risk ED patients receiving HCT’ (2.30, p < 0.05), ‘the burden of offering HCT in a clinical environment’ (3.21, p < 0.05), and ‘comfort with disclosing HCT results’ (3.81, p < 0.05). Conclusions Controlled exposure to new practices with a structured implementation period can shift attitudes beginning a process of practice normalization. In our study, we observed improvements in provider attitudes regarding the benefits of HCT and the burden of offering HCT to all patients in the ED. Research activities may have a role in mitigating resistance to change and supporting intervention adoption.
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Affiliation(s)
- Aditi Rao
- Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Victoria H Chen
- Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sarah Hill
- Krieger School of Arts and Sciences, The Johns Hopkins University, Baltimore, MD, USA
| | - Steven J Reynolds
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew D Redd
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David Stead
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa.,Department of Internal Medicine, Frere and Cecilia Makiwane Hospitals, Eastern Cape, East London, South Africa
| | - Christopher Hoffmann
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas C Quinn
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bhakti Hansoti
- Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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11
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Chadwick DR, Page E, Wilkinson D, Savulescu J. Implied consent for HIV testing in the UK: time for a new approach? THE LANCET HIV 2022; 9:e63-e66. [PMID: 34890561 PMCID: PMC7612157 DOI: 10.1016/s2352-3018(21)00276-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 11/17/2022]
Abstract
Despite HIV infection being a treatable chronic illness and with many advances in testing for HIV, late diagnosis is still common with associated avoidable morbidity and mortality. Requirements for explicit consent for HIV testing are different to other blood tests and are major barriers to testing. We argue that the disparity is illogical and outdated. We propose a model for normalising HIV testing which allows routine testing in various healthcare settings via implied consent, where other blood tests are being performed. Inclusion of testing for hepatitis B and C might also be incorporated into this model. The ethical argument for this is principally beneficence towards those with undiagnosed infection and those they may infect. Patient autonomy would be maintained using systems allowing individuals to opt-out of implied consent.
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Affiliation(s)
- David R Chadwick
- Centre for Clinical Infection, James Cook University Hospital, Middlesbrough, UK.
| | - Emma Page
- Department of Virology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Dominic Wilkinson
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
| | - Julian Savulescu
- Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK
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12
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Raben D, Sullivan A. Implementation of indicator condition guided HIV testing still lagging behind the evidence. EClinicalMedicine 2021; 36:100918. [PMID: 34124637 PMCID: PMC8173272 DOI: 10.1016/j.eclinm.2021.100918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Dorthe Raben
- CHIP, Rigshospitalet, University of Copenhagen, Denmark
- Corresponding author.
| | - Ann Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, UK
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13
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Weissman S, Yang X, Zhang J, Chen S, Olatosi B, Li X. Using a machine learning approach to explore predictors of healthcare visits as missed opportunities for HIV diagnosis. AIDS 2021; 35:S7-S18. [PMID: 33867485 PMCID: PMC8172090 DOI: 10.1097/qad.0000000000002735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES A significant number of individuals with a new HIV diagnosis are still late presenters despite numerous healthcare encounters prior to HIV diagnosis. We employed a machine learning approach to identify the predictors for the missed opportunities for earlier HIV diagnosis. METHODS The cohort comprised of individuals who were diagnosed with HIV in South Carolina from January 2008 to December 2016. Late presenters (LPs) (initial CD4 ≤200 cells/mm3 within one month of HIV diagnosis) with any healthcare visit during three years prior to HIV diagnosis were defined as patients with a missed opportunity. Using least absolute shrinkage and selection operator (LASSO) regression, two prediction models were developed to capture the impact of facility type (model 1) and physician specialty (model 2) of healthcare visits on missed opportunities. RESULTS Among 4,725 eligible participants, 72.2% had at least one healthcare visit prior to their HIV diagnosis, with most of the healthcare visits (78.5%) happening in the emergency departments (ED). A total of 1,148 individuals were LPs, resulting in an overall prevalence of 24.3% for the missed opportunities for earlier HIV diagnosis. Common predictors in both models included ED visit, older age, male gender, and alcohol use. CONCLUSIONS The findings underscored the need to reinforce the universal HIV testing strategy ED remains an important venue for HIV screening, especially for medically underserved or elder population. An improved and timely HIV screening strategy in clinical settings can be a key for early HIV diagnosis and play an increasingly important role in ending HIV epidemic.
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Affiliation(s)
- Sharon Weissman
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC, USA, 29208
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Xueying Yang
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Jiajia Zhang
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Shujie Chen
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Bankole Olatosi
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA, 29208
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14
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Gökengin D, Wilson-Davies E, Nazlı Zeka A, Palfreeman A, Begovac J, Dedes N, Tarashenko O, Stevanovic M, Patel R. 2021 European guideline on HIV testing in genito-urinary medicine settings. J Eur Acad Dermatol Venereol 2021; 35:1043-1057. [PMID: 33666276 DOI: 10.1111/jdv.17139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/14/2021] [Indexed: 11/30/2022]
Abstract
Testing for HIV is critical for early diagnosis of HIV infection, providing long-term good health for the individual and prevention of onward transmission if antiretroviral treatment is initiated early. The main purpose of the 2021 European Guideline on HIV Testing in Genito-Urinary Settings is to provide 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. The guideline presents the details of best practice and offers practical guidance to clinicians and laboratories to identify and offer HIV testing to appropriate patient groups.
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Affiliation(s)
- D Gökengin
- Faculty of Medicine, Department of Clinical Microbiology and Infectious Diseases, Ege University, Izmir, Turkey.,Ege University HIV/AIDS Research and Practice Center, Izmir, Turkey
| | - E Wilson-Davies
- Southampton Specialist Virology Center, University Hospitals Southampton, Southampton, UK
| | - A Nazlı Zeka
- Faculty of Medicine, Department of Clinical Microbiology and Infectious Diseases, Dokuz Eylül University, Izmir, Turkey
| | - A Palfreeman
- Department of Infectious Diseases, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - J Begovac
- Department of Infectious Diseases, University Hospital for Infectious Diseases, University of Zagreb School of Medicine, Zagreb, Croatia
| | - N Dedes
- Positive Voice, Athens, Greece
| | - O Tarashenko
- Head Center of Hygiene and Epidemiology, Federal Medical-Biological Agency (FMBA) of Russia, Moscow, Russia
| | - M Stevanovic
- Clinic for Infectious Diseases and Febrile Conditions, Skopje, Former Yugoslav Republic of Macedonia
| | - R Patel
- Solent NHS Trust, Southampton, UK
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15
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Palfreeman A, Sullivan A, Rayment M, Waters L, Buckley A, Burns F, Clutterbuck D, Cormack I, Croxford S, Dean G, Delpech V, Josh J, Kifetew C, Larbalestier N, Mackie N, Matthews P, Murchie M, Nardone A, Randell P, Skene H, Smithson K, Trevelion R, Trewinnard K, White A, Young E, Peto T. British HIV Association/British Association for Sexual Health and HIV/British Infection Association adult HIV testing guidelines 2020. HIV Med 2020; 21 Suppl 6:1-26. [PMID: 33333625 DOI: 10.1111/hiv.13015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Adrian Palfreeman
- Honorary Associate Professor, Consultant in Genitourinary Medicine, University Hospitals of Leicester NHS Trust
| | - Ann Sullivan
- Consultant in HIV and Sexual Health, Chelsea and Westminster Healthcare NHS Foundation Trust and Imperial College, London
| | - Michael Rayment
- Consultant in Genitourinary Medicine and HIV, Chelsea and Westminster Hospital NHS Foundation Trust, London
| | - Laura Waters
- Chair British HIV Association, Consultant in HIV & Sexual Health, Mortimer Market Centre, CNWL NHS Trust, London
| | - Anna Buckley
- Consultant in Emergency Medicine, University College Hospital NHS Trust, London
| | - Fiona Burns
- Associate Professor in HIV and Sexual Health, Institute for Global Health, University College London
| | - Daniel Clutterbuck
- Clinical Lead for Sexual and Reproductive Health and HIV, Lothian Sexual and Reproductive Health Service, Edinburgh
| | - Ian Cormack
- Clinical Lead HIV Medicine, Croydon University Hospital
| | - Sara Croxford
- Senior HIV/STI Prevention Scientist, Public Health England, London
| | - Gillian Dean
- Consultant in Genitourinary/HIV Medicine, Brighton & Sussex University Hospitals NHS Trust
| | | | | | - Chamut Kifetew
- Project Manager, National HIV Prevention Programme, Terrence Higgins Trust and HIV, Prevention England
| | - Nick Larbalestier
- Consultant in HIV Medicine, Guy's & St. Thomas' NHS Foundation Trust, London
| | - Nicola Mackie
- Consultant in HIV/Sexual Health, Imperial College Healthcare NHS Trust, London
| | - Philippa Matthews
- General Practitioner, Medical Director, Islington GP Federation, Islington Clinical Lead for Sexual Health, London
| | - Martin Murchie
- Lecturer in Adult Nursing/Sexual Health Adviser, Glasgow Caledonian University/Sandyford Sexual Health NHS GGC
| | - Anthony Nardone
- Consultant Scientist (Sexual Health Promotion), HIV/STI Department, Public Health England (September 2016 to June 2018) and Senior Epidemiologist, Epiconcept, Paris (June 2018 to November 2019)
| | - Paul Randell
- Consultant Virologist, Imperial College Healthcare NHS Trust
| | - Hannah Skene
- Clinical Lead for Acute Medicine, Chelsea and Westminster Hospital, London
| | | | | | - Karen Trewinnard
- Sexual and Reproductive Health Clinician and Trainer, Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians & Gynaecologists
| | | | - Emma Young
- Consultant Emergency Medicine, Barts Health NHS Trust, London
| | - Tim Peto
- Consultant in Infectious Diseases, John Radcliffe Hospital, Oxford
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16
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Apers H, Nöstlinger C, Van Beckhoven D, Deblonde J, Apers L, Verheyen K, Loos J. Identifying key elements to inform HIV-testing interventions for primary care in Belgium. Health Promot Int 2020; 35:301-311. [PMID: 31056680 PMCID: PMC7250498 DOI: 10.1093/heapro/daz037] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
General practitioners (GPs) play a key role in reducing the hidden HIV-epidemic, but many diagnostic opportunities are missed in primary care. This study aimed at informing the development of an HIV-testing intervention for GPs in Flanders (Belgium) using formative research with a participatory approach. Through the active involvement of an advisory board and 16 group discussions with 122 Flemish GPs, GPs’ current HIV-testing practices and perceived practical relevance of 2 distinct HIV-testing strategies (i.e. provider-initiated testing of key populations and indicator condition-based testing) were explored in terms of their relevance and feasibility in routine primary care. Self-reported HIV-testing practices revealed that most tests performed were patient-initiated, pretest counseling was rarely done, and post-test counseling was offered mainly for patients with an HIV-diagnosis. GPs reported multiple barriers to provider-initiated HIV-testing, i.e. personal discomfort, fear of offending their patient, limited knowledge of benefits of early HIV-diagnosis, misconceptions about HIV-risks, lack of guidelines and time. Difficulties to identify patient’s sexual orientation or ethical concerns were mentioned as barriers for target group-based HIV testing. GPs assessed the current list of 64 indicator conditions as too difficult to integrate in routine care, deeming a reduced list of GP-relevant conditions as more feasible. Combined strategies (i.e. target group- and indicator-based testing) supported by official screening recommendations were perceived as successful strategies for provider-initiated HIV-testing in primary care. This formative research delivered qualitative evidence for the development of an HIV-testing intervention for primary care settings.
