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Mahmoud M, Ballouz T, Lahoud C, Adnan J, Habib PA, Saab R, Farhat H, Hussein ME, Rizk N. Late presentations and missed opportunities among newly diagnosed HIV patients presenting to a specialty clinic in Lebanon. Sci Rep 2024; 14:8296. [PMID: 38594292 PMCID: PMC11004126 DOI: 10.1038/s41598-024-55277-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/22/2024] [Indexed: 04/11/2024] Open
Abstract
Late presentation to medical care of individuals infected with the human immunodeficiency virus (HIV) is linked to poor outcomes and increased morbidity and mortality. Missed opportunities for a prompt diagnosis are frequently reported among late presenters. We aimed to estimate the proportion of late presenters and missed opportunities in diagnosis among newly diagnosed HIV-positive subjects presenting to a specialty clinic in Lebanon. This is a retrospective chart review of all newly diagnosed adult HIV-positive subjects presenting to clinic from 2012 to 2022. Demographic, laboratory, and clinical data were collected at initial HIV diagnosis or presentation to medical care. We defined late presentation as having a CD4 count < 350 or AIDS-defining event regardless of CD4 count. Advanced disease is defined as having a CD4 count below 200 cells/μL or the presence of an AIDS-defining illness, regardless of the CD4 count. A missed opportunity was defined as the presence of an indicator condition (IC) that suggests infection with HIV/AIDS during 3 years preceding the actual HIV diagnosis and not followed by a recommendation for HIV testing. The proportions for demographic, epidemiological, and clinical characteristics are calculated by excluding cases with missing information from the denominator. Our cohort included 150 subjects (92.7% males; 63.6% men who have sex with men (MSM); 33.3% heterosexuals; median age 30.5 years at diagnosis). 77 (51.3%) were late presenters and 53 (35.3% of all subjects, 68.8% of late presenters) had advanced HIV on presentation. Up to 76.5% of late presenters had a presentation with an HIV-related condition at a healthcare provider without getting HIV test within the previous 3 years. The most frequent ICs were weight loss, generalized lymphadenopathy, constitutional symptoms, and chronic idiopathic diarrhea. Overall mortality rate was 4% (6/150 individuals). All-cause mortality among those who presented with AIDS was 15.4% (6/39 subjects). In our setting, late presentations and missed opportunities for HIV diagnosis are common. In the Middle East, AIDS mortality remains high with a large gap in HIV testing. To effectively influence policies, comprehensive analyses should focus on estimating the preventable health and financial burdens of late HIV presentations. Another concern pertains to healthcare providers' attitudes and competencies.
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Affiliation(s)
- Maya Mahmoud
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Tala Ballouz
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Chloe Lahoud
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Jana Adnan
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Paola Abi Habib
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Reem Saab
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Haya Farhat
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohammad El Hussein
- Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nesrine Rizk
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Riad El Solh, Beirut, 1107 2020, Lebanon.
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Bogers S, Zimmermann H, Ndong A, Davidovich U, Kersten MJ, Reiss P, Schim van der Loeff M, Geerlings S. Mapping hematologists' HIV testing behavior among lymphoma patients-A mixed-methods study. PLoS One 2023; 18:e0279958. [PMID: 36595516 PMCID: PMC9810165 DOI: 10.1371/journal.pone.0279958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND HIV testing among patients with malignant lymphoma (PWML) is variably implemented. We evaluated HIV testing among PWML, and mapped factors influencing hematologists' testing behavior. MATERIALS We conducted a mixed-methods study assessing HIV testing among PWML, factors influencing HIV testing and opportunities for improvement in five hospitals in the region of Amsterdam, the Netherlands. The proportion of PWML tested for HIV within 3 months before or after lymphoma diagnosis and percentage positive were assessed from January 2015 through June 2020. Questionnaires on intention, behavior and psychosocial determinants for HIV testing were conducted among hematologists. Through twelve semi-structured interviews among hematologists and authors of hematology guidelines, we further explored influencing factors and opportunities for improvement. FINDINGS Overall, 1,612 PWML were included for analysis, including 976 patients newly diagnosed and 636 patients who were referred or with progressive/relapsed lymphoma. Seventy percent (678/976) of patients newly diagnosed and 54% (343/636) of patients with known lymphoma were tested for HIV. Overall, 7/1,021 (0.7%) PWML tested HIV positive, exceeding the 0.1% cost-effectiveness threshold. Questionnaires were completed by 40/77 invited hematologists, and 85% reported intention to test PWML for HIV. In the interviews, hematologists reported varying HIV testing strategies, including testing all PWML or only when lymphoma treatment is required. Recommendations for improved HIV testing included guideline adaptations, providing electronic reminders and monitoring and increasing awareness. CONCLUSIONS Missed opportunities for HIV testing among PWML occurred and HIV test strategies varied among hematologists. Efforts to improve HIV testing among PWML should include a combination of approaches.
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Affiliation(s)
- Saskia Bogers
- Amsterdam UMC, Location University of Amsterdam, Internal Medicine, 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
- * E-mail:
| | - Hanne Zimmermann
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Amie Ndong
- Amsterdam UMC, Location University of Amsterdam, Internal Medicine, Amsterdam, the Netherlands
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Department of Social Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Marie José Kersten
- Amsterdam UMC, Location University of Amsterdam, Hematology, Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Peter Reiss
- Amsterdam UMC, Location University of Amsterdam, Internal Medicine, Amsterdam, the Netherlands
- Stichting HIV Monitoring, Amsterdam, the Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
- Amsterdam UMC, Location University of Amsterdam, Global Health, Amsterdam, the Netherlands
| | - Maarten Schim van der Loeff
- Amsterdam UMC, Location University of Amsterdam, Internal Medicine, 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
| | - Suzanne Geerlings
- Amsterdam UMC, Location University of Amsterdam, Internal Medicine, 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
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3
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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).
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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
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Ortega-Gonzalez E, Martínez-Roma M, Dolores Ocete M, Jimeno C, Fornos A, Esteban A, Martinez M, Valero C, Gómez-Muñoz N, Carrodeguas A, Medina D, Garcia-Deltoro M. HIV screening and linkage to care in a health department in Valencia, Spain: Lessons learned from a healthcare quality improvement project. Medicine (Baltimore) 2022; 101:e30400. [PMID: 36254051 PMCID: PMC9575804 DOI: 10.1097/md.0000000000030400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Spain's rate of new human immunodeficiency virus (HIV) diagnoses exceeds that of the European Economic Area average (8.6 vs 5.6:100,000 in 2018). The country has failed to meet the first of United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets for HIV control by 2020, with 87.0% of people living with HIV knowing their status, and late presentation rates of 47.6% and 51.5% country-wide and in the Valencian autonomous community, respectively. Advancing screening and linkage to care (SLTC) practices is necessary to effectively control the epidemic. The Valencia Viral Screening (CRIVALVIR) project adopted the TEST model for opportunistic and systematic HIV SLTC in individuals aged 18 to 80 who required blood work for any purpose, as of February 2019. SLTC was integrated into routine clinical workflow across primary care centers serving a population of 360,000 people in Valencia, Spain. Our project successfully upscaled total HIV testing by 194% to over 32,000 patients tested in 14 months. We found an overall prevalence of 0.13% (0.08-0.21) among those screened per protocol (n = 13,061), with foreign-born citizens presenting a 12.5 times significantly higher likelihood of acquiring HIV (95% confidence interval 4.63-33.96, P < .0001). We improved late presentation by 18.2 percentage points and prevented an estimated 58 to 70 new secondary infections. HIV screening of the general population in primary care is an effective strategy for achieving timely diagnosis and preventing new infections. Opportunistic, systematic, opt-out approaches are essential to control the HIV epidemic.
