1
|
Gill RC, Levett T, Youssef E. An audit of HIV testing practice in people aged 50 years and over presenting with a known clinical indicator condition in secondary care. HIV Med 2023; 24:231-235. [PMID: 35811462 DOI: 10.1111/hiv.13355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/19/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate HIV testing of patients aged ≥50 years presenting to secondary care with clinical indicator conditions (CICs) for HIV. METHODS Retrospective audit of electronic records for patients aged ≥50 years discharged from hospital between January 1st and July 31st 2019 who had at least one documented CIC. Patient demographics and HIV testing data were collected from clinical systems (excluding sexual health databases). RESULTS 2478 patients with a CIC were identified. 222 (9.0%) received an HIV test within 31 days of discharge. Patients receiving a test were significantly younger (mean 68.6 versus 75.3 years; P < 0.001) and significantly more men underwent testing than women (60.4% versus 39.6%; P = 0.001). 32 CICs were identified across nine disease systems. By system, those with a haematological CIC were significantly more likely to undergo testing compared with all other CICs combined (P < 0.001). Of individual CICs, patients with Kaposi's sarcoma, hepatitis C, neutropenia, lymphadenopathy, pyrexia of unknown origin and thrombocytopenia (P < 0.001), and seborrhoeic dermatitis, hepatitis B, other unexplained blood dyscrasia, and non-Hodgkin's lymphoma (P < 0.05) were more likely to undergo testing than those presenting with other CICs. Patients with dementia and lung cancer were less likely to undergo testing (P < 0.001). Patients presenting with a greater number of CICs were significantly more likely to undergo testing (P = 0.002). CONCLUSIONS HIV testing among patients aged ≥50 years presenting to secondary care with a CIC is low. Work is needed to improve HIV testing practice in this patient group.
Collapse
Affiliation(s)
| | - Tom Levett
- Brighton and Sussex Medical School, Brighton, East Sussex, UK
| | - Elaney Youssef
- Brighton and Sussex Medical School, Brighton, East Sussex, UK
| |
Collapse
|
2
|
Fleisher I, Geboy AG, Nichols W, Desale S, Fernandez S, Basch P, Fishbein DA. HIV testing in patients who are HCV positive: Compliance with CDC guidelines in a large healthcare system. PLoS One 2021; 16:e0252412. [PMID: 34077476 PMCID: PMC8171936 DOI: 10.1371/journal.pone.0252412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 05/16/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There are approximately 300,000 people in the United States who are co-infected with HIV and HCV. Several organizations recommend that individuals who are HCV infected, as well as persons over the age of 13, should be HIV tested. Comorbidities associated with HCV can be reduced with early identification of HIV. Our objective was to determine whether providers routinely followed HIV testing guidelines for patients who tested HCV positive (HCV+). METHODS A retrospective chart review was conducted of all patients in primary care at an academic health system from 7/2015-3/2017 who tested HCV+. As part of a primary database, HCV testing data was collected; HIV testing data was abstracted manually. We collected and described the intervals between HCV and HIV tests. To determine associations with HIV testing univariable and multivariable analyses were performed. RESULTS We identified 445 patients who tested HCV+: 56.6% were tested for HIV, the mean age was 57 ± 10.9 years, 77% were from the Birth Cohort born 1945-1965 (BC); 61% were male; and 51% were Black/AA. Patients in the BC were more likely to be HIV tested if they were: male (p = 0.019), Black/AA (p<0.001), and had Medicaid (p = 0.005). These differences were not found in the non-BC. Six patients who were tested for both HIV and HCV were found to be newly HIV positive at the time of testing. CONCLUSION As demonstrated, providers did not routinely follow CDC recommendations as almost half of the HCV+ patients were not correctly tested for HIV. It is important to emphasize that six persons were tested HIV positive simultaneously with their HCV+ diagnosis. If providers did not follow the CDC guidelines, then these patients may not have been identified. Improvements in EHR clinical decision support tools and provider education can help improve the HIV testing rate among individuals who are HCV+.