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Affiliation(s)
- Hanne Apers
- Group HIV and Sexual Health, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- Corresponding author. E-mail:
| | - Christiana Nöstlinger
- Group HIV and Sexual Health, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Dominique Van Beckhoven
- Epidemiology of Infectious Diseases Unit, Department of Public Health and Surveillance, Sciensano - Belgian Scientific Institute of Public Health, Ixelles, Belgium
| | - Jessika Deblonde
- Epidemiology of Infectious Diseases Unit, Department of Public Health and Surveillance, Sciensano - Belgian Scientific Institute of Public Health, Ixelles, Belgium
| | - Ludwig Apers
- HIV/STI clinic, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Katleen Verheyen
- General Practitioner, Opglabbeek, Belgium
- ELIZA - Center for General Practice, Department of Primary & Interdisciplinary Care Antwerp, University of Antwerp, Antwerp, Belgium
| | - Jasna Loos
- Group HIV and Sexual Health, Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
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17
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Rosso MT, Sharma A. Willingness of Adults in the United States to Receive HIV Testing in Dental Care Settings: Cross-Sectional Web-Based Study. JMIR Public Health Surveill 2020; 6:e17677. [PMID: 32706732 PMCID: PMC7404012 DOI: 10.2196/17677] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/28/2020] [Accepted: 05/24/2020] [Indexed: 01/30/2023] Open
Abstract
Background The Centers for Disease Control and Prevention estimates that 1.1 million people in the United States are living with HIV and 1 in 8 are estimated to be unaware of their serostatus. Little is known about whether individuals would consider being tested for HIV in nontraditional health care settings such as a dentist’s office. Studies in selected US cities have indicated high acceptability of receiving an HIV test among people attending dental clinics. However, we are not aware of studies that have assessed willingness to receive HIV testing in dental care settings at a national level. Objective Using a web-based sample of adult residents of the United States, we sought to assess the self-reported willingness to receive any type of HIV testing (ie, oral fluid rapid testing, finger-stick blood rapid testing, or venipuncture blood testing) in a dental care setting and evaluate independent associations of willingness with the extent to which dental care providers were perceived as knowledgeable about HIV and how comfortable participants felt discussing HIV with their dental care providers. Methods Participants were recruited using banner advertisements featured on social networking platforms (Facebook and Instagram) from December 2018 to February 2019. Demographic and behavioral data including information on sexual behaviors in the past 6 months, HIV testing history, and dental/health care–seeking history were collected using an anonymous web-based survey. Willingness to receive any type of HIV testing in a dental care setting was assessed on 4-point scale from very willing to very unwilling. Factors independently associated with participants’ willingness were identified using a multivariable logistic regression model. Results Of the 421 participants in our study aged 18 to 73 years, 271 (64.4%) reported having oral sex, 197 (46.8%) reported having vaginal sex, and 136 (32.3%) reported having anal sex in the past 6 months. Approximately one-third had never been tested for HIV (137/421, 32.5%), and the same proportion had not been tested in the past year (137/421, 32.5%). Most participants had dental insurance coverage (356/421, 84.6%), and more than three-fourths reported being very or somewhat willing (326/421, 77.4%) to receive any type of HIV testing in a dental care setting. Higher levels of willingness were associated with being 18 to 24 years versus ≥35 years (aOR 3.22, 95% CI 1.48-6.98), 25 to 34 years versus ≥35 years (aOR 5.26, 95% CI 2.52-10.98), believing that one’s dental care provider is knowledgeable about HIV (aOR 2.04, 95% CI 1.06-3.92), and feeling comfortable discussing HIV with one’s dental care provider (aOR 9.84, 95% CI 3.99-24.27). Conclusions Our data indicate high acceptability of receiving HIV testing in a dental care setting, especially among those who report having a positive patient-provider relationship. Future research should focus on assessing dental care providers’ attitudes, self-efficacy, and beliefs about whether HIV testing fits into the scope of dentistry.
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Affiliation(s)
- Matthew T Rosso
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, United States
| | - Akshay Sharma
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, United States.,Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, United States
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18
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Abstract
SUMMARY In this paper we build on work investigating the feasibility of human immunodeficiency virus (HIV) testing in emergency departments (EDs), estimating the prevalence of hepatitis B, C and HIV infections among persons attending two inner-London EDs, identifying factors associated with testing positive in an ED. We also undertook molecular characterisation to look at the diversity of the viruses circulating in these individuals, and the presence of clinically significant mutations which impact on treatment and control.Blood-borne virus (BBV) testing in non-traditional settings is feasible, with emergency departments (ED) potentially effective at reaching vulnerable and underserved populations. We investigated the feasibility of BBV testing within two inner-London EDs. Residual samples from biochemistry for adults (⩾18 years) attending The Royal Free London Hospital (RFLH) or the University College London Hospital (UCLH) ED between January and June 2015 were tested for human immunodeficiency virus (HIV)Ag/Ab, anti-hepatitis C (HCV) and HBsAg. PCR and sequence analysis were conducted on reactive samples. Sero-prevalence among persons attending RFH and UCLH with residual samples (1287 and 1546), respectively, were 1.1% and 1.0% for HBsAg, 1.6% and 2.3% for anti-HCV, 0.9% and 1.6% for HCV RNA, and 1.3% and 2.2% for HIV. For RFH, HBsAg positivity was more likely among persons of black vs. white ethnicity (odds ratio 9.08; 95% confidence interval 2.72-30), with anti-HCV positivity less likely among females (0.15, 95% CI 0.04-0.50). For UCLH, HBsAg positivity was more likely among non-white ethnicity (13.34, 95% CI 2.20-80.86 (Asian); 8.03, 95% CI 1.12-57.61 (black); and 8.11, 95% CI 1.13-58.18 (other/mixed)). Anti-HCV positivity was more likely among 36-55 year olds vs. ⩾56 years (7.69, 95% CI 2.24-26.41), and less likely among females (0.24, 95% CI 0.09-0.65). Persons positive for HIV-markers were more likely to be of black vs. white ethnicity (4.51, 95% CI 1.63-12.45), and less likely to have one ED attendance (0.39, 95% CI 0.17-0.88), or female (0.12, 95% CI 0.04-0.42). These results indicate that BBV-testing in EDs is feasible, providing a basis for further studies to explore provider and patient acceptability, referral into care and cost-effectiveness.
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19
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Desai S, Tavoschi L, Sullivan AK, Combs L, Raben D, Delpech V, Jakobsen SF, Amato‐Gauci AJ, Croxford S. HIV testing strategies employed in health care settings in the European Union/European Economic Area (EU/EEA): evidence from a systematic review. HIV Med 2020; 21:163-179. [PMID: 31729150 PMCID: PMC7065119 DOI: 10.1111/hiv.12809] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Despite the availability of HIV testing guidelines to facilitate prompt diagnosis, late HIV diagnosis remains high across Europe. The study synthesizes recent evidence on HIV testing strategies adopted in health care settings in the European Union/European Economic Area (EU/EEA). METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and systematic searches were run in five databases (2010-2017) to identify studies describing HIV testing interventions in health care settings in the EU/EEA. The grey literature was searched for unpublished studies (2014-2017). Two reviewers independently performed study selection, data extraction and critical appraisal. RESULTS One hundred and thirty intervention and/or feasibility studies on HIV testing in health care settings were identified. Interventions included testing provision (n = 94), campaigns (n = 14) and education and training for staff and patients (n = 20). HIV test coverage achieved through testing provision varied: 2.9-94% in primary care compared to 3.9-66% in emergency departments. HIV test positivity was lower in emergency departments (0-1.3%) and antenatal services (0-0.05%) than in other hospital departments (e.g. inpatients: 0-5.3%). Indicator condition testing programmes increased HIV test coverage from 3.9-72% before to 12-85% after their implementation, with most studies reporting a 10-20% increase. There were 51 feasibility and/or acceptability studies that demonstrated that HIV testing interventions were generally acceptable to patients and providers in health care settings (e.g. general practitioner testing acceptable: 77-93%). CONCLUSIONS This review has identified several strategies that could be adopted to achieve high HIV testing coverage across a variety of health care settings and populations in the EU/EEA. Very few studies compared the intervention under investigation to a baseline, but, where this was assessed, data suggested increases in testing.
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Affiliation(s)
- S Desai
- Centre for Infectious Disease Surveillance and ControlPublic Health EnglandLondonUK
| | - L Tavoschi
- European Centre for Disease Prevention and ControlSolnaSweden
- University of PisaPisaItaly
| | - AK Sullivan
- Directorate of HIV and Sexual HealthChelsea and Westminster Hospital NHS Foundation TrustLondonUK
| | - L Combs
- CHIPRigshospitalet ‐ University of CopenhagenCopenhagen ØDenmark
| | - D Raben
- CHIPRigshospitalet ‐ University of CopenhagenCopenhagen ØDenmark
| | - V Delpech
- Centre for Infectious Disease Surveillance and ControlPublic Health EnglandLondonUK
| | - SF Jakobsen
- CHIPRigshospitalet ‐ University of CopenhagenCopenhagen ØDenmark
| | - AJ Amato‐Gauci
- European Centre for Disease Prevention and ControlSolnaSweden
| | - S Croxford
- Centre for Infectious Disease Surveillance and ControlPublic Health EnglandLondonUK
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20
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Hojat L, Avery A, Greco PJ, Kaelber DC. Doubling Hepatitis C Virus Screening in Primary Care Using Advanced Electronic Health Record Tools-A Non-Randomized Controlled Trial. J Gen Intern Med 2020; 35:498-504. [PMID: 31792863 PMCID: PMC7018893 DOI: 10.1007/s11606-019-05536-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 07/26/2019] [Accepted: 10/11/2019] [Indexed: 12/09/2022]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is a major public health burden, affecting over 4 million people. The Centers for Disease Control and Prevention and the US Preventive Services Task Force guidelines recommend screening everyone born between 1945 and 1965, but screening rates remain low. OBJECTIVE To determine whether bulk ordering and electronic messaging to patients improves guideline-based HCV screening rates. DESIGN A non-randomized controlled trial of 1024 adults from November 2016 to March 2017. PARTICIPANTS Patients due for HCV screening with at least one primary care office visit in one of three primary care clinics and enrolled in the healthcare system's tethered personal health record (tPHR). INTERVENTIONS Control patients received normal care for HCV screening, consisting of passive HCV reminders to providers during face-to-face visits and passive HCV screening notification through the patient's tPHR. Intervention patients received normal care and also had HCV antibody tests ordered for them and customized messages sent through their tPHR inviting them to go directly to the lab for HCV screening over a 12-week period. MAIN MEASURES Percentage/number of patients receiving HCV antibody tests during the intervention period. Percentage/number of intervention group patients receiving HCV screening with other blood work. KEY RESULTS In the intervention group, 33% (168 of 514) completed HCV testing, compared with 19% (97 of 510) of controls (OR 1.7, 95% CI 1.2-2.1). Bulk lab ordering appeared to have a large impact while bulk messaging appeared to have a less significant role. CONCLUSIONS Leveraging population analytics and bulk ordering in an electronic health record with bulk messaging to a tPHR directly engages patients in blood screening tests and can significantly improve completion. This methodology has a broad range of applications including many recommended screening or disease-specific testing. This bulk ordering and direct-to-patient messaging approach improves patient screening while decreasing provider/staff work. TRIAL REGISTRATION MetroHealth IRB16-00776 (ClinicalTrials.gov).