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Affiliation(s)
- Enrique Ortega-Gonzalez
- Fundació Investigació Hospital General Universitari Valencia, Valencia, Spain
- * Correspondence: Enrique Ortega-Gonzalez, Fundació Investigació Hospital General Universitari València, Spain. Av. Tres Cruces, 2, 46014, Valencia, Spain (e-mail: )
| | - María Martínez-Roma
- Fundació Investigació Hospital General Universitari Valencia, Valencia, Spain
| | | | | | | | | | | | - Carmen Valero
- Departament Hospital General València, Valencia, Spain
| | - Neus Gómez-Muñoz
- Fundació Investigació Hospital General Universitari Valencia, Valencia, Spain
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5
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Hobi S, Cafarchia C, Romano V, Barrs VR. Malassezia: Zoonotic Implications, Parallels and Differences in Colonization and Disease in Humans and Animals. J Fungi (Basel) 2022; 8:jof8070708. [PMID: 35887463 PMCID: PMC9324274 DOI: 10.3390/jof8070708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 12/13/2022] Open
Abstract
Malassezia spp. are commensals of the skin, oral/sinonasal cavity, lower respiratory and gastrointestinal tract. Eighteen species have been recovered from humans, other mammals and birds. They can also be isolated from diverse environments, suggesting an evolutionary trajectory of adaption from an ecological niche in plants and soil to the mucocutaneous ecosystem of warm-blooded vertebrates. In humans, dogs and cats, Malassezia-associated dermatological conditions share some commonalities. Otomycosis is common in companion animals but is rare in humans. Systemic infections, which are increasingly reported in humans, have yet to be recognized in animals. Malassezia species have also been identified as pathogenetic contributors to some chronic human diseases. While Malassezia species are host-adapted, some species are zoophilic and can cause fungemia, with outbreaks in neonatal intensive care wards associated with temporary colonization of healthcare worker’s hands from contact with their pets. Although standardization is lacking, susceptibility testing is usually performed using a modified broth microdilution method. Antifungal susceptibility can vary depending on Malassezia species, body location, infection type, disease duration, presence of co-morbidities and immunosuppression. Antifungal resistance mechanisms include biofilm formation, mutations or overexpression of ERG11, overexpression of efflux pumps and gene rearrangements or overexpression in chromosome 4.
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Affiliation(s)
- Stefan Hobi
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University, Tat Chee Avenue, Kowloon, Hong Kong, China
- Correspondence: (S.H.); (V.R.B.)
| | - Claudia Cafarchia
- Department of Veterinary Medicine, University of Bari, Str. prov. per Casamassima Km 3, Valenzano, (Bari), 70010, Italy; (C.C.); (V.R.)
| | - Valentina Romano
- Department of Veterinary Medicine, University of Bari, Str. prov. per Casamassima Km 3, Valenzano, (Bari), 70010, Italy; (C.C.); (V.R.)
| | - Vanessa R. Barrs
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University, Tat Chee Avenue, Kowloon, Hong Kong, China
- Centre for Animal Health and Welfare, City University of Hong Kong, Kowloon Tong, Hong Kong, China
- Correspondence: (S.H.); (V.R.B.)
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Determinants of Late HIV Presentation at Ndlavela Health Center in Mozambique. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084568. [PMID: 35457436 PMCID: PMC9031287 DOI: 10.3390/ijerph19084568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 11/26/2022]
Abstract
Background: There has been tremendous progress in the fight against HIV worldwide; however, challenges persist in the control of HIV infection. These challenges include the high prevalence of late presenters. There are many disadvantages of late presentation—from reduced survival of the infected person to the risk of transmitting the infection. This research aims to analyze the factors that influence the late presentation in patients attending Ndlavela Health Center in Mozambique. Methodology: A retrospective cross-sectional study was carried out at Ndlavela Health Center including patients diagnosed with HIV between 2015 and 2020. The European Late Presenter Consensus working group definitions were used, and univariate and multivariate logistic regression were used to identify factors associated with late presentation. Results: In total, 519 participants were included in the study, of which nearly 47% were classified as late presenters. The male gender (AOR = 2.41), clinical suspicious test (AOR = 4.03), initiated by the health professional (AOR = 2.1,9), and fear of stigma (AOR = 2.80) were the main risk factors for late HIV presentation. Conclusion: Factors that are potentially determinant for late HIV presentation were identified. Actions are needed to focus on risk factors that are most likely to delay presentation.
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Agustí C, Cunillera O, Almeda J, Mascort J, Carrillo R, Olmos C, Montoliu A, Alberny M, Molina I, Cayuelas L, Casabona J. Efficacy of an electronic reminder for HIV screening in primary healthcare based on indicator conditions in Catalonia (Spain). HIV Med 2022; 23:868-879. [DOI: 10.1111/hiv.13270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/18/2022] [Accepted: 01/25/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Cristina Agustí
- Centre of Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalunya (CEEISCAT) Department of Health Generalitat of Catalunya Badalona Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP) Instituto de Salud Carlos III Madrid Spain
| | - Oriol Cunillera
- Institut Universitari d'Investigació en Atenció Primària (IDIAP Jordi Gol) Barcelona Spain
| | - Jesús Almeda
- Institut Universitari d'Investigació en Atenció Primària (IDIAP Jordi Gol) Barcelona Spain
- Research Support Unit Primary Health General Directorate of Costa de Ponent Catalan Institute of Health (ICS) Cornellà de Llobregat Spain
| | - Juanjo Mascort
- Catalan Society of Family and Community Medicine (CAMFiC) Barcelona Spain
- Spanish Society of Family and Community Medicine (semFYC) Barcelona Spain
- Department of Clinical Sciences Faculty of Medicine University of Barcelona (UB) Barcelona Spain
| | - Ricard Carrillo
- Catalan Society of Family and Community Medicine (CAMFiC) Barcelona Spain
- Spanish Society of Family and Community Medicine (semFYC) Barcelona Spain
| | - Carmen Olmos
- Health Department Catalan Government Barcelona Spain
| | - Alexandra Montoliu
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP) Instituto de Salud Carlos III Madrid Spain
- Unit of Infections and Cancer ‐ Information and Interventions (UNIC ‐ I&I) Cancer Epidemiology Research Program (CERP) Hospitalet de Llobregat Barcelona Spain
| | - Mireia Alberny
- Medical Management of Primary Care Servicies STI/HIV Area Catalan Institute of Health (ICS) Barcelona Spain
| | - Izarbe Molina
- Association of Family and Community Nursing of Catalonia (AIFiCC) Barcelona Spain
| | - Laia Cayuelas
- Centro de Atención Primaria Casanova Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE) Barcelona Spain
| | - Jordi Casabona
- Centre of Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalunya (CEEISCAT) Department of Health Generalitat of Catalunya Badalona Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP) Instituto de Salud Carlos III Madrid Spain
- Department of Paediatrics, Obstetrics and Gynecology and Preventive Medicine Universitat Autónoma de Barcelona Badalona Spain
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Nguyen TT, Luong AN, Dao TDT, Nagot N, Laureillard D, Visier L, Le MG. What Shapes Late HIV Diagnosis in Vietnam? A Qualitative Investigation of Multilevel Factors. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:450-463. [PMID: 34596428 DOI: 10.1521/aeap.2021.33.5.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Late HIV treatment remains a global public health issue despite significant efforts. To better understand what shapes this issue, we interviewed 36 Vietnamese ART-naive patients who came to HIV treatment in 2017. Half of them had intake CD4 counts fewer than 100 cells/mm3, the others had intake CD4 counts of 350 cells/mm3 and above. Late diagnosis was the reason of late treatment in our sample. Most late presenters were not members of the key populations at increased risk of HIV (e.g., people who inject drugs, commercial sex workers, and men who have sex with men). Individual-level factors included low risk appraisal, habit of self-medication, and fear of stigma. Network and structural-level factors included challenges to access quality health care, normalization of HIV testing in key populations and inconsistent provider-initiated HIV testing practices. Structural interventions coupled with existing key population-targeted strategies would improve the issue of late HIV diagnosis.
