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Risk-Based Screening Tools to Optimise HIV Testing Services: a Systematic Review. Curr HIV/AIDS Rep 2022; 19:154-165. [PMID: 35147855 PMCID: PMC8832417 DOI: 10.1007/s11904-022-00601-5] [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] [Accepted: 01/31/2022] [Indexed: 12/31/2022]
Abstract
Purpose of review Effective ways to diagnose the remaining people living with HIV who do not know their status are a global priority. We reviewed the use of risk-based tools, a set of criteria to identify individuals who would not otherwise be tested (screen in) or excluded people from testing (screen out). Recent findings Recent studies suggest that there may be value in risk-based tools to improve testing efficiency (i.e. identifying those who need to be tested). However, there has not been any systematic reviews to synthesize these studies. Summary We identified 18,238 citations, and 71 were included. The risk-based tools identified were most commonly from high-income (51%) and low HIV (<5%) prevalence countries (73%). The majority were for “screening in” (70%), with the highest performance tools related to identifying MSM with acute HIV. Screening in tools may be helpful in settings where it is not feasible or recommended to offer testing routinely. Caution is needed for screening out tools, where there is a trade-off between reducing costs of testing with missing cases of people living with HIV. Supplementary Information The online version contains supplementary material available at 10.1007/s11904-022-00601-5.
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Boyd SE, Allison J, Penney CC, Burt K, Allison D, Daley PK. Timeliness of diagnosis of HIV in Newfoundland and Labrador, Canada: A mixed-methods study. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2019; 4:15-23. [PMID: 36338782 PMCID: PMC9603191 DOI: 10.3138/jammi.2018-0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/10/2018] [Indexed: 06/16/2023]
Abstract
BACKGROUND Late diagnosis of HIV is associated with poor outcomes and increased cost. Novel HIV testing promotion strategies may reduce late diagnosis. The purpose of this study was to determine the timeliness of HIV testing in Newfoundland and Labrador (NL), missed opportunities for testing, and barriers to HIV testing. METHODS Demographic and clinical information from individuals diagnosed with HIV in NL from 2006-2016 was retrospectively reviewed. Patients were also invited to participate in semi-structured interviews regarding knowledge about HIV transmission, risk associated with their behaviour, testing decision making, and testing opportunities. RESULTS Fifty-eight new HIV diagnoses occurred during the study period: 53/58 (91.4%) were male and 33/58 (56.9%) were men who have sex with men. The mean age at diagnosis was 40.6 (SD 11.05) years. CD4 count at diagnosis ranged from 2 to 1,408 cells/mm3, with a mean of 387 cells/mm3. For 39/58 (67.2%) of individuals, the first-ever HIV test was positive. Of the 58 patients, 55 (94.8%) had had health care contact within the 5 years prior to diagnosis (mean 13.7 contacts). Heterosexual men were more likely to present with a late diagnosis (p = 0.049). Ten (17.2%) individuals agreed to an interview. Thematic analysis revealed that barriers to testing were stigma, negative health care interactions, denial, and fear of the diagnosis. CONCLUSIONS HIV diagnosis is made later in NL than in other Canadian provinces. Late diagnosis may be prevented if HIV testing became a routine testing procedure.