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Affiliation(s)
- Leila Hojat
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.,Department of Medicine, The MetroHealth System, Case Western Reserve University, Cleveland, OH, USA
| | - Ann Avery
- Department of Medicine, The MetroHealth System, Case Western Reserve University, Cleveland, OH, USA
| | - Peter J Greco
- Department of Medicine, The MetroHealth System, Case Western Reserve University, Cleveland, OH, USA.,Center for Clinical Informatics Research and Education, The MetroHealth System, Case Western Reserve University, Cleveland, OH, USA
| | - David C Kaelber
- Department of Medicine, The MetroHealth System, Case Western Reserve University, Cleveland, OH, USA. .,Center for Clinical Informatics Research and Education, The MetroHealth System, Case Western Reserve University, Cleveland, OH, USA. .,Department of Pediatrics and Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA.
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21
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Traynor SM, Rosen-Metsch L, Feaster DJ. Missed Opportunities for HIV Testing Among STD Clinic Patients. J Community Health 2019; 43:1128-1136. [PMID: 29796786 DOI: 10.1007/s10900-018-0531-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Current HIV testing guidelines recommend that all adolescents and adults aged 13-64 be routinely screened for HIV in healthcare settings. Sexually transmitted disease (STD) clinic patients represent a population at increased risk for HIV, justifying more frequent risk assessment and testing. This analysis describes missed opportunities for HIV testing among a sample of STD clinic patients to identify areas where HIV testing services may be improved. Secondary analysis was conducted using data from Project AWARE, a randomized trial of 5012 adult patients from 9 STD clinics in the United States, enrolled April-December 2010. HIV testing history, healthcare service utilization, and behavioral risks were obtained through audio computer-assisted self-interview. Missed opportunities for HIV testing, defined as having a healthcare visit but no HIV test in the last 12 months, were characterized by location and frequency. Of 2315 (46.2%) participants not tested for HIV in the last 12 months, 1715 (74.1%) had a missed opportunity for HIV testing. These missed opportunities occurred in both traditional (54.9% at family doctor, 20.3% at other medical doctor visits) and non-traditional (28.5% at dental, 19.0% at eye doctor, 13.9% at correctional facility, and 13.3% at psychology visits) testing settings. Of 53 participants positive for HIV at baseline, 16 (30.2%) had a missed testing opportunity. Missed opportunities for HIV testing were common in this population of STD clinic patients. There is a need to increase routinized HIV screening and expand testing services to a broader range of healthcare settings.
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Affiliation(s)
- Sharleen M Traynor
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Room 1066, Miami, FL, 33136, USA.
| | - Lisa Rosen-Metsch
- School of General Studies, Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 West 168th Street, New York, NY, 10032, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Room 1059, Miami, FL, 33136, USA
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22
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Raben D, Sullivan AK, Mocroft A, Kutsyna G, Hadžiosmanović V, Vassilenko A, Chkhartisvili N, Mitsura V, Pedersen C, Anderson J, Begovac J, Bak Dragsted U, Bertisch B, Grzeszczuk A, Minton J, Necsoi VC, Kitchen M, Ajana F, Sokhan A, Comi L, Farazmand P, Pesut D, De Wit S, Gatell JM, Gazzard B, d’Arminio Monforte A, Rockstroh JK, Yazdanpanah Y, Champenois K, Jakobsen ML, Lundgren JD. Improving the evidence for indicator condition guided HIV testing in Europe: Results from the HIDES II Study - 2012 - 2015. PLoS One 2019; 14:e0220108. [PMID: 31408476 PMCID: PMC6692030 DOI: 10.1371/journal.pone.0220108] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 07/09/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND It is cost-effective to perform an HIV test in people with specific indicator conditions (IC) with an undiagnosed HIV prevalence of at least 0.1%. Our aim was to determine the HIV prevalence for 14 different conditions across 20 European countries. METHODS Individuals aged 18-65 years presenting for care with one of 14 ICs between January 2012 and June 2014 were included and routinely offered an HIV test. Logistic regression assessed factors associated with testing HIV positive. Patients presenting with infectious mononucleosis-like syndrome (IMS) were recruited up until September 2015. RESULTS Of 10,877 patients presenting with an IC and included in the analysis, 303 tested positive (2.8%; 95% CI 2.5-3.1%). People presenting with an IC in Southern and Eastern Europe were more likely to test HIV positive as were people presenting with IMS, lymphadenopathy and leukocytopenia/ thrombocytopenia. One third of people diagnosed with HIV after presenting with IMS reported a negative HIV test in the preceding 12 months. Of patients newly diagnosed with HIV where data was available, 92.6% were promptly linked to care; of these 10.4% were reported lost to follow up or dead 12 months after diagnosis. CONCLUSION The study showed that 10 conditions had HIV prevalences > 0.1%. These 10 ICs should be adopted into HIV testing and IC specialty guidelines. As IMS presentation can mimic acute HIV sero-conversion and has the highest positivity rate, this IC in particular affords opportunities for earlier diagnosis and public health benefit.
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Affiliation(s)
- Dorthe Raben
- Centre for Health & Infectious Disease Research, Rigshospitalet, Copenhagen, Denmark
| | - Ann Kathleen Sullivan
- Chelsea and Westminster Hospital, NHS Foundation Trust, London, England, United Kingdom
| | - Amanda Mocroft
- University College London, London, England, United Kingdom
| | | | - Vesna Hadžiosmanović
- Clinical Center University of Sarajevo, Infectious Diseases Clinic, Sarajevo, Bosnia
| | | | | | | | | | - Jane Anderson
- Homerton University Hospital, London, England, United Kingdom
| | - Josip Begovac
- University Hospital of Infectious Diseases, Zagreb, Croatia
| | | | | | | | - Jane Minton
- St James’s University Hospital, Leeds, England, United Kingdom
| | | | | | - Faiza Ajana
- Centre Hospitalier de Tourcoing, Tourcoing, France
| | - Anton Sokhan
- Kharkiv National Medical University, Kharkiv, Ukraine
| | - Laura Comi
- Ospedale di Bergamo, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Dragica Pesut
- University of Belgrade School of Medicine, Clinical Centre of Serbia, Belgrade, Serbia
| | - Stephane De Wit
- Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - José Maria Gatell
- Hospital Clinic de Barcelona/IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Brian Gazzard
- Chelsea and Westminster Hospital, NHS Foundation Trust, London, England, United Kingdom
| | | | | | - Yazdan Yazdanpanah
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
- Hôpital Bichat, Paris, France
| | | | - Marie Louise Jakobsen
- Centre for Health & Infectious Disease Research, Rigshospitalet, Copenhagen, Denmark
| | - Jens Dilling Lundgren
- Centre for Health & Infectious Disease Research, Rigshospitalet, Copenhagen, Denmark
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23
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Bundle N, Balasegaram S, Parry S, Ullah S, Harris RJ, Ahmad K, Foster GR, Tong CYW, Orkin C. Seroprevalence and demographic factors associated with hepatitis B, hepatitis C and HIV infection from a hospital emergency department testing programme, London, United Kingdom, 2015 to 2016. Euro Surveill 2019; 24:1800377. [PMID: 31290390 PMCID: PMC6628754 DOI: 10.2807/1560-7917.es.2019.24.27.1800377] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BackgroundProgress towards HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) elimination requires local prevalence estimates and linkage to care (LTC) of undiagnosed or disengaged cases.AimWe aimed to estimate seroprevalence, factors associated with positive blood-borne virus (BBV) serology and numbers needed to screen (NNS) to detect a new BBV diagnosis and achieve full LTC from emergency department (ED) BBV testing.MethodsDuring a 9-month programme in an ED in east London, England, testing was offered to adult attendees having a full blood count (FBC). We estimated factors associated with positive BBV serology using logistic regression and NNS as the inverse of seroprevalence. Estimates were weighted to the age, sex and ethnicity of the FBC population.ResultsOf 6,211 FBC patients tested, 217 (3.5%) were positive for at least one BBV. Weighted BBV seroprevalence was 4.2% (95% confidence interval (CI): 3.6-4.9). Adjusted odds ratios (aOR) of positive BBV serology were elevated among patients that were: male (aOR: 2.7; 95% CI: 1.9-3.9), 40-59 years old (aOR: 1.9; 95% CI: 1.4-2.7), of Black British/Black other ethnicity (aOR: 1.8; 95% CI: 1.2-2.8) or had no fixed address (aOR: 2.9; 95% CI: 1.5-5.5). NNS to detect a new BBV diagnosis was 154 (95% CI: 103-233) and 135 (95% CI: 93-200) to achieve LTC.ConclusionsThe low NNS suggests routine BBV screening in EDs may be worthwhile. Those considering similar programmes should use our findings to inform their assessments of anticipated public health benefits.