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Affiliation(s)
- Thu Trang Nguyen
- Centre for Research and Training on Substance Abuse-HIV, Hanoi Medical University, Vietnam
| | - Anh Ngoc Luong
- Centre for Research and Training on Substance Abuse-HIV, Hanoi Medical University, Vietnam
| | - Thi Dieu Thuy Dao
- Centre for Research and Training on Substance Abuse-HIV, Hanoi Medical University, Vietnam
| | | | - Didier Laureillard
- Infectious Disease and Tropical Disease Department, University Hospital, Nîmes, France
| | | | - Minh Giang Le
- Centre for Research and Training on Substance Abuse-HIV, Hanoi Medical University, Vietnam
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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.
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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
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Features of the Skin Microbiota in Common Inflammatory Skin Diseases. Life (Basel) 2021; 11:life11090962. [PMID: 34575111 PMCID: PMC8468136 DOI: 10.3390/life11090962] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/29/2021] [Accepted: 09/10/2021] [Indexed: 12/12/2022] Open
Abstract
Many relatively common chronic inflammatory skin diseases manifest on the face (seborrheic dermatitis, rosacea, acne, perioral/periorificial dermatitis, periocular dermatitis, etc.), thereby significantly impairing patient appearance and quality of life. Given the yet unexplained pathogenesis and numerous factors involved, these diseases often present therapeutic challenges. The term “microbiome” comprises the totality of microorganisms (microbiota), their genomes, and environmental factors in a particular environment. Changes in human skin microbiota composition and/or functionality are believed to trigger immune dysregulation, and consequently an inflammatory response, thereby playing a potentially significant role in the clinical manifestations and treatment of these diseases. Although cultivation methods have traditionally been used in studies of bacterial microbiome species, a large number of bacterial strains cannot be grown in the laboratory. Since standard culture-dependent methods detect fewer than 1% of all bacterial species, a metagenomic approach could be used to detect bacteria that cannot be cultivated. The skin microbiome exhibits spatial distribution associated with the microenvironment (sebaceous, moist, and dry areas). However, although disturbance of the skin microbiome can lead to a number of pathological conditions and diseases, it is still not clear whether skin diseases result from change in the microbiome or cause such a change. Thus far, the skin microbiome has been studied in atopic dermatitis, seborrheic dermatitis, psoriasis, acne, and rosacea. Studies on the possible association between changes in the microbiome and their association with skin diseases have improved the understanding of disease development, diagnostics, and therapeutics. The identification of the bacterial markers associated with particular inflammatory skin diseases would significantly accelerate the diagnostics and reduce treatment costs. Microbiota research and determination could facilitate the identification of potential causes of skin diseases that cannot be detected by simpler methods, thereby contributing to the design and development of more effective therapies.
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Asabor EN, Lett E, Moll A, Shenoi SV. "We've Got Our Own Beliefs, Attitudes, Myths": A Mixed Methods Assessment of Rural South African Health Care Workers' Knowledge of and Attitudes Towards PrEP Implementation. AIDS Behav 2021; 25:2517-2532. [PMID: 33763802 DOI: 10.1007/s10461-021-03213-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2021] [Indexed: 11/26/2022]
Abstract
South Africa maintains the world's largest HIV prevalence, accounting for 20.4% of people living with HIV internationally. HIV Pre-exposure prophylaxis (PrEP) has demonstrated efficacy; however, there is limited data on PrEP implementation in South Africa, particularly in rural areas. Using grounded theory analysis of semi-structured interviews and exploratory factor analyses of structured surveys, this mixed methods study examines healthcare workers' (HCWs)' beliefs about their patients and the likelihood of PrEP uptake in their communities. The disproportionate burden of HIV among Black South Africans is linked to the legacy of apartheid and resulting disparities in wealth and employment. HCWs in our study emphasized the importance of addressing these structural barriers, including increased travel burden among men in the community looking for work, poor transportation infrastructure, and limited numbers of highly skilled clinical staff in their rural community. HCWs also espoused a vision of PrEP that prioritizes women due to perceived constraints on their sexual agency, and that minimizes the impact of HIV-related stigma on PrEP implementation. However, HCWs' additional concerns for risk compensation may reflect dominant social mores around sexual behavior. In recognition of HCWs' role as both informants and community members, implementation scientists should invite local HCWs to partner as early as the priority-setting stage for PrEP interventions. Inviting leadership from local HCWs may increase the likelihood of delivery plans that account for unique local context and structural barriers researchers may otherwise struggle to uncover.
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Affiliation(s)
- Emmanuella Ngozi Asabor
- Yale University School of Medicine, New Haven, CT, USA.
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, CT, USA.
- Penn Medicine Center for Health Equity Advancement, University of Pennsylvania, Philadelphia, PA, USA.
| | - Elle Lett
- Penn Medicine Center for Health Equity Advancement, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Anthony Moll
- Church of Scotland Hospital, Tugela Ferry, South Africa
| | - Sheela V Shenoi
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA
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Promoting HIV indicator condition-guided testing in hospital settings (PROTEST 2.0): study protocol for a multicentre interventional study. BMC Infect Dis 2021; 21:519. [PMID: 34078315 PMCID: PMC8173796 DOI: 10.1186/s12879-021-06183-8] [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: 12/10/2020] [Accepted: 05/14/2021] [Indexed: 11/17/2022] Open
Abstract
Background Late presentation remains a key barrier towards controlling the HIV epidemic. Indicator conditions (ICs) are those that are AIDS-defining, associated with a prevalence of undiagnosed HIV > 0.1%, or whose clinical management would be impeded if an HIV infection were undiagnosed. IC-guided HIV testing is an effective strategy in identifying undiagnosed HIV, but opportunities for earlier HIV diagnosis through IC-guided testing are being missed. We present a protocol for an interventional study to improve awareness of IC-guided testing and increase HIV testing in patients presenting with ICs in a hospital setting. Methods We designed a multicentre interventional study to be implemented at five hospitals in the region of Amsterdam, the Netherlands. Seven ICs were selected for which HIV test ratios (proportion of patients with an IC tested for HIV) will be measured: tuberculosis, cervical/vulvar cancer or high-grade cervical/vulvar dysplasia, malignant lymphoma, hepatitis B and C, and peripheral neuropathy. Prior to the intervention, a baseline assessment of HIV test ratios across ICs will be performed in eligible patients (IC diagnosed January 2015 through May 2020, ≥18 years, not known HIV positive) and an assessment of barriers and facilitators for HIV testing amongst relevant specialties will be conducted using qualitative (interviews) and quantitative methods (questionnaires). The intervention phase will consist of an educational intervention, including presentation of baseline results as competitive graphical audit and feedback combined with discussion on implementation and opportunities for improvement. The effect of the intervention will be assessed by comparing HIV test ratios of the pre-intervention and post-intervention periods. The primary endpoint is the HIV test ratio within ±3 months of IC diagnosis. Secondary endpoints are the HIV test ratio within ±6 months of diagnosis, ratio ever tested for HIV, HIV positivity percentage, proportion of late presenters and proportion with known HIV status prior to initiating treatment for their IC. Discussion This protocol presents a strategy aimed at increasing awareness of the benefits of IC-guided testing and increasing HIV testing in patients presenting with ICs in hospital settings to identify undiagnosed HIV in Amsterdam, the Netherlands. Trial registration Dutch trial registry: NL7521. Registered 14 February 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06183-8.
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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).