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Affiliation(s)
- Sarah Elizabeth Boyd
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Jill Allison
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Carla Chantil Penney
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | | | - David Allison
- Eastern Health Region, St. John’s, Newfoundland, Canada
| | - Peter Kenneth Daley
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
- Eastern Health Region, St. John’s, Newfoundland, Canada
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Reyes-Urueña J, Fernàndez-López L, Casabona J. Cribado del VIH con base en condiciones indicadoras y conductas de riesgo en los servicios de urgencias. Enferm Infecc Microbiol Clin 2018; 36:392. [DOI: 10.1016/j.eimc.2017.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 11/18/2017] [Indexed: 10/18/2022]
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Reyes-Urueña J, Fernàndez-López L, Casabona J. Respondiendo el cómo, cuándo y a quién. Cribado selectivo del VIH en los servicios de urgencias. Enferm Infecc Microbiol Clin 2018; 36:205. [DOI: 10.1016/j.eimc.2017.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 11/01/2017] [Indexed: 10/18/2022]
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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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Nunn A, Towey C, Chan PA, Parker S, Nichols E, Oleskey P, Yolken A, Harvey J, Banerjee G, Stopka T, Trooskin S. Routine HIV Screening in an Urban Community Health Center: Results from a Geographically Focused Implementation Science Program. Public Health Rep 2016; 131 Suppl 1:30-40. [PMID: 26862228 DOI: 10.1177/00333549161310s105] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE CDC has recommended routine HIV screening since 2006. However, few community health centers (CHCs) routinely offer HIV screening. Research is needed to understand how to implement routine HIV screening programs, particularly in medically underserved neighborhoods with high rates of HIV infection. A routine HIV screening program was implemented and evaluated in a Philadelphia, Pennsylvania, neighborhood with high rates of HIV infection. METHODS Implementation science is the study of methods to promote the integration of research findings and evidence into health-care policy and practice. Using an implementation science approach, the results of the program were evaluated by measuring acceptability, adoption, and penetration of routine HIV screening. RESULTS A total of 5,878 individuals were screened during the program. HIV screening was highly accepted among clinic patients. In an initial needs assessment of 516 patients, 362 (70.2%) patients reported that they would accept testing if offered. Routine screening policies were adopted clinic-wide. Staff trainings, new electronic medical records that prompted staff members to offer screening and evaluate screening rates, and other continuing quality-improvement policies helped promote screenings. HIV screening offer rates improved from an estimated 5.0% of eligible patients at baseline in March 2012 to an estimated 59.3% of eligible patients in December 2014. However, only 5,878 of 13,827 (42.5%) patients who were offered screening accepted it, culminating in a 25.2% overall screening rate. Seventeen of the 5,878 patients tested positive, for a seropositivity rate of 0.3%. CONCLUSION Routine HIV screening at CHCs in neighborhoods with high rates of HIV infection is feasible. Routine screening is an important tool to improve HIV care continuum outcomes and to address racial and geographic disparities in HIV infection.
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Affiliation(s)
- Amy Nunn
- Rhode Island Public Health Institute, Providence, RI; Brown University, School of Public Health, Providence, RI
| | - Caitlin Towey
- Rhode Island Public Health Institute, Providence, RI
| | - Philip A Chan
- Brown University, School of Public Health, Providence, RI
| | | | - Emily Nichols
- Family Practice & Counseling Network, Philadelphia, PA
| | | | | | - Julia Harvey
- Rhode Island Public Health Institute, Providence, RI
| | - Geetanjoli Banerjee
- Brown University, School of Public Health, Department of Epidemiology, Providence, RI
| | | | - Stacey Trooskin
- Drexel University, College of Medicine, Division of Infectious Diseases and HIV Medicine, Philadelphia, PA
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Lyons MS, Lindsell CJ, Ruffner AH, Wayne DB, Hart KW, Sperling MI, Trott AT, Fichtenbaum CJ. Randomized comparison of universal and targeted HIV screening in the emergency department. J Acquir Immune Defic Syndr 2013; 64:315-23. [PMID: 23846569 PMCID: PMC4241750 DOI: 10.1097/qai.0b013e3182a21611] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Universal HIV screening is recommended but challenging to implement. Selectively targeting those at risk is thought to miss cases, but previous studies are limited by narrow risk criteria, incomplete implementation, and absence of direct comparisons. We hypothesized that targeted HIV screening, when fully implemented and using maximally broad risk criteria, could detect nearly as many cases as universal screening with many fewer tests. METHODS This single-center cluster-randomized trial compared universal and targeted patient selection for HIV screening in a lower prevalence urban emergency department. Patients were excluded for age (<18 and >64 years), known HIV infection, or previous approach for HIV testing that day. Targeted screening was offered for any risk indicator identified from charts, staff referral, or self-disclosure. Universal screening was offered regardless of risk. Baseline seroprevalence was estimated from consecutive deidentified blood samples. RESULTS There were 9572 eligible visits during which the patient was approached. For universal screening, 40.8% (1915/4692) consented with 6 being newly diagnosed [0.31%, 95% confidence interval (CI): 0.13% to 0.65%]. For targeted screening, 37% (1813/4880) had no testing indication. Of the 3067 remaining, 47.4% (1454) consented with 3 being newly diagnosed (0.22%, 95% CI: 0.06% to 0.55%). Estimated seroprevalence was 0.36% (95% CI: 0.16% to 0.70%). Targeted screening had a higher proportion consenting (47.4% vs. 40.8%, P < 0.002), but a lower proportion of ED encounters with testing (29.7% vs. 40.7%, P < 0.002). CONCLUSIONS Targeted screening, even when fully implemented with maximally permissive selection, offered no important increase in positivity rate or decrease in tests performed. Universal screening diagnosed more cases, because more were tested, despite a modestly lower consent rate.