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Affiliation(s)
- Nick Bundle
- United Kingdom Field Epidemiology Training Programme, Public Health England, London, United Kingdom,Field Epidemiology Services, National Infection Service, Public Health England, London, United Kingdom
| | - Sooria Balasegaram
- Field Epidemiology Services, National Infection Service, Public Health England, London, United Kingdom
| | - Sarah Parry
- Queen Mary University of London, London, United Kingdom
| | - Sadna Ullah
- Queen Mary University of London, London, United Kingdom
| | - Ross J Harris
- Statistics, Modelling and Economics Department, National Infection Service, Public Health England, London, United Kingdom
| | - Karim Ahmad
- Barts Health NHS Trust, Emergency Department, Royal London Hospital, London, United Kingdom
| | - Graham R Foster
- Blizard Institute, Queen Mary University, London, United Kingdom
| | - Cheuk YW Tong
- Barts Health NHS Trust, Virology department, Royal London Hospital, London, United Kingdom
| | - Chloe Orkin
- Queen Mary University of London, London, United Kingdom
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24
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Martínez Sanz J, Pérez Elías MJ, Muriel A, Gómez Ayerbe C, Vivancos Gallego MJ, Sánchez Conde M, Herrero Delgado M, Pérez Elías P, Polo Benito L, de la Fuente Cortés Y, Barea R, Sullivan AK, Fuster Ruiz de Apodaca MJ, Galindo MJ, Moreno S. Outcome of an HIV education program for primary care providers: Screening and late diagnosis rates. PLoS One 2019; 14:e0218380. [PMID: 31265464 PMCID: PMC6605851 DOI: 10.1371/journal.pone.0218380] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/31/2019] [Indexed: 12/16/2022] Open
Abstract
Background Late HIV diagnosis remains one of the challenges in combating the epidemic. Primary care providers play an important role in screening for HIV infection. Our study aims to evaluate the relationship between knowledge and barriers to HIV testing and screening outcomes. The impact of an education program for primary care providers, towards improving HIV testing and late diagnosis rates, is also assessed. Methods A self-administered questionnaire that was developed within the framework of the European project OptTEST was used to examine HIV knowledge and barriers to HIV testing scores before and after being involved in an HIV education program. A quasi-experimental design with pre- and post-intervention measures was performed to investigate its impact. We performed multivariable logistic regression analysis to assess the relationship between variables for the HIV testing offer. Results A total of 20 primary care centers and 454 primary care staff were included. Baseline OptTEST results showed that more knowledgeable staff offered an HIV test more frequently (OR 1.07; CI 95% 1.01–1.13; p = 0.027) and had lower barrier scores (OR 0.89; CI 95% 0.77–0.95; p = 0.005). Nurses had lower scores in knowledge-related items (OR 0.28; CI 95% 0.17–0.46; p<0.001), but higher scores in barrier-related items than physicians (OR 3.28; CI 95% 2.01–5.46; p<0.001). Specific centers with more knowledgeable staff members had a significant association with a greater level of new HIV diagnosis rates (OR 1.61; CI 95% 1.04–2.49; p = 0.032). After the intervention, we found that 12 out of 14 individual questions showed improved scores. In the 6 months after the training program, we similarly found a higher HIV testing rate (OR 1.19; CI 1.02–1.42; p = 0.036). Conclusions This study highlights the association between knowledge and barriers to HIV testing, including HIV testing rates. It shows that it is possible to modify knowledge and reduce perceived barriers through educational programs, subsequently improving HIV screening outcomes.
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Affiliation(s)
- Javier Martínez Sanz
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - María Jesús Pérez Elías
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
- * E-mail: ,
| | - Alfonso Muriel
- Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Cristina Gómez Ayerbe
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | | | - Matilde Sánchez Conde
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | | | | | | | | | | | - Ann K. Sullivan
- Chelsea and Westminster Healthcare NHS Foundation Trust, London, United Kingdom
| | | | - María José Galindo
- Infectious Diseases Unit, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Santiago Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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25
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Bradshaw D, Rae C, Rayment M, Turner N, Turner R, Pickard G, Pillay K, Roberts P, Foxton M, Sullivan AK. HIV/HCV/HBV testing in the emergency department: a feasibility and seroprevalence study. HIV Med 2019; 19 Suppl 1:52-57. [PMID: 29488696 DOI: 10.1111/hiv.12590] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aims of this study were to to assess the feasibility of simultaneous testing for the blood-borne viruses (BBV), HIV, hepatitis C (HCV) and hepatitis B (HBV), in the Emergency Department (ED) and ascertain the seroprevalence for these three viruses in this setting. METHODS A pilot BBV testing program was undertaken as part of routine clinical care in the ED. All ED attendees aged between 16 and 65 years old who were able to consent were tested over a 55 week period on an opt out basis. Patients with positive test results were linked to clinical services. Interventions aimed at improving testing rates were implemented and evaluated by quality improvement (QI) methodology. RESULTS Of 25,520 age-eligible ED attendees, 6108 (24%) underwent BBV testing; an additional 1160 (4.5%) underwent a standalone HIV test (total of 7268 (28%) individuals).There were 83/7268 (1.1%) non-negative (ie reactive or equivocal) results for HIV and 103/6108 (1.7%) and 32/6108 (0.52%) for anti-HCV IgG and HBsAg, respectively. Of these, 12 (0.17%), 16 (0.26%) and 8 (0.13%) were new reactive tests for HIV, HCV and HBV, respectively, which were able to be confirmed on a second test. Specific QI interventions led to temporary increases in testing rates. CONCLUSIONS An opt out BBV testing program in the ED is feasible and effective at finding new cases. However, the testing rate was low at 24%. Although QI interventions led to some improvement in testing rates, further studies are required to identify ways to achieve sustained increases in testing in this setting.
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Affiliation(s)
- D Bradshaw
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - C Rae
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - M Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - N Turner
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - R Turner
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - G Pickard
- Imperial College Healthcare NHS Trust, London, UK
| | - K Pillay
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - P Roberts
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - M Foxton
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - A K Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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26
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Marín-Navarrete R, Villalobos-Gallegos L, Medina-Mora ME, Magis-Rodríguez C. Rapid testing and counseling for HIV/STIs in Mexican community-based residential care facilities for substance use disorders: A prospective study protocol. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1572801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Rodrigo Marín-Navarrete
- Clinical Trials Unit on Addiction and Mental Health, National Institute of Psychiatry “Ramón de la Fuente Muñiz” (INPRFM), Mexico City, Mexico
| | - Luis Villalobos-Gallegos
- Clinical Trials Unit on Addiction and Mental Health, National Institute of Psychiatry “Ramón de la Fuente Muñiz” (INPRFM), Mexico City, Mexico
| | - María Elena Medina-Mora
- Global Mental Health Research Center, National Institute of Psychiatry “Ramón de la Fuente Muñiz” (INPRFM), Mexico City, Mexico
| | - Carlos Magis-Rodríguez
- Directorate of Integrative Care, National Center for the Prevention and Control of HIV and AIDS (CENSida), Mexico City, Mexico
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27
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Cullen L, Grenfell P, Rodger A, Orkin C, Mandal S, Rhodes T. 'Just another vial…': a qualitative study to explore the acceptability and feasibility of routine blood-borne virus testing in an emergency department setting in the UK. BMJ Open 2019; 9:e024085. [PMID: 31048425 PMCID: PMC6501954 DOI: 10.1136/bmjopen-2018-024085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Increased test uptake for HIV and viral hepatitis is fast becoming a health priority at both national and global levels. Late diagnosis of these infections remains a critical public health concern in the UK. Recommendations have been issued to expand blood-borne virus (BBV) testing in alternative settings. Emergency departments (EDs) offer a potentially important point of testing. This paper presents findings from a qualitative study which aimed to explore the acceptability and feasibility of a routine opt-out combined BBV testing intervention implemented at an inner London ED. METHODS We conducted 22 semistructured interviews with patients and service providers in the ED over a 4-month period during the intervention pilot. A grounded analytical approach was employed to conduct thematic analysis of qualitative study data. RESULTS Core interrelating thematic areas, identified and analytically developed in relation to test intervention implementation and experience, included the following: the remaking of routine test procedure; notions of responsibility in relation to status knowledge and test engagement; the opportunity and constraints of the ED as a site for testing; and the renegotiation of testing cultures within and beyond the clinic space. CONCLUSION Study findings demonstrate how relational and spatial dynamics specific to the ED setting shape test meaning and engagement. We found acceptability of the test practice was articulated through narratives of situated responsibility, with the value of the test offset by perceptions of health need and justification of the test expense. Participant accounts indicate that the nontargeted approach of the test affords a productive disruption to 'at-risk' identities, yet they also reveal limits to the test intervention's 'normalising' effect. Evaluation of the intervention must attend to the situated dynamics of the test practice if opportunities of an opt-out BBV test procedure are to be fully realised. Findings also highlight the critical need to further evaluate post-test intervention practices and experiences.
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Affiliation(s)
- Lucy Cullen
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Health Research (NIHR), Health Protection Research Unit (HPRU) in Blood Borne and SexuallyTransmitted Infections, London, UK
| | - Pippa Grenfell
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Health Research (NIHR), Health Protection Research Unit (HPRU) in Blood Borne and SexuallyTransmitted Infections, London, UK
| | - Alison Rodger
- National Institute for Health Research (NIHR), Health Protection Research Unit (HPRU) in Blood Borne and SexuallyTransmitted Infections, London, UK
- Infection & Population Health, Institute for Global Health, University College London, London, UK
| | - Chloe Orkin
- HIV Medicine, Barts Health NHS Trust, London, UK
| | - Sema Mandal
- National Institute for Health Research (NIHR), Health Protection Research Unit (HPRU) in Blood Borne and SexuallyTransmitted Infections, London, UK
- Immunisation, Hepatitis, Blood Safety and Countermeasures Response, Public Health England, London, UK
| | - Tim Rhodes
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- National Institute for Health Research (NIHR), Health Protection Research Unit (HPRU) in Blood Borne and SexuallyTransmitted Infections, London, UK
- National Centre for Social Research on Health, University of New South Wales, Sydney, Australia
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28
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Matulionytė R, Žagminas K, Balčiūnaitė E, Matulytė E, Paulauskienė R, Bajoriūnienė A, Ambrozaitis A. Routine HIV testing program in the University Infectious Diseases Centre in Lithuania: a four-year analysis. BMC Infect Dis 2019; 19:21. [PMID: 30616558 PMCID: PMC6322331 DOI: 10.1186/s12879-018-3661-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 12/26/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND HIV transmission remains a major concern in Eastern Europe, and too many people are diagnosed late. Expanded testing strategies and early and appropriate access to care are required. Infectious disease departments might be targets for expanded HIV testing owing to the intense passage of key patient populations that carry indicators of HIV disease. Our objective was to evaluate the feasibility and clinical effectiveness of a fully integrated, opt-out routine, rapid HIV testing program. METHODS A retrospective four-year study of a screening program was conducted from 2010 through 2014. The program was divided into two periods: from 2010 to 2012 (pilot study) and from 2013 to 2014. The pilot study consisted of routine HIV testing of patients aged 18-55 that were hospitalized in one department. In the second period, all inpatients aged 18-65 were eligible. Targeted testing was conducted in the other inpatient department during the pilot study and the outpatient department during both periods. RESULTS During the pilot study, 2203 patients were hospitalized, 1314 (59.6%) were eligible, 954 (72.6%) were tested, and 3 (0.31%) were newly diagnosed HIV-positive. In the second period, 4911 patients were hospitalized, 3727 (75.9%) were eligible, 3303 (88.6%) were tested, and 7 (0.21%) were HIV-positive. In total, 2800 targeted tests were performed, and 4 (0.14%) patients tested positive with newly discovered HIV. All 14 newly diagnosed patients were provided with care. Comparing cumulative groups of routine and targeted testing, the HIV prevalence was 0.23% vs. 0.14% (p = 0.40) and was above the reported cost-effectiveness threshold of 0.1% (p = 0.012). A lower proportion of advanced disease and a higher proportion of heterosexually transmitted infection were found in the routine testing group. CONCLUSION Routine HIV testing in admissions of infectious diseases is acceptable, feasible, sustainable and clinically effective. Compared to targeted testing, routine testing helped to discover more patients in earlier stages and those with heterosexually transmitted HIV infection.