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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
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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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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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van den Bogaart L, Ranzani A, Oreni L, Giacomelli A, Corbellino M, Rusconi S, Galli M, Antinori S, Ridolfo AL. Overlooked cases of HIV infection: An Italian tale of missed diagnostic opportunities. Eur J Intern Med 2020; 73:30-35. [PMID: 31635999 DOI: 10.1016/j.ejim.2019.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/06/2019] [Accepted: 09/12/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Late diagnoses are still a cause of increased HIV-related morbidity and mortality despite the availability of highly effective treatments. The aim of this study was to identify indicator conditions (ICs) in late presenters with HIV infection (LPs) that may represent missed opportunities of undertaking earlier HIV testing. METHODS The medical records of LPs referred to a specialist clinic in Milan, Italy, between 2011 and 2017 were reviewed to assess the frequency of ICs during the five years preceding diagnosis. Logistic regression analysis was used to investigate the factors associated with missed opportunities of making an earlier diagnosis. RESULTS The analysis considered 203 LPs (60.6% of the patients newly diagnosed as having HIV infection during the study period). Most had had ≥1 medical encounter in the five years before diagnosis, and 54 (26.6%) had been diagnosed as having ≥1 IC without undergoing HIV testing. The most frequent ICs were herpes zoster (19.8%), constitutional symptoms (17.4%) and lympho/thrombocytopenia (12.8%), and the missed opportunities for testing occurred in the settings of primary care (44.9%), specialist medical (38.2%) or surgical services (11.3%), and emergency departments (5.6%). Twenty-five (53.2%) of the 47 subjects with a non AIDS-defining IC had AIDS at the time of the diagnosis of HIV infection. Subjects aged >60 years were at increased risk of missed diagnostic opportunities (aOR 4.80, p = 0.008). CONCLUSION Implementing IC-guided HIV testing in non-specialist settings is an essential means of reducing late diagnoses of HIV infection even in the case of older subjects.
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Affiliation(s)
- Lorena van den Bogaart
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy.
| | - Alice Ranzani
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Letizia Oreni
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Andrea Giacomelli
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Mario Corbellino
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Stefano Rusconi
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Massimo Galli
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Spinello Antinori
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy; III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Anna Lisa Ridolfo
- III Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Milan, Italy
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Ahlström MG, Ronit A, Omland LH, Vedel S, Obel N. Algorithmic prediction of HIV status using nation-wide electronic registry data. EClinicalMedicine 2019; 17:100203. [PMID: 31891137 PMCID: PMC6933258 DOI: 10.1016/j.eclinm.2019.10.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Late HIV diagnosis is detrimental both to the individual and to society. Strategies to improve early diagnosis of HIV must be a key health care priority. We examined whether nation-wide electronic registry data could be used to predict HIV status using machine learning algorithms. METHODS We extracted individual level data from Danish registries and used algorithms to predict HIV status. We used various algorithms to train prediction models and validated these models. We calibrated the models to mimic different clinical scenarios and created confusion matrices based on the calibrated models. FINDINGS A total 4,384,178 individuals, including 4,350 with incident HIV, were included in the analyses. The full model that included all variables that included demographic variables and information on past medical history had the highest area under the receiver operating characteristics curves of 88·4% (95%CI: 87·5% - 89·4%) in the validation dataset. Performance measures did not differ substantially with regards to which machine learning algorithm was used. When we calibrated the models to a specificity of 99·9% (pre-exposure prophylaxis (PrEP) scenario), we found a positive predictive value (PPV) of 8·3% in the full model. When we calibrated the models to a sensitivity of 90% (screening scenario), 384 individuals would have to be tested to find one undiagnosed person with HIV. INTERPRETATION Machine learning algorithms can learn from electronic registry data and help to predict HIV status with a fairly high level of accuracy. Integration of prediction models into clinical software systems may complement existing strategies such as indicator condition-guided HIV testing and prove useful for identifying individuals suitable for PrEP. FUNDING The study was supported by funds from the Preben and Anne Simonsens Foundation, the Novo Nordisk Foundation, Rigshospitalet, Copenhagen University, the Danish AIDS Foundation, the Augustinus Foundation and the Danish Health Foundation.
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Gompels M, Michael S, Davies C, Jones T, Macleod J, May M. Trends in HIV testing in the UK primary care setting: a 15-year retrospective cohort study from 2000 to 2015. BMJ Open 2019; 9:e027744. [PMID: 31767577 PMCID: PMC6887055 DOI: 10.1136/bmjopen-2018-027744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To estimate trends in HIV testing, positivity and prevalence in UK primary care for 2000-2015 as part of a wider investigation into reasons for late diagnosis of HIV. DESIGN Retrospective cohort study using the Clinical Practice Research Datalink (CPRD) which is derived from computerised clinical records produced during consultations in primary care. SETTING 404 general practices in England. PARTICIPANTS 5 979 598 adults aged ≥16 years registered between 2000 and 2015 with 45 093 761 person years of observation. OUTCOMES Annual HIV testing rates, proportion of positive tests and prevalence of HIV-infected people recorded in primary care 2000-2015. RESULTS HIV testing in primary care increased from 2000 to 2010, but then declined. Testing was higher in females than in males and in those aged 16-44 years compared with older adults. Rates per 100 000 in women aged 16-44 years were 177 (95% CI 167 to 188); 1309 (95% CI 1282 to 1336); 1789 (95% CI 1757 to 1821) and 839 (95% CI 817 to 862) in 2000, 2005, 2010 and 2015, respectively, and for non-pregnant women: 22.5 (95% CI 19 to 26); 134 (95% CI 125 to 143); 262 (95% CI 250 to 275); 190 (95% CI 179 to 201). For men aged 16-44 years rates were: 26 (95% CI 22 to 29); 107 (95% CI 100 to 115); 196 (95% CI 185 to 206); 137 (95% CI 127 to 146). Over the study period, there were approximately two positive results per 1000 HIV tests. Men were eightfold more likely to test positive than women. The percentage of HIV diagnoses among adults recorded in CPRD may be as low as 55% in London and 67% in the rest of the UK. CONCLUSIONS HIV testing rates in primary care peaked in 2010 and subsequently declined. Access to testing was higher for women despite the prevalence of HIV being higher in men. IMPLICATIONS AND FURTHER RESEARCH NEEDED Opportunities remain in primary care for increasing HIV testing to prevent costly late diagnoses and decrease HIV transmission. Interventions to improve targeting of tests and increase adherence to HIV testing guidelines are needed in primary care.
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Affiliation(s)
- Mark Gompels
- Department of Immunology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Skevi Michael
- Institute of Statistical Science, School of Mathematics, University of Bristol, Bristol, UK
| | - Charlotte Davies
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tim Jones
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - John Macleod
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute of Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions, University of Bristol, Bristol, UK
| | - Margaret May
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute of Health Research Health Protection Research Unit (NIHR HPRU) in Evaluation of Interventions, University of Bristol, Bristol, UK
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Rüütel K, Lemsalu L, Lätt S. Monitoring HIV-indicator condition guided HIV testing in Estonia. HIV Med 2019; 19 Suppl 1:47-51. [PMID: 29488700 DOI: 10.1111/hiv.12586] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The aim of the study was to assess indicator condition (IC) guided HIV testing in Estonia from 2012-2015. METHODS We used Estonian Health Insurance Fund (EHIF) data. EHIF is the core purchaser of health care services in Estonia, covering health care costs for insured people (94% of the total population). After health care services' provision, the provider sends an invoice to EHIF, which includes patient information (e.g. age, gender, diagnoses based on ICD-10) and services provided (e.g. what tests were performed). RESULTS Among the ICs analysed, the highest proportion of patients tested was among those presenting with infectious mononucleosis-like illness (27-33% of patients) and viral hepatitis (28-32%), the lowest proportion of patients tested was among those presenting with herpes zoster (4-5%) and pneumonia (4-8%). Women were tested somewhat less than men, especially in cases of sexually transmitted infections (9-13% and 18-21%, respectively). CONCLUSIONS Our data shows that IC-guided HIV testing rates are low in Estonia. Therefore, it is critical to follow Estonian HIV testing guidelines, which recommend IC-guided testing. In general, health insurance data can be used to monitor IC-guided HIV testing.
