Barreras para el diagnóstico de las infecciones de transmisión sexual y virus de la inmunodeficiencia humana en Atención Primaria en España

[Evaluation of the approach to sexuality in primary care consultations in Spain: A multicentre comparative study (2004-2017)]

OBJECTIVE

To describe how sexuality is addressed in general practitioners' (GP) consultations, as well as to compare the results of a questionnaire carried out in 2017 that updated the data obtained from a 2004 survey.

MATERIAL AND METHODS

Descriptive, analytical, multicentre study with 2cross-sections. Of the 3,500 GP who met the selection criteria (holding current accreditation as a resident tutor and being an active worker at the time of the study), 598 doctors participated in the survey in 2017 and 357 in 2004.

RESULTS

In both studies, the majority (98.6% in 2017 and 96% in 2004) consider that the sexual sphere is an important component in people's health, but less than half (40, 6% in 2017 and 21.6% in 2004) systematically recorded it in their clinical history. The main source of training in sexuality in both studies were continuing education courses (50.6% in 2017 and 31.4% in 2004). The main barriers found in both studies were lack of time (85.5% in 2017 and 82.1% in 2004) and lack of training (75.2% in 2017 and 74.5% in 2004).

CONCLUSIONS

GP are aware of the importance of sexuality in people's health, despite this, few professionals systematically record it in their medical records. The main source of training in sexuality is continuing education courses, which has increased in recent years. The main barriers in both studies are lack of time and poor training.

Exploration of clients living with HIV needs for reporting on experiences with sex

Talking about sex with people living with HIV receives insufficient attention in health care. A cross-sectional and exploratory study describes the preferences of people living with HIV to talk about sex with specialized HIV physicians and nurses in a clinic in Barcelona (Spain). A 27-item self-administered questionnaire was used between June 2017 and May 2018. One hundred fourteen people agreed to participate. Data were analyzed using multivariate logistic regression. Most of the participants reported "never or almost never" having been asked about sex practices in visits with the HIV specialist physician (n = 65 [57.0%]) or nurse (n = 74 [64.9%]). Older participants stated that neither physicians nor nurses talked about sex during visits. Women felt that physicians hardly ever asked about their sexual practices. Men who had sex with other men indicated that their physicians always asked about their sex practices compared with heterosexuals living with HIV. Health professionals should reformulate how to talk about sex with people living with HIV to facilitate communication and provide adequate care.

Prevalence and Risk Factors for HIV Infection in a Population of Homosexual, Bisexual, and Other Men Who Have Sex with Men in the Metropolitan Region of Chile: A Re-emerging Health Problem

According to the most recent UNAIDS report, the number of new HIV infections has increased by 34% since 2010 in Chile, representing the largest increase in the Americas. The objective of this study was to identify factors associated with HIV prevalence among men who have sex with men (MSM) in the metropolitan region (MR) of Santiago, Chile. Cross-sectional study of MSM living in the MR, recruited using respondent-driven sampling (RDS). Participants were tested using Human Immunodeficiency virus rapid test, and reactive cases were confirmed withELISA. Participants were interviewed using a questionnaire adapted for the Chilean population. Descriptive and logistic regression analyses were then performed. All applicable ethical norms were followed in the execution of this study. The total sample consisted of 375 individuals. HIV prevalence among MSM was 17.6% overall. Among the HIV-negative men, most (71.5%) had not been tested for sexually-transmitted diseases (STIs) other than HIV in the past 12 months, and 24.1% had never been tested for HIV. Participants who had been tested for an STI other than HIV in the past 12 months had a 3.56-fold greater OR for HIV-positive status than those who had not. Conversely, having had an HIV test in the past 12 months was a protective factor against positive HIV status (OR = 0.09). The high prevalence of HIV among MSM suggests a re-emergence of the disease in Chile, and cases are specifically concentrated among young MSM. Access to sexual health care and STI testing in Chile is insufficient. Targeted prevention efforts are urgently needed as part of the Chilean national strategy to combat the spread of HIV, including community-based testing programs.

[Acceptability of the opportunistic search for human immunodeficiency virus infection by serology in patients recruited in Primary Care Centres in Spain]

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.