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Affiliation(s)
- Michael S. Lyons
- Department of Emergency Medicine, University of Cincinnati College of Medicine
| | | | - Andrew H. Ruffner
- Department of Emergency Medicine, University of Cincinnati College of Medicine
| | - D. Beth Wayne
- Department of Emergency Medicine, University of Cincinnati College of Medicine
| | - Kimberly W. Hart
- Department of Emergency Medicine, University of Cincinnati College of Medicine
| | - Matthew I. Sperling
- Department of Emergency Medicine, University of Cincinnati College of Medicine
| | - Alexander T. Trott
- Department of Emergency Medicine, University of Cincinnati College of Medicine
| | - Carl J. Fichtenbaum
- Division of Infectious Diseases, University of Cincinnati College of Medicine
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Czarnogorski M, Halloran Cns J, Pedati C, Dursa EK, Durfee J, Martinello R, Davey V, Ross D. Expanded HIV testing in the US Department of Veterans Affairs, 2009-2011. Am J Public Health 2013; 103:e40-5. [PMID: 24134344 DOI: 10.2105/ajph.2013.301376] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We measured HIV testing and seropositivity among veterans in Veterans Affairs (VA) care for calendar years 2009 through 2011 and analyzed 2011 results by patient demographics. METHODS We performed a repeated-measures cross-sectional study using standardized electronic data extraction from the VA electronic health records for all veterans with at least 1 outpatient visit during 2009 through 2011. We analyzed testing rates and seropositivity by demographic characteristics for 2011. RESULTS Of veterans with an outpatient visit, 20.0% had an HIV test in 2011, compared with 9.2% in 2009. Documented HIV testing rates were highest in women and Blacks. Of confirmed positive test results, 67.0% were in outpatients older than 50 years. Seropositivity was highest among men aged 30 to 49 years, women aged 50 to 69 years, and Black outpatients of both genders. Implementation of an electronic clinical reminder was associated with higher testing rates. CONCLUSIONS The significant effect of an electronic clinical reminder suggests that such decision support tools can substantially increase testing rates. The frequency of positive test results in older individuals suggests the need for additional work to define optimum approaches to HIV testing in this population.
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Affiliation(s)
- Maggie Czarnogorski
- All authors are with the Department of Veterans Affairs, Office of Public Health, Washington, DC
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Point-of-Care HIV Testing and Linkage in an Urban Cohort in the Southern US. AIDS Res Treat 2013; 2013:789413. [PMID: 24159384 PMCID: PMC3789279 DOI: 10.1155/2013/789413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 06/14/2013] [Accepted: 07/23/2013] [Indexed: 11/18/2022] Open
Abstract
The Southern states experience the highest rates of HIV and AIDS in the US, and point-of-care (POC) testing outside of primary care may contribute to status awareness in medically underserved populations in this region. To evaluate POC screening and linkage to care at an urban south site, analyses were performed on a dataset of 3,651 individuals from an integrated rapid-result HIV testing and linkage program to describe this test-seeking cohort and determine trends associated with screening, results, and linkage to care. Four percent of the population had positive results. We observed significant differences by test result for age, race and gender, reported risk behaviors, test location, and motivation for screening. The overall linkage rate was 86%, and we found significant differences for clients who were linked to HIV care versus persons whose linkage could not be confirmed with respect to race and gender, location, and motivation. The linkage rate for POC testing that included a comprehensive intake visit and colocated primary care services for in-state residents was 97%. Additional research on integrated POC screening and linkage methodologies that provide intake services at time of testing is essential for increasing status awareness and improving linkage to HIV care in the US.
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Greater HIV testing after Veterans Health Administration policy change: the experience from a VA Medical Center in a high HIV prevalence area. J Acquir Immune Defic Syndr 2012; 60:165-8. [PMID: 22627183 DOI: 10.1097/qai.0b013e318251aefe] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Veterans Health Administration changed its HIV testing policy to remove requirements for written informed consent with pretest/posttest counseling and to make testing part of routine care in August 2009. HIV testing percentages were compared for 1-year periods before and after this change at our medical center located in Washington, DC, the city with the highest US HIV prevalence. After this policy change, HIV screening rose from 5.5% to 10.3% of persons in care with the majority of testing in outpatient settings and the greatest increase among veterans aged 61-70. Broadening of HIV testing has significance for HIV detection and prevention.
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