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Affiliation(s)
- K Rüütel
- National Institute for Health Development, Tallinn, Estonia
| | - L Lemsalu
- National Institute for Health Development, Tallinn, Estonia
| | - S Lätt
- Estonian Health Insurance Fund, Tallinn, Estonia
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20
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Kesten JM, Davies CF, Gompels M, Crofts M, Billing A, May MT, Horwood J. Qualitative evaluation of a pilot educational intervention to increase primary care HIV-testing. BMC FAMILY PRACTICE 2019; 20:74. [PMID: 31151414 PMCID: PMC6544931 DOI: 10.1186/s12875-019-0962-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/15/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND UK guidelines recommend a 'routine offer of HIV testing' in primary care where HIV diagnosed prevalence exceeds 2 in 1000. However, current primary care HIV testing rates are low. Efforts to increase primary care HIV testing are needed. To examine how an educational intervention to increase HIV testing in general practice was experienced by healthcare professionals (HCPs) and to understand the perceived impacts on HIV testing. METHOD Qualitative interviews with general practitioners (GPs) and nurses 3-months after receiving an educational intervention developed from an adapted version of the Medical Foundation for HIV and Sexual Health (MEDFASH) HIV Testing In Practice (TIPs) online educational tool which included training on HIV associated clinical indicator conditions, why, who, and how to test. The intervention was delivered in 19 high-HIV prevalence general practices in Bristol. 27 semi-structured interviews were conducted across 13 practices with 16 GPs, 10 nurses and the sexual health clinician who delivered the intervention. Transcripts were analysed thematically informed by Normalisation Process Theory. RESULTS HCPs welcomed the opportunity to update their HIV knowledge through a tailored, interactive session. Post-training, HCPs reported increased awareness of HIV indicator conditions, confidence to offer HIV tests and consideration of HIV tests. Continued testing barriers include perceived lack of opportunity. CONCLUSIONS This qualitative study found that HIV education is perceived as valuable in relation to perceived awareness, confidence, and consideration of HIV testing. However, repetition and support from other strategies are needed to encourage HCPs to offer HIV tests. Future interventions should consider using behaviour change theory to develop a complex intervention that addresses not only HCP capability to offer an HIV test, but also issues of opportunity and motivation.
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Affiliation(s)
- Joanna M. Kesten
- National Institute for Health Research (NIHR) Health Protection Research Unit in Evaluation of Interventions, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
- NIHR Collaborations for Leadership in Applied Health Research and Care West (CLAHRC West), University Hospitals Bristol, NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Charlotte F. Davies
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Mark Gompels
- Department of Immunology, Southmead Hospital, North Bristol NHS Trust, Westbury-on-Trym, Bristol, BS10 5NB UK
| | - Megan Crofts
- Genitourinary medicine, Unity Sexual Health, Bristol Sexual Health Services, Tower Hill, Bristol, BS2 0JD UK
| | - Annette Billing
- Bristol, North Somerset and South Gloucestershire CCG, South Plaza, Marlborough Street, Bristol, BS1 3NX UK
| | - Margaret T. May
- National Institute for Health Research (NIHR) Health Protection Research Unit in Evaluation of Interventions, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Jeremy Horwood
- NIHR Collaborations for Leadership in Applied Health Research and Care West (CLAHRC West), University Hospitals Bristol, NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
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21
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Nanditha NGA, St-Jean M, Tafessu H, Guillemi SA, Hull MW, Lu M, Henry B, Barrios R, Montaner JSG, Lima VD. Missed opportunities for earlier diagnosis of HIV in British Columbia, Canada: A retrospective cohort study. PLoS One 2019; 14:e0214012. [PMID: 30897143 PMCID: PMC6428302 DOI: 10.1371/journal.pone.0214012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 03/05/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Late HIV diagnosis is associated with increased AIDS-related morbidity and mortality as well as an increased risk of HIV transmission. In this study, we quantified and characterized missed opportunities for earlier HIV diagnosis in British Columbia (BC), Canada. DESIGN Retrospective cohort. METHODS A missed opportunity was defined as a healthcare encounter due to a clinical manifestation which may be caused by HIV infection, or is frequently present among those with HIV infection, but no HIV diagnosis followed within 30 days. We developed an algorithm to identify missed opportunities within one, three, and five years prior to diagnosis. The algorithm was applied to the BC STOP HIV/AIDS population-based cohort. Eligible individuals were ≥18 years old, and diagnosed from 2001-2014. Multivariable logistic regression identified factors associated with missed opportunities. RESULTS Of 2119 individuals, 7%, 12% and 14% had ≥1 missed opportunity during one, three and five years prior to HIV diagnosis, respectively. In all analyses, individuals aged ≥40 years, heterosexuals or people who ever injected drugs, and those residing in Northern health authority had increased odds of experiencing ≥1 missed opportunity. In the three and five-year analysis, individuals with a CD4 count <350 cells/mm3 were at higher odds of experiencing ≥1 missed opportunity. Prominent missed opportunities were related to recurrent pneumonia, herpes zoster/shingles among younger individuals, and anemia related to nutritional deficiencies or unspecified cause. CONCLUSIONS Based on our newly-developed algorithm, this study demonstrated that HIV-diagnosed individuals in BC have experienced several missed opportunities for earlier diagnosis. Specific clinical indicator conditions and population sub-groups at increased risk of experiencing these missed opportunities were identified. Further work is required in order to validate the utility of this proposed algorithm by establishing the sensitivity, specificity, positive and negative predictive values corresponding to the incidence of the clinical indicator conditions among both HIV-diagnosed and HIV-negative populations.
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Affiliation(s)
- Ni Gusti Ayu Nanditha
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Martin St-Jean
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Hiwot Tafessu
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Silvia A. Guillemi
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Mark W. Hull
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Division of AIDS, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Michelle Lu
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Bonnie Henry
- British Columbia Ministry of Health, Victoria, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Vancouver Coastal Health, Vancouver, Canada
| | - Julio S. G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Viviane D. Lima
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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22
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Scognamiglio P, Navarra A, Orchi N, De Carli G, Pittalis S, Mastrorosa I, Visco Comandini U, Agrati C, Antinori A, Puro V, Ippolito G, Girardi E. Unawareness of HCV serostatus among persons newly diagnosed with HIV. J Infect Public Health 2019; 12:733-737. [PMID: 30737128 DOI: 10.1016/j.jiph.2019.01.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/27/2018] [Accepted: 01/14/2019] [Indexed: 11/30/2022] Open
Abstract
Treatment of chronic HCV infection with direct acting antivirals can achieve high rates of sustained viral response in persons with HIV. In the perspective of HCV elimination in this population, high rates of HCV detection will be needed. We evaluated the unawareness of HCV infection in 2927 persons newly diagnosed with HIV during 2004-2015 in Rome, Italy. Two-hundred-fifty persons (8.5%) were anti-HCV positive. The proportion of HCV-unaware individuals at the time of HIV diagnosis was 58.0% (145/250), without significant variations over time, 17.2% showed an advanced fibrosis stage. The absence of previous HIV testing was significantly associated with HCV unawareness.