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Affiliation(s)
- Raimonda Matulionytė
- Department of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Infectious Diseases Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Kęstutis Žagminas
- Institute of Health Sciences, Vilnius University, Vilnius, Lithuania
| | - Eglė Balčiūnaitė
- Centre of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Elžbieta Matulytė
- Department of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Infectious Diseases Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Rasutė Paulauskienė
- Infectious Diseases Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Almina Bajoriūnienė
- Centre of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Arvydas Ambrozaitis
- Department of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Infectious Diseases Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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29
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Tan R, Hugli O, Cavassini M, Darling K. Non-targeted HIV testing in the emergency department: not just how but where. Expert Rev Anti Infect Ther 2018; 16:893-905. [PMID: 30406726 DOI: 10.1080/14787210.2018.1545575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The emergency department (ED) has the potential to enhance early HIV diagnosis through HIV testing programs. How these are implemented is a subject of debate. Areas covered: We describe the main HIV testing approaches: diagnostic testing, targeted screening, and non-targeted screening, and review ED-based non-targeted HIV screening studies conducted after 2006 among ≥5000 patients. As well as examining how testing is offered, we focus on where it is offered, through the patient's journey from registration, via triage and the waiting room, to the bedside. Barriers to the testing offer, acceptance and performance were examined at each location. While testing offer rates were higher at registration and triage, compared to the waiting room and bedside, this was sometimes at the expense of testing acceptance and performance. Variables affecting testing rates included type of consent, employment of external staff and type of testing: fourth generation serological testing versus rapid testing. Expert commentary: These large studies shed light on the importance of where as well as how HIV testing is performed, and the ways in which the 'where' can influence non-targeted screening yields. This perspective enables testing approaches to be tailored to specific ED settings in order to maximize testing rates.
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Affiliation(s)
- Rainer Tan
- a Infectious Diseases Service , Lausanne University Hospital , Lausanne , Switzerland
| | - Olivier Hugli
- b Emergency Department , Lausanne University Hospital , Lausanne , Switzerland
| | - Matthias Cavassini
- a Infectious Diseases Service , Lausanne University Hospital , Lausanne , Switzerland
| | - Katharine Darling
- a Infectious Diseases Service , Lausanne University Hospital , Lausanne , Switzerland
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Deblonde J, Van Beckhoven D, Loos J, Boffin N, Sasse A, Nöstlinger C, Supervie V. HIV testing within general practices in Europe: a mixed-methods systematic review. BMC Public Health 2018; 18:1191. [PMID: 30348140 PMCID: PMC6196459 DOI: 10.1186/s12889-018-6107-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 10/10/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Late diagnosis of HIV infection remains a key challenge in Europe. It is acknowledged that general practitioners (GPs) may contribute greatly to early case finding, yet there is evidence that many diagnostic opportunities are being missed. To further promote HIV testing in primary care and to increase the utility of available research, the existing evidence has been synthesised in a systematic review adhering to the PRISMA guidelines. METHODS The databases PubMed, Scopus and Embase were searched for the period 2006-2017. Two authors judged independently on the eligibility of studies. Through a mixed-methods systematic review of 29 studies, we provide a description of HIV testing in general practices in Europe, including barriers and facilitators. RESULTS The findings of the study show that although various approaches to target patients are used by GPs, most tests are still carried out based on the patient's request. Several barriers obstruct HIV testing in general practice. Included are a lack of communication skills on sexual health, lack of knowledge about HIV testing recommendations and epidemic specificities, difficulties with using the complete list of clinical HIV indicator diseases and lack of experience in delivering and communicating test results. The findings also suggest that the provision of specific training, practical tools and promotion programmes has an impact on the testing performance of GPs. CONCLUSIONS GPs could have an increased role in provider-initiated HIV-testing for early case finding. To achieve this objective, solutions to the reported barriers should be identified and testing criteria adapted to primary healthcare defined. Providing guidance and training to better identify priority groups for HIV testing, as well as information on the HIV epidemic's characteristics, will be fundamental to increasing awareness and testing by GPs.
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Affiliation(s)
- Jessika Deblonde
- Sciensano, Health Services Research, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | | | - Jasna Loos
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Nicole Boffin
- Sciensano, Health Services Research, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - André Sasse
- Sciensano, Health Services Research, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Christiana Nöstlinger
- Department of Public Health, Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Virginie Supervie
- Institut Pierre Louis d’Epidémiologie et de Santé Publique, INSERM, Sorbonne Université, 56 Bd. Vincent Auriol, CS 81393, 75646 Paris Cedex 13, France
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Whalen M, Mda P, Parrish A, Quinn TC, Rothman R, Stead D, Hansoti B. Implementing emergency department-based HIV testing in a low-resource setting: The value of a structured feasibility assessment tool. South Afr J HIV Med 2018; 19:793. [PMID: 30167338 PMCID: PMC6111602 DOI: 10.4102/sajhivmed.v19i1.793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 04/17/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction HIV is a worldwide health problem with continuing high rates of new infections in many parts of the world. This lack of progress in decreasing overall incidence rates has sparked innovative HIV testing strategies, including expansion of testing into the emergency department (ED) setting. Emergency departments have been shown to be high-yield testing venues in the United States and other developed world settings. The feasibility of expanding public health HIV services in the ED in limited-resource countries is unclear. Methods We performed a cross-sectional feasibility assessment of a convenience sample of four hospitals in the Eastern Cape, South Africa. We administered three adapted interview tools from a previously field-tested survey instrument at each facility (total of 10 interviews) to gather an overview of the health facility, their HIV counselling and testing services, and their laboratory services. Results All of the health facilities had access to basic commodities such as water and electricity. Many had severe human resource limitations and provided care to wide population catchment areas. In addition, there was little integration of HIV testing into current daily ED operations. Hospital staff identified numerous barriers to future ED testing efforts. Conclusions Although control of the HIV epidemic requires innovative testing strategies and treatment, specific assessments are warranted on how to incorporate routine HIV testing into an acute care facility like the ED, which typically has many competing priorities. The use of a prospective structured tool incorporating both barriers and benefits can provide valuable field-tested guidance for increased programme planning for HIV testing.
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Affiliation(s)
| | - Pamela Mda
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, South Africa
| | - Andy Parrish
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, South Africa.,Department of Internal Medicine, Frere and Cecilia Makiwane Hospitals, South Africa
| | - Thomas C Quinn
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, United States.,Division of Infectious Diseases, Johns Hopkins School of Medicine, Unite States
| | - Richard Rothman
- Department of Internal Medicine, Frere and Cecilia Makiwane Hospitals, South Africa
| | - David Stead
- Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, South Africa.,Department of Internal Medicine, Frere and Cecilia Makiwane Hospitals, South Africa
| | - Bhakti Hansoti
- Department of Emergency Medicine, Johns Hopkins University, United States
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Croxford S, Yin Z, Kall M, Burns F, Simmons R, Copas A, Ireland G, Kirwan P, Chau C, Delpech V. Where do we diagnose HIV infection? Monitoring new diagnoses made in nontraditional settings in England, Wales and Northern Ireland. HIV Med 2018; 19:465-474. [PMID: 29745055 DOI: 10.1111/hiv.12627] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objectives of the study were to describe 10-year trends in HIV diagnosis setting and to explore predictors of being diagnosed outside a sexual health clinic (SHC). METHODS Analyses of national HIV surveillance data were restricted to adults (aged ≥ 15 years) diagnosed in 2005-2014 in England, Wales and Northern Ireland. Logistic regression identified factors associated with diagnosis outside an SHC (2011-2014). RESULTS Between 2005 and 2014, 63 599 adults were newly diagnosed with HIV infection; 83% had a diagnosis setting reported. Most people were diagnosed in SHCs (69%) followed by: medical admissions/accident and emergency (A&E; 8.6%), general practice (6.4%), antenatal services (5.5%), out-patient services (3.6%), infectious disease units (2.7%) and other settings (4.0%). The proportion of people diagnosed outside SHCs increased from 2005 to 2014, overall (from 27% to 32%, respectively) and among men who have sex with men (MSM) (from 14% to 21%) and black African men (from 25% to 37%) and women (from 39% to 52%) (all trend P < 0.001). Median CD4 increased across all settings, but was highest in SHCs (384 cells/μL) and lowest in medical admissions/A&E (94 cells/μL). Predictors of being diagnosed outside SHCs included: acquiring HIV through heterosexual contact [adjusted odds ratio (aOR) 1.99; 95% confidence interval (CI) 1.81-2.18] or injecting drug use (aOR: 3.28; 95% CI: 2.56-4.19; reference: MSM), being diagnosed late (< 350 cells/μL) (aOR: 2.55; 95% CI: 2.36-2.74; reference: diagnosed promptly) and being of older age at diagnosis (35-49 years: aOR: 1.60; 95% CI: 1.39-1.83; ≥ 50 years: aOR: 2.48; 95% CI: 2.13-2.88; reference: 15-24 years). CONCLUSIONS The proportion of HIV diagnoses made outside SHCs has increased over the past decade in line with evolving HIV testing guidelines. However, the rate of late diagnosis remains high, indicating that further expansion of testing is necessary, as many people may have had missed opportunities for earlier diagnosis.
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Affiliation(s)
- S Croxford
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
- Institute for Global Health, University College London, London, UK
| | - Z Yin
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - M Kall
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
- Institute for Global Health, University College London, London, UK
| | - F Burns
- Institute for Global Health, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - R Simmons
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - A Copas
- Institute for Global Health, University College London, London, UK
| | - G Ireland
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - P Kirwan
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - C Chau
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - V Delpech
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
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Is surgical preadmission an underused opportunity in HIV? Lancet HIV 2018; 3:e459-60. [PMID: 27687036 DOI: 10.1016/s2352-3018(16)30159-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 08/22/2016] [Indexed: 11/20/2022]
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Implementing routine blood-borne virus testing for HCV, HBV and HIV at a London Emergency Department - uncovering the iceberg? Epidemiol Infect 2018; 146:1026-1035. [PMID: 29661260 DOI: 10.1017/s0950268818000870] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
UK guidelines recommend routine HIV testing in high prevalence emergency departments (ED) and targeted testing for HBV and HCV. The 'Going Viral' campaign implemented opt-out blood-borne virus (BBV) testing in adults in a high prevalence ED, to assess seroprevalence, uptake, linkage to care (LTC) rates and staff time taken to achieve LTC. Diagnosis status (new/known/unknown), current engagement in care, and severity of disease was established. LTC was defined as patient informed plus ⩾1 clinic visit. A total of 6211/24 981 ED attendees were tested (uptake 25%); 257 (4.1%) were BBV positive (15 co-infected), 84 (33%) required LTC. 100/147 (68%) HCV positives were viraemic; 44 (30%) required LTC (13 new, 16 disengaged). 26/54 (48%) HBV required LTC (seven new, 11 disengaged). 16/71 (23%) HIV required LTC (10 new, five disengaged). 26/84 (31%) patients requiring LTC had advanced disease (CD4 1, Fibroscan F3/F4 or liver cancer), including five with AIDS-defining conditions and three hepatocellular carcinomas. There were five BBV-related deaths. BBV prevalence was high (4.1%); most were HCV (2.4%). HIV patients were more successfully and quickly LTC than HBV or HCV patients. ED testing was valuable as one-third of those requiring LTC (new, disengaged or unknown status patients) had advanced disease.