Collapse
Affiliation(s)
- Ilan Fleisher
- MedStar Health Research Institute, MedStar Health, Hyattsville, MD, United States of America
- New York Medical College, Valhalla, NY, United States of America
- * E-mail:
| | - Alexander G. Geboy
- MedStar Health Research Institute, MedStar Health, Hyattsville, MD, United States of America
- Association of American Medical Colleges, Washington, DC, United States of America
| | - Whitney Nichols
- MedStar Health Research Institute, MedStar Health, Hyattsville, MD, United States of America
- Frank H. Netter School of Medicine at Quinnipiac, North Haven, CT, United States of America
| | - Sameer Desale
- MedStar Health Research Institute, MedStar Health, Hyattsville, MD, United States of America
| | - Stephen Fernandez
- MedStar Health Research Institute, MedStar Health, Hyattsville, MD, United States of America
| | - Peter Basch
- MedStar Health, Columbia, MD, United States of America
| | - Dawn A. Fishbein
- MedStar Health Research Institute, MedStar Health, Hyattsville, MD, United States of America
- MedStar Washington Hospital Center, Washington, DC, United States of America
| |
Collapse
|
3
|
Bogers S, Hulstein S, Schim van der Loeff M, de Bree G, Reiss P, van Bergen J, Geerlings S. Current evidence on the adoption of indicator condition guided testing for HIV in western countries: A systematic review and meta-analysis. EClinicalMedicine 2021; 35:100877. [PMID: 34027336 PMCID: PMC8129933 DOI: 10.1016/j.eclinm.2021.100877] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/09/2021] [Accepted: 04/15/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Indicator condition (IC) guided testing for HIV is an effective way to identify undiagnosed people living with HIV, but studies suggest its implementation is lacking. This systematic review provides an overview of the adoption of IC-guided testing in Western countries. METHODS Seven ICs were selected: tuberculosis (TB), malignant lymphoma, hepatitis B, hepatitis C, cervical/vulvar carcinoma/intraepithelial neoplasia grade 2+ (CC/CIN2+, VC/VIN2+), and peripheral neuropathy (PN). Embase and Ovid MEDLINE were searched up to November 20th, 2020. Publications of all types, using data from ≥2009, reporting on HIV test ratios in patients ≥18 years in all settings in Western countries were eligible. HIV test ratios and positivity were reported per IC. A random effects-model for proportions was used to calculate estimated proportions (ES) with 95% CIs. This study was registered at PROSPERO, registration number CRD42020160243. FINDINGS Fifty-seven references, including 23 full-text articles and 34 other publications were included. Most (28/57) reported on HIV testing in TB. No reports on HIV testing in VC/VIN2+ or PN patients were eligible for inclusion. Large variation in HIV test ratios was observed between and within ICs, resulting from different testing approaches. Highest HIV test ratios (pooled ratio: 0·72, 95%CI 0·63-0·80) and positivity (0·05, 95% CI 0·03-0·06) were observed among TB patients, and lowest among CC/CIN2+ patients (pooled ES test ratio: 0·12, 95%CI 0·01-0·31, positivity: 0·00, 95%CI 0·00-0·00). INTERPRETATION IC-guided HIV testing is insufficiently implemented in Western countries. The large variation in test ratios provides insight into priority areas for implementing routine IC-guided HIV testing in the future. FUNDING HIV Transmission Elimination in Amsterdam (H-TEAM) consortium and Aidsfonds (grant number P-42,702).
Collapse
Affiliation(s)
- S.J. Bogers
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, room D3-226, Meibergdreef 9, Amsterdam 1105, Netherlands
| | - S.H. Hulstein
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - M.F. Schim van der Loeff
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, room D3-226, Meibergdreef 9, Amsterdam 1105, Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - G.J. de Bree
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, room D3-226, Meibergdreef 9, Amsterdam 1105, Netherlands
| | - P. Reiss
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, room D3-226, Meibergdreef 9, Amsterdam 1105, Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
- Department of Global Health, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
- HIV Monitoring Foundation, Amsterdam, Netherlands
| | - J.E.A.M van Bergen
- Department of General Practice, Amsterdam University Medical Centers, location Academic Medical Center, Netherlands
- STI AIDS Netherlands, Amsterdam, Netherlands
| | - S.E. Geerlings
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, room D3-226, Meibergdreef 9, Amsterdam 1105, Netherlands
| | - HIV Transmission Elimination AMsterdam (H-TEAM) Consortium
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, room D3-226, Meibergdreef 9, Amsterdam 1105, Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
- Department of Global Health, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
- HIV Monitoring Foundation, Amsterdam, Netherlands
- Department of General Practice, Amsterdam University Medical Centers, location Academic Medical Center, Netherlands
- STI AIDS Netherlands, Amsterdam, Netherlands
| |
Collapse
|