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Affiliation(s)
- Paola Scognamiglio
- AIDS Reference Center - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Assunta Navarra
- Clinical Epidemiology Unit - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy.
| | - Nicoletta Orchi
- AIDS Reference Center - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Gabriella De Carli
- AIDS Reference Center - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Silvia Pittalis
- Clinical Epidemiology Unit - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Ilaria Mastrorosa
- Clinical Division of HIV/AIDS - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Ubaldo Visco Comandini
- Clinical Division of Hepatology - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Chiara Agrati
- Laboratory of Virology - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Andrea Antinori
- Clinical Division of HIV/AIDS - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Vincenzo Puro
- AIDS Reference Center - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Giuseppe Ippolito
- Office of the Scientific Director - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
| | - Enrico Girardi
- Clinical Epidemiology Unit - National Institute for Infectious Diseases "Lazzaro Spallanzani" - IRCCS, Rome, Italy
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23
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Davies CF, Kesten JM, Gompels M, Horwood J, Crofts M, Billing A, Chick C, May MT. Evaluation of an educational intervention to increase HIV-testing in high HIV prevalence general practices: a pilot feasibility stepped-wedged randomised controlled trial. BMC FAMILY PRACTICE 2018; 19:195. [PMID: 30545301 PMCID: PMC6292019 DOI: 10.1186/s12875-018-0880-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/22/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND HIV-infected patients often present to primary care several times with HIV-indicator conditions before diagnosis but the opportunity to test by healthcare professionals (HCPs) is frequently missed. Current HIV testing rates in primary care are low and educational interventions to facilitate HCPs to increase testing and awareness of HIV are needed. METHOD We implemented a pilot feasibility stepped-wedged randomised controlled trial of an educational intervention in high HIV prevalence practices in Bristol. The training delivered to HCPs including General Practitioners (GP) aimed to increase HIV testing and included why, who, and how to test. The intervention was adapted from the Medical Foundation for HIV and Sexual Health HIV Testing in Practice (MEDFASH) educational tool. Questionnaires assessed HCP feedback and perceived impacts of the intervention. HIV testing rates were compared between control and intervention practices using 12 monthly laboratory totals. RESULTS 169 HCPs (from 19 practices) received the educational intervention. 127 (75%) questionnaires were completed. Delivery of the intervention was received positively and was perceived as valuable for increasing awareness, confidence and consideration of testing, with HCPs gaining more awareness of HIV testing guidelines. The main pre-training HIV testing barrier reported by GPs was the patient not considering themselves at risk, whilst for nurses it was a concern about embarrassing or offending the patient. Most HCPs reported the intervention addressed these barriers. The HIV testing rate increased more in the control than in the intervention practices: mean difference 2.6 (95% CI 0.5,4.7) compared with 1.9 (- 0.5,4.3) per 1000 patients, respectively. The number of HIV tests across all practices increased from 1154 in the first 6 months to 1299 in the second 6 months, an annual increase in testing rate of 2.0 (0.7,3.4) from 16.3 to 18.3 per 1000 patients. CONCLUSION There was a small increase in HIV testing rates over the study period, but this could not be attributed to the educational intervention. More effective and sustainable programmes tailored to each practice context are needed to change testing culture and HCP behaviour. Repeated training, supported by additional measures, such as testing prompts, may be needed to influence primary care HIV testing.
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Affiliation(s)
- Charlotte F Davies
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Joanna M Kesten
- Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.,National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol, NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, England.,National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Mark Gompels
- Department of Immunology, Southmead Hospital, North Bristol NHS Trust, Westbury-on-Trym, Bristol, BS10 5NB, UK
| | - Jeremy Horwood
- National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol, NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, England
| | - Megan Crofts
- Genitourinary medicine, Unity Sexual Health, Bristol Sexual Health Services, Tower Hill, Bristol, BS2 0JD, UK.
| | - Annette Billing
- NHS Bristol, North Somerset and South Gloucestershire CCG, South Plaza, Marlborough Street, Bristol, BS1 3NX, UK.
| | - Charlotte Chick
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Margaret T May
- Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.,National Institute of Health Research (NIHR) Health Protection Research Unit (HPRU) in Evaluation of Interventions, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
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24
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Wilton J, Light L, Gardner S, Rachlis B, Conway T, Cooper C, Cupido P, Kendall CE, Loutfy M, McGee F, Murray J, Lush J, Rachlis A, Wobeser W, Bacon J, Kroch AE, Gilbert M, Rourke SB, Burchell AN. Late diagnosis, delayed presentation and late presentation among persons enrolled in a clinical HIV cohort in Ontario, Canada (1999-2013). HIV Med 2018; 20:110-120. [PMID: 30430742 DOI: 10.1111/hiv.12686] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Timely HIV diagnosis and presentation to medical care are important for treatment and prevention. Our objective was to measure late diagnosis, delayed presentation and late presentation among individuals in the Ontario HIV Treatment Network Cohort Study (OCS) who were newly diagnosed in Ontario. METHODS The OCS is a multi-site clinical cohort study of people living with HIV in Ontario, Canada. We measured prevalence of late diagnosis [CD4 count < 350 cells/μL or an AIDS-defining condition (ADC) within 3 months of HIV diagnosis], delayed presentation (≥ 3 months from HIV diagnosis to presentation to care), and late presentation (CD4 count < 350 cells/μL or ADC within 3 months of presentation). We identified characteristics associated with these outcomes and explored their overlap. RESULTS A total of 1819 OCS participants were newly diagnosed in Ontario from 1999 to 2013. Late diagnosis (53.0%) and presentation (54.0%) were common, and a quarter (23.1%) of participants were delayed presenters. In multivariable models, the participants of delayed presentation decreased over calendar time, but that of late diagnosis/presentation did not. Late diagnosis contributed to the majority (> 87%) of late presentation, and the prevalence of delayed presentation was similar among those diagnosed late versus early (13.4 versus 13.4%, respectively; P = 0.99). Characteristics associated with higher odds of late diagnosis/presentation in multivariable analyses included older age at diagnosis/presentation; African, Caribbean and Black race/ethnicity; Indigenous race/ethnicity; female sex; and being a male who did not report sex with men. There were lower odds of late diagnosis/presentation among participants who had ever injected drugs. In contrast, delayed presentation risk factors included younger age at diagnosis and having ever injected drugs. CONCLUSIONS Late presentation is common in Ontario, as it is in other high-income countries. Our findings suggest that efforts to reduce late presentation should focus on facilitating earlier diagnosis for the populations identified in this analysis.
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Affiliation(s)
- J Wilton
- Ontario HIV Treatment Network, Toronto, Canada
| | - L Light
- Ontario HIV Treatment Network, Toronto, Canada
| | - S Gardner
- Baycrest Health Sciences, Toronto, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - B Rachlis
- Ontario HIV Treatment Network, Toronto, Canada.,Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - T Conway
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Canadian Positive People Network, Ottawa, Canada
| | - C Cooper
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - P Cupido
- Ontario HIV Treatment Network, Toronto, Canada
| | - C E Kendall
- Ottawa Hospital Research Institute, Ottawa, Canada.,Bruyère Research Institute, Ottawa, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - M Loutfy
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - F McGee
- AIDS Bureau, Ontario Ministry of Health and Long-Term Care, Toronto, Canada
| | - J Murray
- AIDS Bureau, Ontario Ministry of Health and Long-Term Care, Toronto, Canada
| | - J Lush
- AIDS Bureau, Ontario Ministry of Health and Long-Term Care, Toronto, Canada
| | - A Rachlis
- Department of Medicine, University of Toronto, Toronto, Canada.,Sunnybrook Health Science Centre, Toronto, Canada
| | - W Wobeser
- Department of Molecular and Biomedical Sciences, Queen's University, Kingston, Canada.,Department of Public Health, Queen's University, Kingston, Canada
| | - J Bacon
- Ontario HIV Treatment Network, Toronto, Canada
| | - A E Kroch
- Ontario HIV Treatment Network, Toronto, Canada.,Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - M Gilbert
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - S B Rourke
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - A N Burchell
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.,Department of Family and Community Medicine, St Michael's Hospital, Toronto, Canada.,Department of Family and Community Medicine and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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25
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van Opstal SEM, van der Zwan JS, Wagener MN, Been SK, Miedema HS, Roelofs PDDM, van Gorp ECM. Late Presentation of HIV Infection in the Netherlands: Reasons for Late Diagnoses and Impact on Vocational Functioning. AIDS Behav 2018; 22:2593-2603. [PMID: 29550940 PMCID: PMC6097719 DOI: 10.1007/s10461-018-2082-9] [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] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Late diagnosis of HIV remains a major challenge in the HIV epidemic. In Europe, about 50% of all people living with HIV are diagnosed late after infection has occurred. Insight into the reasons for late diagnoses is necessary to increase the number of early diagnoses and optimize treatment options. This qualitative study explored the experiences of 34 late-presenters through in-depth semi-structured interviews. A variety of reasons for late diagnoses emerged from our data and led to a division into four groups, characterized by two dimensions. Regarding vocational functioning, the consequences of late diagnoses were health-related problems prior to and since diagnosis, and problems concealing the HIV status. Healthcare providers should offer HIV tests to groups at risk, and be alert for clinical HIV indicator conditions. It is recommended to increase awareness of HIV transmission routes, symptoms and tests, and the benefits of early testing and early entry to HIV care.