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Qualitative impact assessment of an educational workshop on primary care practitioner attitudes to NICE HIV testing guidelines. BJGP Open 2018; 2:bjgpopen18X101433. [PMID: 30564709 PMCID: PMC6181084 DOI: 10.3399/bjgpopen18x101433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/21/2017] [Indexed: 11/23/2022] Open
Abstract
Background In 2013, Public Health England piloted the ‘3Cs (chlamydia, contraception, condoms) and HIV (human immunodeficiency virus)’ educational intervention in 460 GP surgeries. The educational HIV workshop aimed to improve the ability and confidence of staff to offer HIV testing in line with national guidelines. Aim To qualitatively assess the impact of an educational workshop on GP staff’s attitudes to NICE HIV testing guidelines. Design & setting Qualitative interviews with GP staff across England before and after an educational HIV workshop. Method Thirty-two GP staff (15 before and 17 after educational HIV workshop) participated in interviews exploring their views and current practice of HIV testing. Interview transcripts were thematically analysed and examined, using the components of the theory of planned behaviour (TPB) and normalisation process theory (NPT) as a framework. Results GPs reported that the educational HIV workshop resulted in increased knowledge of, and confidence to offer, HIV tests based on indicator conditions. However, overall participants felt they needed additional HIV training around clinical care pathways for offering tests, giving positive HIV results, and current treatments and outcomes. Participants did not see a place for point-of-care testing in general practice. Conclusion Implementation of national HIV guidelines will require multiple educational sessions, especially to implement testing guidelines for indicator conditions in areas of low HIV prevalence. Additional role-play or discussions around scripts suggesting how to offer an HIV test may improve participants’ confidence and facilitate increased testing. Healthcare assistants (HCAs) may need specific training to ensure that they are skilled in offering HIV testing within new patient checks.
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Bruton J, Rai T, Day S, Ward H. Patient perspectives on the HIV continuum of care in London: a qualitative study of people diagnosed between 1986 and 2014. BMJ Open 2018; 8:e020208. [PMID: 29602851 PMCID: PMC5884332 DOI: 10.1136/bmjopen-2017-020208] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/01/2018] [Accepted: 03/06/2018] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES To describe the experiences of the HIV treatment cascade of diagnosis, engagement with care and initiation of treatment from the perspective of patients; we explored whether this differed according to the year of their diagnosis, for example, whether they had experienced HIV care in the pretreatment era. DESIGN Qualitative interview study with framework analysis. SETTING Two large HIV adult outpatient clinics in central London. PARTICIPANTS 52 HIV-positive individuals, 41 men, 11 women, purposively sampled to include people who had been diagnosed at different stages in the history of the epidemic classified as four 'generations': pre-1996 (preantiretroviral therapy (ART)), 1997-2005 (complex ARTs), 2006-2012 (simpler ARTs) and 2013 onwards (recent diagnoses). RESULTS Some important differences were identified; for earlier generations, the visible illness and deaths from AIDS made it harder to engage with care following diagnosis. Subsequent decisions about starting treatment were deeply influenced by the fear of severe side effects from early ART. However, despite improvements in ART and life expectancy over the epidemic, we found a striking similarity across participants' accounts of the key stages of the care continuum, regardless of when they were diagnosed. Diagnosis was a major traumatic life event for almost everyone. Fear of testing positive or having low self-perceived risk affected the timing of testing and diagnosis. Engaging with care was facilitated by a flexible approach from services/clinicians. Initiating treatment was a major life decision. CONCLUSION We found patients' experiences are influenced by when they were diagnosed, with earliest cohorts facing substantial challenges. However, being diagnosed with HIV and starting treatment continue to be significant life-altering events even in the era of effective, simple treatments. Despite the advances of biomedical treatment, services should continue to recognise the needs of patients for whom the diagnosis and treatment remain significant challenges.
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Affiliation(s)
- Jane Bruton
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Tanvi Rai
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Sophie Day
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
- Department of Anthropology, Goldsmiths University of London, London, UK
| | - Helen Ward
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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[Acceptability of the opportunistic search for human immunodeficiency virus infection by serology in patients recruited in Primary Care Centres in Spain]. Aten Primaria 2018; 48:383-93. [PMID: 26522781 PMCID: PMC6877831 DOI: 10.1016/j.aprim.2015.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 07/19/2015] [Accepted: 07/22/2015] [Indexed: 11/22/2022] Open
Abstract
Objetivo Valorar la aceptabilidad de la prueba del virus de la inmunodeficiencia humana (VIH) mediante búsqueda oportunista. Diseño Estudio observacional, transversal. Emplazamiento Centros de atención primaria (CAP) del Sistema Nacional de Salud. Participantes Pacientes de 18 a 65 años a los que hubiese que realizar una analítica y que nunca antes se hubiesen realizado la prueba del VIH. Mediciones principales Edad, sexo, pareja estable, nivel de instrucción, consumo de tabaco/alcohol, motivo de la analítica, aceptabilidad de la prueba del VIH, motivo por el que no acepta o por el que no se le ha realizado antes. Se realizó un análisis estadístico descriptivo, bivariante y multivariante (regresión logística). Resultados Doscientos ocho médicos de 150 CAP captaron 3.314 pacientes. La aceptabilidad del test del VIH fue del 93,1% (IC 95%: 92,2-93,9). De estos, el 56,9% no se la habían realizado antes por no considerarse en riesgo, y el 34,8% por no habérsela ofertado su médico. Del 6,9% que rechazaron la serología, el 73,9% alegaron no considerarse en riesgo. Mediante análisis de regresión logística las variables que mostraron relación con la aceptabilidad de la prueba positivamente fueron: la edad (grupo de 26 a 35 años; OR = 1,79; IC 95%:1,10-2,91) y ser no fumador (OR = 1,39; IC 95%: 1,01-1,93). Los residentes en poblaciones entre 10.000 y 50.000 habitantes (OR = 0,57; IC 95%: 0,40-0,80) fueron los que en menor grado aceptaron la prueba. La prevalencia de VIH detectada fue del 0,24%. Conclusiones La prueba serológica del VIH tiene una alta aceptación entre los usuarios que acuden para hacerse un análisis de sangre a los CAP. La búsqueda oportunista es coste-efectiva.
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Domínguez-Berjón MF, Pichiule-Castañeda M, García-Riolobos MC, Esteban-Vasallo MD, Arenas-González SM, Morán-Arribas M, Verdejo-Ortés J, Zoni AC, Álvarez-Castillo MC, Astray J. A feasibility study for 3 strategies promoting HIV testing in primary health care in Madrid, Spain (ESTVIH project). J Eval Clin Pract 2017; 23:1408-1414. [PMID: 28971579 DOI: 10.1111/jep.12813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 07/23/2017] [Accepted: 07/24/2017] [Indexed: 11/27/2022]
Abstract
RATIONALE AND OBJECTIVES Late diagnosis of HIV infection is a public health problem. Framed by the international guidelines for improving HIV testing, in 2014, the Spanish Ministry of Health published a guide of recommendations to promote early diagnosis of HIV in health care settings. In the Community of Madrid, in order to implement these recommendations, we defined 3 new HIV testing strategies in primary health care. The objectives of this study were to know the interest of professionals and the acceptability for patients towards these strategies. METHODS We performed a quasi-experimental study to assess the feasibility of the implementation of new strategies (indicator condition, risk based, and universal offer) to promote early detection of HIV infection in the framework of the ESTVIH project. The centres participating in this project were randomly chosen among centres located in the health areas with the highest incidence of HIV infection. The feasibility was assessed in 6 centres. We considered outcomes by strategy in relation to the participation of professionals (family physician and nursing) and patients. RESULTS Overall, 56.9% of eligible professionals agreed to take part in the study; however, the percentage of professionals who recruited patients was 25.9%. This percentage was higher in the indicator condition strategy (47.2%, versus 18.5% in the universal offer and 14.3% in the risk-based strategy, P-value < 0.05). The test uptake percentage was greater than 80%, and there were no statistically significant differences between strategies. CONCLUSION Different strategies promoting HIV testing in primary care had different acceptability among professionals and similar among patients. At the end of the ESTVIH project, these results will be complemented with others related to the contribution of each strategy to improving the early diagnosis of HIV infection.
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Affiliation(s)
| | | | | | | | | | | | - José Verdejo-Ortés
- Public Health Directorate, Madrid Regional Health Authority, Madrid, Spain
| | - Ana Clara Zoni
- Public Health Directorate, Madrid Regional Health Authority, Madrid, Spain
| | | | - Jenaro Astray
- Public Health Directorate, Madrid Regional Health Authority, Madrid, Spain
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Elgalib A, Fidler S, Sabapathy K. Hospital-based routine HIV testing in high-income countries: a systematic literature review. HIV Med 2017; 19:195-205. [PMID: 29168319 DOI: 10.1111/hiv.12568] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To produce a summary of the published evidence of the barriers and facilitators for hospital-based routine HIV testing in high-income countries. METHODS Electronic databases were searched for studies, which described the offer of HIV testing to adults attending emergency departments (EDs) and acute medical units (AMUs) in the UK and US, published between 2006 and 2015. Other high-income countries were not included, as their guidelines do not recommend routine testing for HIV. The main outcomes of interest were HIV testing uptake, HIV testing coverage, factors facilitating HIV screening and barriers to HIV testing. Fourteen studies met the pre-defined inclusion criteria and critically appraised using mixed methods appraisal tool (MMAT). RESULTS HIV testing coverage ranged from 9.7% to 38.3% and 18.7% to 26% while uptake levels were high (70.1-84% and 53-75.4%) in the UK and US, respectively. Operational barriers such as lack of time, the need for training and concerns about giving results and follow-up of HIV positive results, were reported. Patient-specific factors including female sex, old age and low risk perception correlated with refusal of HIV testing. Factors that facilitated the offer of HIV testing were venous sampling (vs. point-of-care tests), commitment of medical staff to HIV testing policy and support from local HIV specialist providers. CONCLUSIONS There are several barriers to routine HIV testing in EDs and AMUs. Many of these stem from staff fears about offering HIV testing due to the perceived lack of knowledge about HIV. Our systematic review highlights areas which can be targeted to increase coverage of routine HIV testing.