Perception of nurses who perform rapid tests in Health Centers

ABSTRACT Objective: Learn about the perception of health professionals who perform rapid tests in Health Centers (HCs). Method: This is a descriptive and qualitative study conducted in nine HCs in Recife. Data were collected through individual interviews and evaluated using Bardin’s content analysis, in its thematic category. Results: Challenges were observed in rapid tests related to the supply of products, physical structure, training for pre- and post-test counseling, and the need for improvements in permanent education actions. Final considerations: These issues can be resolved with management improvements, systematization of permanent education activities, and definition of care flows that enable early diagnosis. Besides the diagnosis, care lines should be created for people living with HIV and AIDS who use the HCs for early health care process.

Indicator condition based HIV testing: Missed opportunities for earlier diagnosis in men who have sex with men

INTRODUCTION

Contact with the healthcare system by a sample of seropositive men who have sex with men (MSM) prior to their HIV diagnosis are analysed, and missed opportunities (MO) for an earlier HIV diagnosis are identified.

METHODOLOGY

Between 2012-2013, an online survey was conducted among HIV-positive MSM, mainly recruited from gay websites. Those who were diagnosed with HIV between 2010-2013 were analysed. MO were defined as episodes prior to the HIV diagnosis in which the healthcare system was contacted due to an indicator condition of HIV infection and the test was not suggested. The proportion of missed opportunities were compared according to the type of indicator condition, the department consulted and the healthcare professional's knowledge that the patient was MSM.

RESULTS

Overall, 639 participants (66% of 966) reported 1,145 episodes with some indicator condition, the majority of these being identified in primary care (n=527; 46%). The highest percentage of MOs is also observed in primary care (63%). Although the indicator condition with the highest number of MOs was STIs (n=124), the highest percentage of MOs was observed in consultations due to diarrhoea with no known cause (69.8%). The percentage of MOs when the doctor knew that the patient was MSM was 40 vs. 70% when the doctor did not know.

CONCLUSION

The majority of HIV-positive MSM analysed in this study went to healthcare services for HIV-infection indicator conditions prior to their HIV diagnosis. Primary care was the most-frequently-visited department and is also where the most opportunities were missed to perform an HIV test, even when it was known that the patient was a MSM.

[Early diagnosis of HIV in Primary Care in Spain. Results of a pilot study based on targeted screening based on indicator conditions, behavioral criteria and region of origin]

Objetivos

Estimar la prevalencia de la infección por VIH en pacientes diagnosticados con una condición indicadora (CI) para el VIH y/o que habían tenido una conducta de riesgo para su adquisición y/o que provenían de países con elevada prevalencia. Determinar la aceptabilidad y viabilidad de ofrecer la prueba del VIH basada en CI y criterios conductuales y de origen en atención primaria (AP).

Diseño

Estudio transversal en una muestra de conveniencia.

Emplazamiento

Seis centros de AP en España.

Participantes

Los criterios de inclusión fueron: pacientes entre 16 y 65 años que presentaban al menos una de las CI propuestas y/o al menos uno de los criterios conductuales y/o de origen propuestos. Participaron 388 pacientes.

Intervención

Se ofreció la serología del VIH a todos los pacientes que cumplían con los criterios de inclusión.

Mediciones principales

Descripción de la frecuencia de CI, criterios conductuales y de origen. Prevalencia de infección por VIH. Nivel de aceptabilidad y viabilidad de la oferta de la prueba del VIH basada en criterios conductuales y de origen y CI.

Resultados

Un total de 174 pacientes presentaron una CI (44,84%). El criterio conductual más común fue: haber mantenido relaciones sexuales desprotegidas alguna vez en la vida con personas que desconocían su estado serológico para el VIH (298; 76,8%). Se diagnosticaron 4 pacientes VIH+ (1,03%). Todos presentaban una CI y eran hombres que mantenían sexo con hombres. El nivel de aceptabilidad en AP fue elevada.

Conclusiones

Ofrecer la prueba del VIH a pacientes con CI y criterios conductuales es viable y efectiva en AP.

[Acceptability and feasibility among primary care doctors of the opportunistic search for HIV in Health Care centers in Spain]

Objetivo

Valorar la aceptabilidad y la factibilidad de la búsqueda oportunista del VIH por parte de los profesionales de atención primaria. Conocer el perfil del médico que participa en este tipo de estudio.

Diseño

Estudio observacional, transversal.

Emplazamiento

Centros de atención primaria del Sistema Nacional de Salud.

Participantes

Médicos de familia y residentes que participaron en el estudio VIH-AP para medir la aceptabilidad de la búsqueda oportunista del VIH por parte de los pacientes.