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Affiliation(s)
- S E M van Opstal
- Center of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK, Rotterdam, The Netherlands.
- Erasmus MC, Department of Viroscience, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - J S van der Zwan
- Center of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK, Rotterdam, The Netherlands
| | - M N Wagener
- Center of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK, Rotterdam, The Netherlands
| | - S K Been
- Erasmus MC, Department of Internal Medicine and Infectious Diseases, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - H S Miedema
- Center of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK, Rotterdam, The Netherlands
| | - P D D M Roelofs
- Center of Expertise Innovations in Care, Rotterdam University of Applied Sciences, Rochussenstraat 198, 3015 EK, Rotterdam, The Netherlands
| | - E C M van Gorp
- Erasmus MC, Department of Viroscience, University Medical Center Rotterdam, Rotterdam, The Netherlands
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26
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Tang H, Mao Y, Tang W, Han J, Xu J, Li J. "Late for testing, early for antiretroviral therapy, less likely to die": results from a large HIV cohort study in China, 2006-2014. BMC Infect Dis 2018; 18:272. [PMID: 29895275 PMCID: PMC5998580 DOI: 10.1186/s12879-018-3158-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 05/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Timely HIV testing and initiation of antiretroviral therapy are two major determinants of survival for HIV-infected individuals. Our study aimed to explore the trend of late HIV/AIDS diagnoses and to assess the factors associated with these late diagnoses in China between 2006 and 2014. METHODS We used data from the Chinese Comprehensive Response Information Management System of HIV/AIDS (CRIMS). All individuals who tested positive for HIV between 2006 and 2014 in China and were at least 15 years of age were included. A late diagnosis was defined as an instance in which an individual was diagnosed as having AIDS or WHO stage 3 or 4 HIV/AIDS, or had a CD4 cell count less than 200 cells/mm3 at the time of diagnosis. RESULTS Among the 528,234 individuals (≥15 years old) newly diagnosed with HIV between 2006 and 2014, 179,700 (34.0%) people were considered to have received late diagnoses. The late diagnosis rate decreased from 33.9% in 2006 to 29.7% in 2014 (P < 0.01). Late diagnoses were more likely to be found among those who were 45-54 years old (adjusted odds ratio [aOR]: 3.25, 95% confidence interval [CI]: 3.17-3.34) or 55+ years old (OR: 2.94, 95% CI: 2.86-3.02), male (aOR: 1.15, 95% CI: 1.13,1.17), employed as a farmer or rural laborer (aOR: 1.13, 95% CI: 1.11-1.14), infected through blood or plasma transfusion (aOR: 4.18, 95% CI: 4.02, 4.35), diagnosed at hospitals (OR: 1.17, 95% CI: 1.15, 1.19), of Han ethnicity (aOR: 1.30, 95% CI: 1.28, 1.32), and married (OR: 1.12, 95% CI: 1.11,1.13). Of those people living with HIV (PLHIV) who received late diagnoses, 7.4%(8637) and 46.1%(28,462) ultimately died with or without receiving antiretroviral therapy within a year of diagnosis, respectively. CONCLUSION A large proportion of individuals with HIV/AIDS receive late diagnoses, and this proportion has witnessed a slight decline in recent years. Expanded testing is needed to increase early HIV diagnosis and antiretroviral therapy should be recommended to all diagnosed individuals as early as possible to reduce AIDS-related death.
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Affiliation(s)
- Houlin Tang
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yurong Mao
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Weiming Tang
- University of North Carolina at Chapel Hill Project-China, Guangzhou, China.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Jing Han
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Juan Xu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jian Li
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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28
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Pregnant with HIV before age 25: data from a large national study in Italy, 2001-2016. Epidemiol Infect 2017; 145:2360-2365. [PMID: 28712385 DOI: 10.1017/s0950268817001340] [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: 11/07/2022] Open
Abstract
Young pregnant women with HIV may be at significant risk of unplanned pregnancy, lower treatment coverage, and other adverse pregnancy outcomes. In a large cohort of pregnant women with HIV in Italy, among 2979 pregnancies followed in 2001-2016, 9·0% were in women <25 years, with a significant increase over time (2001-2005: 7·0%; 2006-2010: 9·1%; 2011-2016: 12·2%, P < 0·001). Younger women had a lower rate of planned pregnancy (23·2% vs. 37·7%, odds ratio (OR) 0·50, 95% confidence interval (CI) 0·36-0·69), were more frequently diagnosed with HIV in pregnancy (46·5% vs. 20·9%, OR 3·29, 95% CI 2·54-4·25), and, if already diagnosed with HIV before pregnancy, were less frequently on antiretroviral treatment at conception (<25 years: 56·3%; ⩾25 years: 69·0%, OR 0·58, 95% CI 0·41-0·81). During pregnancy, treatment coverage was almost universal in both age groups (98·5% vs. 99·3%), with no differences in rate of HIV viral suppression at third trimester and adverse pregnancy outcomes. The data show that young women represent a growing proportion of pregnant women with HIV, and are significantly more likely to have unplanned pregnancy, undiagnosed HIV infection, and lower treatment coverage at conception. During pregnancy, antiretroviral treatment, HIV suppression, and pregnancy outcomes are similar compared with older women. Earlier intervention strategies may provide additional benefits in the quality of care for women with HIV.
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29
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Levy I, Maor Y, Mahroum N, Olmer L, Wieder A, Litchevski V, Mor O, Rahav G. Missed opportunities for earlier diagnosis of HIV in patients who presented with advanced HIV disease: a retrospective cohort study. BMJ Open 2016; 6:e012721. [PMID: 28186940 PMCID: PMC5129188 DOI: 10.1136/bmjopen-2016-012721] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To quantify and characterise missed opportunities for earlier HIV diagnosis in patients diagnosed with advanced HIV. DESIGN A retrospective observational cohort study. SETTING A central tertiary medical centre in Israel. MEASURES The proportion of patients with advanced HIV, the proportion of missed opportunities to diagnose them earlier, and the rate of clinical indicator diseases (CIDs) in those patients. RESULTS Between 2010 and 2015, 356 patients were diagnosed with HIV, 118 (33.4%) were diagnosed late, 57 (16%) with advanced HIV disease. Old age (OR=1.45 (95% CI 1.16 to 1.74)) and being heterosexual (OR=2.65 (95% CI 1.21 to 5.78)) were significant risk factors for being diagnosed late. All patients with advanced disease had at least one CID that did not lead to an HIV test in the 5 years prior to AIDS diagnosis. The median time between CID and AIDS diagnosis was 24 months (IQR 10-30). 60% of CIDs were missed by a general practitioner and 40% by a specialist. CONCLUSIONS Missed opportunities to early diagnosis of HIV occur in primary and secondary care. Lack of national guidelines, lack of knowledge regarding CIDs and communication barriers with patients may contribute to a late diagnosis of HIV.