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Affiliation(s)
- A Elgalib
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - S Fidler
- Department of HIV Medicine, Imperial College NHS Trust, London, UK
| | - K Sabapathy
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
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Leblanc J, Hejblum G, Costagliola D, Durand-Zaleski I, Lert F, de Truchis P, Verbeke G, Rousseau A, Piquet H, Simon F, Pateron D, Simon T, Crémieux AC. Targeted HIV Screening in Eight Emergency Departments: The DICI-VIH Cluster-Randomized Two-Period Crossover Trial. Ann Emerg Med 2017; 72:41-53.e9. [PMID: 29092761 DOI: 10.1016/j.annemergmed.2017.09.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/09/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE This study compares the effectiveness and cost-effectiveness of nurse-driven targeted HIV screening alongside physician-directed diagnostic testing (intervention strategy) with diagnostic testing alone (control strategy) in 8 emergency departments. METHODS In this cluster-randomized, 2-period, crossover trial, 18- to 64-year-old patients presenting for reasons other than potential exposure to HIV were included. The strategy applied first was randomly assigned. During both periods, diagnostic testing was prescribed by physicians following usual care. During the intervention periods, patients were asked to complete a self-administered questionnaire. According to their answers, the triage nurse suggested performing a rapid test to patients belonging to a high-risk group. The primary outcome was the proportion of new diagnoses among included patients, which further refers to effectiveness. A secondary outcome was the intervention's incremental cost (health care system perspective) per additional diagnosis. RESULTS During the intervention periods, 74,161 patients were included, 16,468 completed the questionnaire, 4,341 belonged to high-risk groups, and 2,818 were tested by nurses, yielding 13 new diagnoses. Combined with 9 diagnoses confirmed through 97 diagnostic tests, 22 new diagnoses were established. During the control periods, 74,166 patients were included, 92 were tested, and 6 received a new diagnosis. The proportion of new diagnoses among included patients was higher during the intervention than in the control periods (3.0 per 10,000 versus 0.8 per 10,000; difference 2.2 per 10,000, 95% CI 1.3 to 3.6; relative risk 3.7, 95% CI 1.4 to 9.8). The incremental cost was €1,324 per additional new diagnosis. CONCLUSION The combined strategy of targeted screening and diagnostic testing was effective.
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Affiliation(s)
- Judith Leblanc
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Center of East of Paris, Paris, France; Université Paris Saclay-Université Versailles St Quentin, INSERM UMR 1173, Garches, France.
| | - Gilles Hejblum
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique UMRS 1136, Paris, France
| | - Dominique Costagliola
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique UMRS 1136, Paris, France
| | - Isabelle Durand-Zaleski
- Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel-Dieu, URC Eco Île-de-France, Paris, France, and Université Paris Diderot, Univ Paris 07, INSERM, ECEVE, UMR 1123, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Santé publique, Créteil, France
| | - France Lert
- Université Paris Sud, Univ Paris 11, INSERM, Centre for Research in Epidemiology and Population Health, U 1018, Villejuif, France
| | - Pierre de Truchis
- Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Infectious Diseases Department, Garches, France
| | - Geert Verbeke
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven, Leuven, Belgium, and UHasselt, Hasselt, Belgium
| | - Alexandra Rousseau
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Unit of East of Paris, Paris, France
| | - Hélène Piquet
- Assistance Publique-Hôpitaux de Paris, Hôpital St Antoine, Emergency Department, Paris, France
| | - François Simon
- Assistance Publique-Hôpitaux de Paris, Hôpital St Louis, Microbiology Department, INSERM U941, Paris, France
| | - Dominique Pateron
- Assistance Publique-Hôpitaux de Paris, Hôpital St Antoine, Emergency Department, Paris, France
| | - Tabassome Simon
- Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Center of East of Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Department of Clinical Pharmacology and Clinical Research Platform of East of Paris, and Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR 1148, Paris, France
| | - Anne-Claude Crémieux
- Université Paris Saclay-Université Versailles St Quentin, INSERM UMR 1173, Garches, France; Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, Infectious Diseases Department, Université Paris Diderot, Univ Paris 07, Paris, France
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Patient and doctor perspectives on HIV screening in the emergency department: A prospective cross-sectional study. PLoS One 2017; 12:e0180389. [PMID: 28732088 PMCID: PMC5521743 DOI: 10.1371/journal.pone.0180389] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 06/14/2017] [Indexed: 11/26/2022] Open
Abstract
Background The emergency department (ED) is mentioned specifically in the Swiss HIV testing recommendations as a site at which patients can benefit from expanded HIV testing to optimise early HIV diagnosis. At our centre, where local HIV seroprevalence is 0.2–0.4%, 1% of all patients presenting to the ED are tested for HIV. Barriers to HIV testing, from the patient and doctor perspective, and patient acceptability of rapid HIV testing were examined in this study. Methods Between October 2014 and May 2015, 100 discrete patient-doctor encounter pairs undertook a survey in the ED of Lausanne University Hospital, Switzerland. Patients completed a questionnaire on HIV risk factors and were offered free rapid HIV testing (INSTI™). For every patient included, the treating doctor was asked if HIV testing had 1) been indicated according to the national testing recommendations, 2) mentioned, and 3) offered during the consultation. Results Of 100 patients, 30 had indications for HIV testing through risk factors or a suggestive presenting complaint (PC). Fifty patients accepted rapid testing; no test was reactive. Of 50 patients declining testing, 82% considered themselves not at risk or had recently tested negative and 16% wished to focus on their PC. ED doctors identified 20 patients with testing indications, mentioned testing to nine and offered testing to six. The main reason for doctors not mentioning or not offering testing was the wish to focus on the PC. Discussion Patients and doctors at our ED share the testing barrier of wishing to focus on the PC. Rapid HIV testing offered in parallel to the patient-doctor consultation increased the testing rate from 6% (offered by doctors) to 50%. Introducing this service would enable testing of patients not offered tests by their doctors and reduce missed opportunities for early HIV diagnosis.
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Witzel TC, Weatherburn P, Rodger AJ, Bourne AH, Burns FM. Risk, reassurance and routine: a qualitative study of narrative understandings of the potential for HIV self-testing among men who have sex with men in England. BMC Public Health 2017; 17:491. [PMID: 28532401 PMCID: PMC5440893 DOI: 10.1186/s12889-017-4370-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 05/05/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND HIV testing has seen a rapid evolution over the last decade with multiple modalities now in use globally. In recent years HIV self-testing (HIVST) has been legalised in the UK paving the way for further expansion of testing. Interventions are delivered in particular social contexts which shape uptake. It is therefore important to understand how novel interventions are likely to be received by their intended users. This study aims to understand how HIVST compliments existing testing strategies considered or adopted by men who have sex with men (MSM). We do this by analysing normative discourses surrounding HIV testing and their perceptions of HIVST's potential future roles. METHODS Six focus group discussions (FGDs) were conducted with 47 MSM in London, Manchester and Plymouth. One focus group included only MSM who reported higher risk behaviours and one with those who had never tested for HIV. Data were analysed through a thematic framework analysis. RESULTS Three main narratives for testing for HIV were identified: (i) testing in response to a specific risk event; (ii) as reassurance when there was a small amount of doubt or anxiety related to HIV; and (iii) in response to social norms perpetuated through peers, HIV community groups and the medical establishment to test regularly for HIV. HIVST had limited utility for men when testing in response to specific risk events except in the case of significant structural barriers to other testing opportunities. HIVST was considered to have utility when seeking reassurance, and was thought to be very useful when testing to satisfy the needs and expectations of others around regular testing. There was some ambivalence about the incursion of a clinical intervention into the home. CONCLUSIONS HIVST following risk events will likely be limited to those for whom existing service provision is insufficient to meet immediate needs based on structural or personal barriers to testing. Obligations of biological citizenship are central to MSM's understanding of the utility of HIVST. In the context of discourses of biocitizenship, men perceive HIVST to have dual roles: firstly as a tool to manage (mild) anxiety around one's HIV status based on an acknowledgment of HIV vulnerability arising from being homosexually active. Secondly, HIVST is useful in complying with social norms and meeting the perceived demands of biomedicine.
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Affiliation(s)
- T. Charles Witzel
- Sigma Research, Department of Social and Environmental Health Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Weatherburn
- Sigma Research, Department of Social and Environmental Health Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Alison J. Rodger
- Research Department of Infection & Population Health, UCL and Royal Free London NHS Foundation Trust, London, UK
| | - Adam H. Bourne
- Sigma Research, Department of Social and Environmental Health Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Fiona M. Burns
- Research Department of Infection & Population Health, UCL and Royal Free London NHS Foundation Trust, London, UK
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Osorio G, Hoenigl M, Quartarolo J, Barger K, Morris SR, Reed SL, Lee J, Little SJ. Evaluation of opt-out inpatient HIV screening at an urban teaching hospital. AIDS Care 2017; 29:1014-1018. [PMID: 28114789 DOI: 10.1080/09540121.2017.1282106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study evaluated opt-out inpatient HIV screening delivered by admitting physicians, and compared number of HIV tests and diagnoses to signs and symptoms-directed HIV testing (based on physician orders) in the emergency department (ED). The opt-out inpatient HIV screening program was conducted over a one year period in patients who were admitted to the 386-bed University of California San Diego (UCSD) teaching hospital. Numbers of HIV tests and diagnoses were compared to those observed among ED patients who underwent physician-directed HIV testing during the same time period. Survey data were collected from a convenience sample of patients and providers regarding the opt-out testing program. Among 8488 eligible inpatients, opt-out HIV testing was offered to 3017 (36%) patients, and rapid antibody testing was performed in 1389 (16.4%) inpatients, resulting in 6 (0.4% of all tests) newly identified HIV infections (5/6 were admitted through the ED). Among 27,893 ED patients, rapid antibody testing was performed in 88 (0.3%), with 7 (8.0% of all tests) new HIV infections identified. HIV diagnoses in the ED were more likely to be men who have sex with men (MSM) (p = 0.029) and tended to have AIDS-related opportunistic infections (p = 0.103) when compared to HIV diagnoses among inpatients. While 85% of the 150 physicians who completed the survey were aware of the HIV opt-out screening program, 44% of physicians felt that they did not have adequate time to consent patients for the program, and only 30% agreed that a physician is best-suited to consent patients. In conclusion, the yield of opt-out HIV rapid antibody screening in inpatients was comparable to the national HIV prevalence average. However, uptake of screening was markedly limited in this setting where opt-out screening was delivered by physicians during routine care, with limited time resources being the major barrier.
