1
|
García-Ruiz de Morales AG, Vivancos MJ, Lázaro J, Romero Hernández B, Mateos B, Pérez-Elías P, Herrero Delgado M, Villanova Cuadra L, Moreno S, Martínez-Sanz J, Pérez-Elías MJ. Design and Proof of Concept of a Web-Based Questionnaire to Identify Patients at Risk for HIV and HCV Infection. Biomedicines 2024; 12:1846. [PMID: 39200310 PMCID: PMC11352123 DOI: 10.3390/biomedicines12081846] [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: 07/11/2024] [Revised: 08/06/2024] [Accepted: 08/12/2024] [Indexed: 09/02/2024] Open
Abstract
Despite remarkable improvement in the human immunodeficiency virus (HIV) and hepatitis C virus (HCV) care continuum, the rate of late diagnosis of HIV and HCV in high-income countries remains unacceptably high. Testing relies mainly on primary care physicians' identification of risk factors. We aimed to adapt an analogic to an online questionnaire to help HIV and HCV screening and perform a pilot study to assess its accuracy and acceptability. We used the Delphi method to adapt a previously validated analogical questionnaire to a user-friendly online tool. It aimed to identify participants who should be screened for HIV or HCV and those who should be referred for pre-exposure prophylaxis (PrEP). We then designed a proof-of-concept pilot study from July to October 2022 to test its feasibility and suitability for use on a larger scale and to assess its accuracy in identifying patients at risk for HIV or HCV or with indication for PrEP. The final questionnaire consisted of 37 questions. A total of 142 participants provided informed consent, and 102 completed the questionnaire: 41 random patients recruited at the primary care level, 10 participants recently diagnosed with HIV, 20 participants with HIV on follow-up, 21 participants from the PrEP program, and 10 patients diagnosed with HCV. The tool adequately indicated the need for testing in more than 98% of participants with confirmed HIV/HCV infections or in the PrEP program. Furthermore, it adequately assessed PrEP referral in 94% of participants already on PrEP or with known HIV infection. Participants were highly satisfied with the tool, and 98% of them recommended its use. A self-administered web-based tool to identify patients who should be tested for HIV or HCV or referred to PrEP could simplify patient selection and help reduce late diagnosis.
Collapse
Affiliation(s)
- Alejandro G. García-Ruiz de Morales
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Viejo, Km 9.100, 28034 Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Medicine, University of Alcalá, 28801 Alcalá de Henares, Spain
| | - María Jesús Vivancos
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Viejo, Km 9.100, 28034 Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Jorge Lázaro
- Department of Medicine, University of Alcalá, 28801 Alcalá de Henares, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Beatriz Romero Hernández
- CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
- Department of Microbiology, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain
| | - Beatriz Mateos
- Department of Gastroenterology, Hospital Universitario Ramón y Cajal, IRYCIS, 28034 Madrid, Spain
| | | | | | | | - Santiago Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Viejo, Km 9.100, 28034 Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Medicine, University of Alcalá, 28801 Alcalá de Henares, Spain
| | - Javier Martínez-Sanz
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Viejo, Km 9.100, 28034 Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - María Jesús Pérez-Elías
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Carretera de Colmenar Viejo, Km 9.100, 28034 Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain
| |
Collapse
|
2
|
Vliegenthart-Jongbloed KJ, Vasylyev M, Jordans CCE, Bernardino JI, Nozza S, Psomas CK, Voit F, Barber TJ, Skrzat-Klapaczyńska A, Săndulescu O, Rokx C. Systematic Review: Strategies for Improving HIV Testing and Detection Rates in European Hospitals. Microorganisms 2024; 12:254. [PMID: 38399659 PMCID: PMC10892502 DOI: 10.3390/microorganisms12020254] [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: 12/22/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
Undiagnosed HIV infection is a prominent clinical issue throughout Europe that requires the continuous attention of all healthcare professionals and policymakers to prevent missed testing opportunities and late diagnosis. This systematic review aimed to evaluate interventions to increase HIV testing rates and case detection in European hospitals. Out of 4598 articles identified, 29 studies fulfilled the selection criteria. Most of the studies were conducted in single Western European capital cities, and only one study was from Eastern Europe. The main interventions investigated were test-all and indicator-condition-based testing strategies. Overall, the prevalence of undiagnosed HIV was well above 0.1%. The studied interventions increased the HIV testing rate and the case detection rate. The highest prevalence of undiagnosed HIV was found with the indicator-condition-driven testing strategy, whereas the test-all strategy had the most profound impact on the proportion of late diagnoses. Nevertheless, the HIV testing rates and case-finding varied considerably across studies. In conclusion, effective strategies to promote HIV testing in European hospitals are available, but relevant knowledge gaps regarding generalizability and sustainability remain. These gaps require the promotion of adherence to HIV testing guidelines, as well as additional larger studies representing all European regions.