Mediciones principales

Mediante encuesta autocumplimentada se determinó: edad, sexo, cualidad de docente, años de investigación, tiempo trabajando con el mismo cupo, aceptabilidad y factibilidad de la búsqueda oportunista del VIH.

Resultados

Un total de 197 médicos con una media de edad de 45,2 ± 9,7 (DT) años. El 18,8% eran menores de 36 años, el 70,1% mujeres y el 62,4% docentes. El 55,8% trabajaban en localidades mayores de 100.000 habitantes y la media de años ocupando el mismo cupo fue de 6,4 ± 6,6. El 91,9% (IC 95%: 88,1-98,7) consideró la búsqueda oportunista del VIH aceptable, el 89,3% (IC 95%: 85,0-93,6), factible de realizar, mostrando el análisis multivariante relación positiva con el realizar actividad docente (OR: 2,74; IC 95%: 1,16-6,49). La aceptación de la prueba por parte de los pacientes fue del 93,1%, y esta se relacionó positivamente con el tiempo que el médico había trabajado en el mismo cupo, la cualidad de docente y los años dedicados a la investigación.

Conclusiones

La búsqueda oportunista del VIH es un método aceptable y factible para los profesionales de atención primaria.

Missed opportunities for HIV testing of patients diagnosed with an indicator condition in primary care in Catalonia, Spain

OBJECTIVE

To estimate the prevalence of HIV testing among patients diagnosed with an indicator condition (IC) for HIV, seen in primary care (PC) in Catalonia, and to estimate the prevalence of HIV infection among those patients.

DESIGN

Cross-sectional and population-based study in patients aged between 16 and 65 diagnosed with an IC within PC in Catalonia.

METHODS

Data used in this study were extracted from a large population-based public health database in Spain, the Information System for the Development of Research in Primary Care (SIDIAP). All participants registered in SIDIAP from 1 January 2010 to 31 August 2012 and with a diagnosis of an IC were screened to identify those with an HIV test within the following 4 months.

RESULTS

99 426 patients were diagnosed with an IC during the study period. In these patients, there were 102 647 episodes in which at least one IC was diagnosed. An HIV test was performed within 4 months in only 18 515 of the episodes in which an IC was diagnosed (18.5%). The prevalence of HIV infection was 1.46%. Women (OR 1.35, 95% CI 1.30 to 1.39), people aged 50 or over (OR 2.85, 95% CI 2.69 to 3.00) and patients having a single IC (OR 3.59. 95% CI 3.20 to 4.03) had the greatest odds of not having an HIV test.

CONCLUSIONS

The study highlights the persistence of missed opportunities for HIV testing within PC in Catalonia. Urgent engagement with PC professionals is required in order to increase HIV testing and prevent late HIV diagnoses.

[Indicator condition guided human immunodeficiency virus requesting in primary health care: results of a collaboration]

INTRODUCTION

The search of HIV infected patients guided by indicator conditions (IC) is a strategy used to increase the early detection of HIV. The objective is to analyze whether a collaboration to raise awareness of the importance of early detection of HIV in 3 primary care centers influenced the proportion of HIV serology requested.

METHODS

Multicenter retrospective study was conducted comparing the baseline and a post-collaboration period. The collaboration consisted of training sessions and participation in the HIDES study (years 2009-2010). Patients between 18 and 64 years old with newly diagnosed herpes zoster, seborrheic eczema, mononucleosis syndrome, and leucopenia/thrombocytopenia in 3 primary care centers in 2008 (baseline period) and 2012 (post-collaboration period). The sociodemographic variables, HIV risk conditions, requests for HIV serology, and outcomes were evaluated.

RESULTS

A total of 1,219 ICs were included (558 in 2008 and 661 in 2012). In 2008 the number of HIV tests in patients with an IC was 3.9%, and rose to 11.8% in 2012 (P<.0001). The HIV infection rate was 2.2% (95% CI: 0.4-7.3) (n=2). It was estimated that 25 new cases (12 in 2008 and 13 in 2012) would have been diagnosed if they had performed the test on all patients with IC. Predictors of HIV request were, having an IC in 2012, a younger age, having an mononucleosis syndrome, and not being Spanish.

CONCLUSIONS

The HIV request demand tripled, after the collaboration with primary care centers, however in 88% the test was not requested, resulting in diagnostic losses. New strategies are needed to raise awareness of the importance of early detection of HIV.