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Affiliation(s)
- Georgina Osorio
- a Division of Infectious Diseases, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , USA.,b Division of Infectious Diseases, Department of Medicine , University of California San Diego (UCSD) , San Diego , USA
| | - Martin Hoenigl
- b Division of Infectious Diseases, Department of Medicine , University of California San Diego (UCSD) , San Diego , USA.,c Division of Pulmonology, Department of Internal Medicine , Medical University of Graz , Graz , Austria.,d Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine , Medical University of Graz , Graz , Austria
| | - Jennifer Quartarolo
- e Department of Medicine , University of California San Diego (UCSD) , San Diego , USA
| | | | - Sheldon R Morris
- b Division of Infectious Diseases, Department of Medicine , University of California San Diego (UCSD) , San Diego , USA
| | - Sharon L Reed
- b Division of Infectious Diseases, Department of Medicine , University of California San Diego (UCSD) , San Diego , USA.,g Department of Pathology , University of California San Diego (UCSD) , San Diego , USA
| | - Joshua Lee
- h Department of Medicine , Stritch School of Medicine, Loyola University of Chicago , Maywood , USA
| | - Susan J Little
- b Division of Infectious Diseases, Department of Medicine , University of California San Diego (UCSD) , San Diego , USA
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Kelly S, Grzelka M, Vaid N. HIV testing in the acute medical unit. Br J Hosp Med (Lond) 2017; 77:C138-43. [PMID: 27640669 DOI: 10.12968/hmed.2016.77.9.c138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S Kelly
- Senior House Officer, London North West Healthcare NHS Trust, Northwick Park Hospital, Harrow
| | - M Grzelka
- Senior House Officer, London North West Healthcare NHS Trust, Northwick Park Hospital, Harrow
| | - N Vaid
- Consultant in Acute Medicine, Northwick Park Hospital, London North West Healthcare NHS Trust, Northwick Park Hospital, Harrow HA1 3UJ
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Orkin C, Flanagan S, Wallis E, Ireland G, Dhairyawan R, Fox J, Nandwani R, O'Connell R, Lascar M, Bulman J, Reeves I, Palfreeman A, Foster GR, Ahmad K, Anderson J, Tong CYW, Lattimore S. Incorporating HIV/hepatitis B virus/hepatitis C virus combined testing into routine blood tests in nine UK Emergency Departments: the "Going Viral" campaign. HIV Med 2016; 17:222-30. [PMID: 26919291 DOI: 10.1111/hiv.12364] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Routine HIV screening is recommended in those UK hospitals and primary care settings where the HIV prevalence is > 0.2%. For hepatitis B virus (HBV) and hepatitis C virus (HCV), however, testing is targeted at at-risk groups. We investigated the prevalence of these blood-borne viruses (BBVs) during a routine testing pilot in UK Emergency Departments (EDs). METHODS During the "Going Viral" campaign (13-19 October 2014), nine UK EDs in areas of high HIV prevalence offered routine tests for HIV, HBV and HCV to adults having blood taken as part of routine care. Patients who tested positive were linked to care. RESULTS A total of 7807 patients had blood taken during their ED visit; of these, 2118 (27%) were tested for BBVs (range 9-65%). Seventy-one BBV tests were positive (3.4%) with 32 (45.1%) new diagnoses. There were 39 HCV infections (15 newly diagnosed), 17 HIV infections (six newly diagnosed), and 15 HBV infections (11 newly diagnosed). Those aged 25-54 years had the highest prevalence: 2.46% for HCV, 1.36% for HIV and 1.09% for HBV. Assuming the cost per diagnosis is £7, the cost per new case detected would be £988 for HCV, £1351 for HBV and £2478 for HIV. CONCLUSIONS In the first study in the UK to report prospectively on BBV prevalence in the ED, we identified a high number of new viral hepatitis diagnoses, especially hepatitis C, in addition to the HIV diagnoses. Testing for HIV alone would have missed 54 viral hepatitis diagnoses (26 new), supporting further evaluation of routine BBV testing in UK EDs.
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Affiliation(s)
- C Orkin
- Ambrose King Centre, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - S Flanagan
- Ambrose King Centre, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - E Wallis
- Ambrose King Centre, Barts Health NHS Trust, Royal London Hospital, London, UK
| | | | - R Dhairyawan
- Sexual Health Department, Barking, Havering and Redbridge NHS Trust, London, UK
| | - J Fox
- Sexual Health Department, Kings College Hospital, London, UK
| | - R Nandwani
- Sexual Health Department, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - R O'Connell
- Ambrose King Centre, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - M Lascar
- Ambrose King Centre, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - J Bulman
- Sexual Health Department, Leeds Teaching Hospital, Leeds, UK
| | - I Reeves
- Sexual Health Department, Homerton University Hospital, London, UK
| | - A Palfreeman
- Sexual Health Department, University Hospital of Leicester NHS Trust, Leicester, UK
| | - G R Foster
- Hepatology Department, Queen Mary University London, London, UK
| | - K Ahmad
- Emergency Department, Barts Health NHS Trust, Royal London Hospital, London, UK
| | | | - C Y W Tong
- Virology Department, Barts Health NHS Trust, Royal London Hospital, London, UK
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Polilli E, Sozio F, Di Stefano P, Sciacca A, Ursini T, Paoloni M, Vecchiet J, Di Giammartino D, Sciotti MP, Grimaldi A, Cortesi V, Fazii P, Ricci E, D'Amario C, Ippolito G, Pippa L, Parruti G. Web-Based HIV Testing in Abruzzo, Italy: Analysis of 15-Month Activity Results. AIDS Patient Care STDS 2016; 30:471-475. [PMID: 27749107 DOI: 10.1089/apc.2016.0082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Undiagnosed cases of HIV infection in developed countries are estimated at 20-30% of individuals living with HIV. Web-based strategies may represent a new approach to easier, wider, and unrestricted access to early testing. The Abruzzo Region, Italy, developed a Web-based tool to recruit persons at high risk of HIV and other sexually transmitted infections (STIs). At the Website www.failtestanchetu.it , browsers found information on STIs (HIV, hepatitis B and C, and syphilis), a structured questionnaire called "risk calculator" to assess one's own risk behaviors and direct booking of their test at one of six sites throughout the region. The Website was advertised on local media and in pharmacies, high schools, sports facilities, and factories. Between February 1, 2014, and May 31, 2015, about 6000 users visited the Website; 3046 people attended a visit for counseling on risk behaviors, signs, or symptoms of STIs and accepted blood drawing for HIV, hepatitis B Virus (HBV), hepatitis C Virus (HCV), and syphilis tests. Fifty-eight (1.90%) subjects were positive for HCV, 56 (1.84%) for HBsAg, 90 (2.95%) for Treponema pallidum antibodies, and 28 (0.92%) for HIV. Ninety-two percent of HIV-positive patients were successfully linked to care. Late presenters were less frequent in this sample than in the population diagnosed with HIV in Italy in 2014. An overall 7% proportion of HIV, HBV, HCV, and syphilis-unaware cases were all transferred to care, with the exception of three people. HIV seropositivity among testers was higher than 2/1000, the cost-effectiveness threshold suggested for effective testing. Therefore, our Web-based unrestricted and free access methodology appears worth further and wider evaluation.
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Affiliation(s)
- Ennio Polilli
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | - Federica Sozio
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | - Paola Di Stefano
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | - Antonina Sciacca
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | - Tamara Ursini
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | - Maurizio Paoloni
- Infectious Diseases Unit, Avezzano General Hospital, Avezzano, Italy
| | - Jacopo Vecchiet
- Infectious Diseases Clinic, University of Chieti, Chieti, Italy
| | | | | | | | | | - Paolo Fazii
- Microbiology and Virology Unit, Pescara General Hospital, Italy
| | - Elena Ricci
- Department of Infectious Disease, ASST Fatebenefratelli Sacco, Milan, Italy
| | | | - Giuseppe Ippolito
- National Institute for Infectious Diseases Lazzaro Spallanzani, Rome, Italy
| | - Lucio Pippa
- Fondazione Onlus Camillo de Lellis per l'Innovazione e la Ricerca in Medicina, Pescara, Italy
| | - Giustino Parruti
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy
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Town K, McNulty CAM, Ricketts EJ, Hartney T, Nardone A, Folkard KA, Charlett A, Dunbar JK. Service evaluation of an educational intervention to improve sexual health services in primary care implemented using a step-wedge design: analysis of chlamydia testing and diagnosis rate changes. BMC Public Health 2016; 16:686. [PMID: 27484823 PMCID: PMC4969638 DOI: 10.1186/s12889-016-3343-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 06/15/2016] [Indexed: 11/24/2022] Open
Abstract
Background Providing sexual health services in primary care is an essential step towards universal provision. However they are not offered consistently. We conducted a national pilot of an educational intervention to improve staff’s skills and confidence to increase chlamydia testing rates and provide condoms with contraceptive information plus HIV testing according to national guidelines, known as 3Cs&HIV. The effectiveness of the pilot on chlamydia testing and diagnosis rates in general practice was evaluated. Methods The pilot was implemented using a step-wedge design over three phases during 2013 and 2014 in England. The intervention combined educational workshops with posters, testing performance feedback and continuous support. Chlamydia testing and diagnosis rates in participating general practices during the control and intervention periods were compared adjusting for seasonal trends in chlamydia testing and differences in practice size. Intervention effect modification was assessed for the following general practice characteristics: chlamydia testing rate compared to national median, number of general practice staff employed, payment for chlamydia screening, practice urban/rurality classification, and proximity to sexual health clinics. Results The 460 participating practices conducted 26,021 tests in the control period and 18,797 tests during the intervention period. Intention-to-treat analysis showed no change in the unadjusted median tests and diagnoses per month per practice after receiving training: 2.7 vs 2.7; 0.1 vs 0.1. Multivariable negative binomial regression analysis found no significant change in overall testing or diagnoses post-intervention (incidence rate ratio (IRR) 1.01, 95 % confidence interval (CI) 0.96–1.07, P = 0.72; 0.98 CI 0.84–1.15, P = 0.84, respectively). Stratified analysis showed testing increased significantly in practices where payments were in place prior to the intervention (IRR 2.12 CI 1.41–3.18, P < 0.001) and in practices with 6–15 staff (6–10 GPs IRR 1.35 (1.07–1.71), P = 0.012; 11–15 GPs IRR 1.37 (1.09–1.73), P = 0.007). Conclusion This national pilot of short educational training sessions found no overall effect on chlamydia testing in primary care. However, in certain sub-groups chlamydia testing rates increased due to the intervention. This demonstrates the importance of piloting and evaluating any service improvement intervention to assess the impact before widespread implementation, and the need for detailed understanding of local services in order to select effective interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3343-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katy Town
- HIV/STI Department, National Infection Service, Public Health England, London, UK.
| | - Cliodna A M McNulty
- Public Health England Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Gloucester, UK
| | - Ellie J Ricketts
- Public Health England Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Gloucester, UK
| | - Thomas Hartney
- HIV/STI Department, National Infection Service, Public Health England, London, UK
| | - Anthony Nardone
- HIV/STI Department, National Infection Service, Public Health England, London, UK
| | - Kate A Folkard
- HIV/STI Department, National Infection Service, Public Health England, London, UK
| | - Andre Charlett
- Statistics, Modelling and Economics Department, Public Health England, 61 Colindale Avenue, NW9 5EQ, London, UK
| | - J Kevin Dunbar
- HIV/STI Department, National Infection Service, Public Health England, London, UK
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Mody N, Ramsay S, Ferraro C, Hewitt M, Gill E, Holliday L, Ikharia A, Reeves I. Audit of HIV testing in a multispecialty acute admissions unit in a London general hospital. Br J Vener Dis 2016; 92:239. [DOI: 10.1136/sextrans-2015-052458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/06/2015] [Indexed: 11/04/2022]
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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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