Collapse
Affiliation(s)
- Klaske J. Vliegenthart-Jongbloed
- Section Infectious Diseases, Department of Internal Medicine, Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; (K.J.V.-J.); (M.V.)
| | - Marta Vasylyev
- Section Infectious Diseases, Department of Internal Medicine, Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; (K.J.V.-J.); (M.V.)
- Astar Medical Center, 79041 Lviv, Ukraine
| | - Carlijn C. E. Jordans
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands;
| | - Jose I. Bernardino
- HIV and Infectious Diseases Section, Department of Internal Medicine, Hospital Universitario La Paz-Carlos III, IdiPAZ, 28029 Madrid, Spain;
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, CIBERINFEC, 28029 Madrid, Spain
| | - Silvia Nozza
- Department of Infectious Diseases, Università Vita Salute IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | | | - Florian Voit
- Department of Internal Medicine II, University Hospital Rechts der Isar, School of Medicine, Technical University of Munich, 80333 Munich, Germany;
| | - Tristan J. Barber
- Department of HIV Medicine, Royal Free Hospital, London NW3 2QG, UK;
- Institute for Global Health, University College London, London WC1E 6BT, UK
| | - Agata Skrzat-Klapaczyńska
- Department of Adults’ Infectious Diseases, Hospital for Infectious Diseases, Medical University of Warsaw, Wolska Street 37, 01-201 Warsaw, Poland;
| | - Oana Săndulescu
- Department of Infectious Diseases I, Carol Davila University of Medicine and Pharmacy Bucharest, No. 1 Dr. Calistrat Grozovici Street, 021105 Bucharest, Romania;
- National Institute for Infectious Diseases “Prof. Dr. Matei Balș”, No. 1 Dr. Calistrat Grozovici Street, 021105 Bucharest, Romania
| | - Casper Rokx
- Section Infectious Diseases, Department of Internal Medicine, Erasmus University Medical Center, 3015 CN Rotterdam, The Netherlands; (K.J.V.-J.); (M.V.)
- Astar Medical Center, 79041 Lviv, Ukraine
| |
Collapse
|
3
|
Bogers SJ, Schim van der Loeff MF, Boyd A, Davidovich U, van der Valk M, Brinkman K, Sigaloff K, Branger J, Bokhizzou N, de Bree GJ, Reiss P, van Bergen JE, Geerlings SE. Improving indicator-condition guided testing for HIV in the hospital setting (PROTEST 2·0): A multicenter, interrupted time-series analysis. THE LANCET REGIONAL HEALTH. EUROPE 2022; 23:100515. [PMID: 36246146 PMCID: PMC9558045 DOI: 10.1016/j.lanepe.2022.100515] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Indicator-condition (IC) guided HIV testing is a feasible and cost-effective strategy to identify undiagnosed people living with HIV (PLHIV), but remains insufficiently implemented. We aimed to promote IC-guided HIV testing in seven ICs. METHODS Relevant departments in five hospitals of the Amsterdam region participated. HIV testing among adult patients without known HIV infection but with an IC was assessed using electronic health records during pre-intervention (January 2015-June 2020) and intervention (July 2020-June 2021) periods. The multifaceted intervention included audit and feedback. The primary endpoint was HIV testing ≤3 months before or after IC diagnosis and the effect of the intervention was evaluated using segmented Poisson regression. FINDINGS Data from 7986 patients were included, of whom 6730 (84·3%) were diagnosed with an IC in the pre-intervention period and 1256 (15·7%) in the intervention period. The proportion HIV tested ≤3 months before or after IC diagnosis increased from 36.8% to 47.0% (adjusted risk ratio [RR]= 1.16, 95% CI=1.03-1.30, p=0.02). For individual ICs, we observed significant increases in HIV testing among patients with cervical cancer or intraepithelial neoplasia grade 3 (adjusted RR=3.62, 95% CI=1.93-6.79) and peripheral neuropathy (adjusted RR=2.27 95% CI=1.48-3.49), but not the other ICs. Eighteen of 3068 tested patients were HIV positive (0.6%). INTERPRETATION Overall IC-guided testing improved after the intervention, but not for all ICs. Variations in effect by IC may have been due to variations in implemented developments, but the effect of separate elements could not be assessed. FUNDING HIV Transmission Elimination Amsterdam (H-TEAM) initiative, Aidsfonds (grant number: P-42702).
Collapse
Affiliation(s)
- Saskia J. Bogers
- Amsterdam UMC location University of Amsterdam,
Internal Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity,
Infectious Diseases, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of
Care, Amsterdam, the Netherlands
| | - Maarten F. Schim van der Loeff
- Amsterdam UMC location University of Amsterdam,
Internal Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity,
Infectious Diseases, Amsterdam, the Netherlands
- Department of Infectious Diseases, Public Health
Service of Amsterdam, Amsterdam, the Netherlands
| | - Anders Boyd
- Amsterdam Institute for Infection and Immunity,
Infectious Diseases, Amsterdam, the Netherlands
- Department of Infectious Diseases, Public Health
Service of Amsterdam, Amsterdam, the Netherlands
- Stichting hiv monitoring, Amsterdam, the
Netherlands
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health
Service of Amsterdam, Amsterdam, the Netherlands
| | - Marc van der Valk
- Amsterdam UMC location University of Amsterdam,
Internal Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity,
Infectious Diseases, Amsterdam, the Netherlands
- Stichting hiv monitoring, Amsterdam, the
Netherlands
| | - Kees Brinkman
- Department of Internal Medicine, Onze Lieve Vrouwe
Gasthuis, Amsterdam, the Netherlands
| | - Kim Sigaloff
- Amsterdam Institute for Infection and Immunity,
Infectious Diseases, Amsterdam, the Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam,
Internal Medicine, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Judith Branger
- Department of Internal Medicine, Flevoziekenhuis,
Almere, the Netherlands
| | - Nejma Bokhizzou
- Department of Internal Medicine, BovenIJ ziekenhuis,
Amsterdam, the Netherlands
| | - Godelieve J. de Bree
- Amsterdam UMC location University of Amsterdam,
Internal Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - Peter Reiss
- Amsterdam UMC location University of Amsterdam,
Internal Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam institute for Global Health and Development,
Amsterdam, the Netherlands
- Amsterdam UMC location University of Amsterdam, Global
Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jan E.A.M. van Bergen
- Amsterdam UMC location University of Amsterdam, General
Practice, Meibergdreef 9, Amsterdam, the Netherlands
- STI AIDS Netherlands, Amsterdam, the
Netherlands
| | - Suzanne E. Geerlings
- Amsterdam UMC location University of Amsterdam,
Internal Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity,
Infectious Diseases, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of
Care, Amsterdam, the Netherlands
| | | |
Collapse
|
4
|
Bulteel N, Henderson N, Parris V, Capstick R, Premchand N, Hunter E, Perry M. HIV testing in secondary care: a multicentre longitudinal mixed methods electronic survey of non-HIV specialist hospital physicians in South-East Scotland and Northern England. J R Coll Physicians Edinb 2021; 51:230-236. [PMID: 34528609 DOI: 10.4997/jrcpe.2021.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Increasing the uptake of HIV testing in people who may have undiagnosed HIV is essential to reduce the morbidity associated with late HIV diagnosis. METHODS We conducted a multicentre, longitudinal, mixed-methods study, surveying the attitudes, knowledge and practice of non-HIV specialist hospital physicians in South-East Scotland and North-East England with respect to HIV testing. RESULTS We found that although awareness of indications for HIV testing had improved over time, only 13% of clinicians recognised all of the surveyed HIV indicator conditions. Physicians were better at recognising the indicator conditions relevant to their specialty. The perception of working with a low-risk patient population was the most frequently cited barrier to offering an HIV test. Only a third of study respondents had requested more than 10 HIV tests in the preceding year. CONCLUSIONS Our study supports a need for targeted and sustained educational initiatives to increase rates of HIV testing in secondary care.
Collapse
Affiliation(s)
| | - Naomi Henderson
- Edinburgh Clinical Infection Research Group, NHS Lothian Infection Service, NHS Lothian
| | | | | | - Nikhil Premchand
- Department of Clinical Infection, Northumbria Healthcare NHS Foundation Trust
| | - Ewan Hunter
- Department of Infection and Tropical Medicine, The Newcastle-upon-Tyne Hospitals NHS Foundation Trust
| | - Meghan Perry
- Edinburgh Clinical Infection Research Group, NHS Lothian Infection Service and Epidemiology Research Group, Usher Institute, University of Edinburgh
| |
Collapse
|
5
|
Sokhi D, Suleiman A, Manji S, Hooker J, Mativo P. Cases of neuromyelitis optica spectrum disorder from the East Africa region, highlighting challenges in diagnostics and healthcare access. eNeurologicalSci 2021; 22:100320. [PMID: 33553703 PMCID: PMC7844578 DOI: 10.1016/j.ensci.2021.100320] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/22/2020] [Accepted: 01/17/2021] [Indexed: 11/29/2022] Open
Abstract
Background Neuromyelitis optica spectrum disorder (NMOSD) is an auto-immune disease of the central nervous system (CNS) associated with the IgG-antibody against aquaporin-4 (AQP4-IgG). There is little published epidemiology of NMOSD from sub-Saharan Africa (SSA). Methods We retrospectively collated NMOSD cases admitted to our tertiary regional neurology centre. Results We identified 11 cases (10 female, average age 30 years). 64% (7/11) were seropositive for AQP4-IgG, measured using indirect immunofluorescence. The remaining cases could either not afford tests, or had pathognomonic radiological features. 57% (4/7) of seropositive cases had concurrent/recent CNS infection. All patients were treated with high-dose intravenous methylprednisolone (IVMP), and 36% (4/11) also had plasma exchange. Only 55% (6/11) of the patients were seen by a neurologist at presentation: they had less relapses (1.3 vs 2.4), less diagnostic delay (2.3 vs 7.4 months), and were less disabled at the end of our review period. 10 cases were immunosuppressed long-term: 60% on mycophenolate, 30% azathioprine, and one on rituximab. Conclusion Our study is the largest case series of NMOSD from the East Africa region. Patients faced challenges of access to appropriate and affordable testing, and timely availability of a neurologist at onset, which had impacts on their functional outcomes. The majority of the seropositive cases had recent/concurrent CNS infections, suggesting triggered auto-immunity.
Collapse
Key Words
- CNS, Central nervous system
- CSF, Cerebrospinal fluid
- EDSS, Extended Disability Status Scale
- HIV, Human immunodeficiency virus
- HSV-2, Herpes simplex virus type 2
- ICD-10, nternational Classification of Diseases version 10
- IPND, International Panel for NMOSD Diagnosis
- IVMP, Intravenous methylprednisolone
- LETM, Longitudinally extensive tranverse myelitis
- MMF, Mycophenolate mofetil
- MOG, Myelin oligodendrocyte glycoprotein
- MRI, Magnetic resonance imaging
- NMOSD, Neuromyelitis optica spectrum disorder
- Neuro-immunology
- Neuro-inflammation
- Neuromyelitis optica spectrum disorder
- OCBs, Oligoclonal bands
- ON, Bilateral simultaneous or sequential optic neuritis
- PLEX, Plasma exchange
- RRMS, Relapsing-remitting multiple sclerosis
- RTX, Rituximab
- Sub-Saharan Africa
- TPHA, Treponema pallidum haemagglutination assay
- nd, not done
Collapse
Affiliation(s)
- Dilraj Sokhi
- Department of Medicine, Faculty of Health Sciences, Aga Khan University Medical College of East Africa, Nairobi, Kenya.,The Aga Khan University Hospital, Nairobi, Kenya
| | - Adil Suleiman
- Department of Medicine, Faculty of Health Sciences, Aga Khan University Medical College of East Africa, Nairobi, Kenya.,The Aga Khan University Hospital, Nairobi, Kenya
| | - Soraiya Manji
- Department of Medicine, Faculty of Health Sciences, Aga Khan University Medical College of East Africa, Nairobi, Kenya.,The Aga Khan University Hospital, Nairobi, Kenya
| | - Juzar Hooker
- The Aga Khan University Hospital, Nairobi, Kenya
| | - Peter Mativo
- Department of Medicine, Faculty of Health Sciences, Aga Khan University Medical College of East Africa, Nairobi, Kenya.,The Aga Khan University Hospital, Nairobi, Kenya
| |
Collapse
|
6
|
Luu MN, Wada PY, Levine-Hall T, Hurley L, Ramalingam N, Tran HN, Slome SB. Using a report card to increase HIV screening in a large primary care group practice. BMJ Open Qual 2021; 10:bmjoq-2020-000988. [PMID: 33414253 PMCID: PMC7797258 DOI: 10.1136/bmjoq-2020-000988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 12/08/2020] [Accepted: 12/29/2020] [Indexed: 11/15/2022] Open
Abstract
Background Despite increased efforts to promote HIV screening, a large proportion of the US population have never been tested for HIV. Objective To determine whether provider education and personalised HIV screening report cards can increase HIV screening rates within a large integrated healthcare system. Design This quality improvement study provided a cohort of primary care physicians (PCPs) a brief educational intervention and personalised HIV screening report cards with quarterly performance data. Participants Participants included a volunteer cohort of 20 PCPs in the department of adult and family medicine. Main measures Per cent of empaneled patients screened for HIV by cohort PCPs compared with PCPs at the Kaiser Permanente Oakland Medical Center (KPOAK) and the non-Oakland Medical Centers in Northern California region (Kaiser Permanente Northern California (KPNC)). Key results Of the 20 participating PCPs, 13 were female and 7 were male. Thirteen were internal medicine and seven family medicine physicians. The average age was 40 years and average practice experience was 9 years after residency. During the 12-month intervention, the estimated increase in HIV screening in the cohort PCP group was 2.6% as compared with 1.9% for KPOAK and 1.8% for KPNC. Conclusions These findings suggest that performance-related report cards are associated with modestly increased rates of HIV screening by PCPs.
Collapse
Affiliation(s)
- Mitchell N Luu
- Adult and Family Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Paul Y Wada
- Graduate Medical Education, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Tory Levine-Hall
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Leo Hurley
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Nirmala Ramalingam
- Graduate Medical Education, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - H Nicole Tran
- Graduate Medical Education, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Sally B Slome
- Infectious Diseases, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| |
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|