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Affiliation(s)
- Itzchak Levy
- Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
| | - Yasmin Maor
- Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
- Infectious Disease Unit, Wolfson Medical Center, Holon, Israel
| | - Naim Mahroum
- Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
| | - Liraz Olmer
- Unit of Biostatistics, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | - Anat Wieder
- Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Orna Mor
- Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
- Central Virology Laboratory, Ministry of Health, National HIV Reference Laboratory, Tel Hashomer, Israel
| | - Galia Rahav
- Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
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30
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Late Presentation of HIV Infection: Prevalence, Trends, and the Role of HIV Testing Strategies in Guangzhou, China, 2008-2013. BIOMED RESEARCH INTERNATIONAL 2016; 2016:1631878. [PMID: 27761466 PMCID: PMC5059519 DOI: 10.1155/2016/1631878] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 08/10/2016] [Accepted: 09/06/2016] [Indexed: 12/13/2022]
Abstract
Background. The prevalence, trends, and the role of different HIV testing strategies in late presentation of HIV infection in China were unknown. Methods. Data of newly reported HIV cases in Guangzhou between 2008 and 2013 was analyzed to examine the prevalence, trends, and characteristics of late presentation of HIV infection by three types of HIV testing strategies. Results. Overall, 53.2% (1412/2653) and 27.3% (724/2653) met the criteria of late presentation and presentation with advanced HIV disease. The overall trend of late presentation of HIV infection within the study period was declining. Late presentation was 62.9% in 2008 and dropped to 43.3% in 2013 (P < 0.001); presentation with advanced HIV disease was 40.3% in 2008 and dropped to 15.2% in 2013 (P < 0.001). Of the three testing strategies, PITC presented higher odds of both late presentation [AOR (95% CI): PITC versus VCT: 1.37 (1.09, 1.73); PITC versus MHT: 3.09 (2.16, 4.42)] and presentation with advanced HIV disease [AOR (95% CI): PITC versus VCT: 1.65 (1.29, 2.11); PITC versus MHT: 13.14 (8.47, 20.39)]. Conclusions. Although the late presentation of HIV infection was declining, it was still high in Guangzhou. The worse situation among PITC cases urges the policy adjustment in medical settings to increase early HIV diagnosis.
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Symptomatic Patients without Epidemiological Indicators of HIV Have a High Risk of Missed Diagnosis: A Multi-Centre Cross Sectional Study. PLoS One 2016; 11:e0162503. [PMID: 27603207 PMCID: PMC5014346 DOI: 10.1371/journal.pone.0162503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/23/2016] [Indexed: 11/19/2022] Open
Abstract
Objectives One quarter of HIV-1 positive individuals in Sweden present for care with HIV or AIDS associated conditions without an HIV test (missed presentations) and 16% report neglect of such symptoms. The objective of this study was to identify risk factors for these missed opportunities of HIV-1 diagnosis. Methods A national study, recruiting 409 newly diagnosed HIV-1 infected adults over a 2.5-year period, was performed. Logistic regression models tested the relationship between missed presentation and patient’s neglect versus socio-demographic and behavioural risk factors. Additionally the initiator of the HIV test was assessed. Results The odds for a missed presentation was lower for migrants (from East Europe, Asia, and Pacific (East): OR 0.4 (0.2–0.8); Sub-Saharan Africa (SSA): 0.3 (0.2–0.6); other: 0.5 (0.2–1.0)), compared to patients born in Sweden, just as symptoms neglected by the patient (East (0.3 (0.1–1.0); SSA (0.4 (0.2–0.8)). The latter was also lower for men who have sex with men (0.5 (0.2–1.0)), compared to patients infected heterosexually. Patients infected in the East, with present/previous substance use or a previous negative HIV test were more likely to take the initiative to test on their own, whereas those >50 years and with a previously missed presentation had significantly reduced odds, p<0.05. Conclusions Individuals without epidemiological indicators of HIV are more likely to have a history of missed presentations, to neglect symptoms and are less prone to take an initiative to test for HIV themselves. It is important to further implement testing to include all patients with symptoms and conditions indicative of HIV.
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Cerini C, Casari S, Donato F, Porteri E, Rodella A, Terlenghi L, Compostella S, Apostoli A, Brianese N, Urbinati L, Salvi A, Rossini A, Agabiti Rosei E, Caruso A, Carosi G, Castelli F. Trigger-oriented HIV testing at Internal Medicine hospital Departments in Northern Italy: an observational study (Fo.C.S. Study). Infect Dis (Lond) 2016; 48:838-43. [PMID: 27622515 DOI: 10.3109/23744235.2016.1169551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Early detection of undiagnosed HIV infected patients is of paramount importance. The attitude of Italian hospital-based Internal Medicine physicians to prescribe HIV testing following the detection of HIV-associated signs, symptoms and behaviours (triggers) has been reported to be poor. The aim of the study is to quantify the extent of the missed opportunities for early HIV diagnosis in Internal Medicine Departments (IMD). METHODS Patients admitted to IMD of a General University Hospital in Italy in March-June 2013 were interviewed using a structured questionnaire investigating the presence of triggers for HIV testing, including patient's characteristics, symptoms and conditions associated with HIV infection. HIV tests performed during hospitalisation were recorded. RESULTS HIV testing was performed in 73 (6.6%) out of 1113 hospitalisations (1072 patients), providing positive results in three cases (4.1%). All of them presented ≥1 triggers. Conversely, 853 triggers were identified in 528 hospitalisations with at least one trigger (47.4%). The proportion of hospitalisations where an HIV testing was prescribed was 3.1%, 9.5% and 16.0% in the presence of zero, one-to-two or more triggers, respectively. Age <70 years, female gender, length of hospital stay, haematological disease, HBV infection, multiple sexual partners and lymphadenopathy were predictors of HIV testing by logistic regression analysis. CONCLUSIONS Although chances of an HIV test being performed in patients hospitalised in IMD increases along with the number of triggers, the number of tests being performed in people presenting with triggers is unacceptably low and requires educational interventions in order to obtain individual and public health advantages.
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Affiliation(s)
- Carlo Cerini
- a Infectious and Tropical Diseases Unit , University of Brescia , Italy
| | - Salvatore Casari
- a Infectious and Tropical Diseases Unit , University of Brescia , Italy
| | - Francesco Donato
- b Institute of Hygiene, Epidemiology and Public Health , University of Brescia , Italy
| | - Enzo Porteri
- c Internal Medicine Unit , University of Brescia , Italy
| | - Anna Rodella
- d Laboratory of Microbiology and Virology , University of Brescia , Italy
| | - Luigina Terlenghi
- d Laboratory of Microbiology and Virology , University of Brescia , Italy
| | | | | | | | - Lucia Urbinati
- a Infectious and Tropical Diseases Unit , University of Brescia , Italy
| | - Andrea Salvi
- e Internal Medicine Unit 3 , Spedali Civili General Hospital , Brescia , Italy
| | - Angelo Rossini
- f Hepatology Unit , Spedali Civili General Hospital , Brescia , Italy
| | | | - Arnaldo Caruso
- d Laboratory of Microbiology and Virology , University of Brescia , Italy
| | | | - Francesco Castelli
- a Infectious and Tropical Diseases Unit , University of Brescia , Italy ;,h Training and empowering human resources for health development in resource-limited countries , University of Brescia , Brescia , Italy
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Noble G, Okpo E, Tonna I, Fielding S. Factors associated with late HIV diagnosis in North-East Scotland: a six-year retrospective study. Public Health 2016; 139:36-43. [PMID: 27393624 DOI: 10.1016/j.puhe.2016.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/24/2016] [Accepted: 06/08/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Late HIV diagnosis is associated with increased morbidity and mortality, increased risk of transmission, impaired response to antiretroviral therapy and increased health care costs. The aim of this study was to determine the factors associated with late HIV diagnosis in Grampian, North-East Scotland. STUDY DESIGN A population based retrospective database analysis. METHODS All newly diagnosed HIV positive individuals in Grampian, North-East Scotland between 2009 and 2014 were included in the study. Participants were classified as having a late diagnosis if the CD4 cell count at presentation was less than 350 cells/mm3. Socio-economic and demographic factors were investigated in relation to outcome (late diagnosis) using Chi-squared and Mann-Whitney tests. RESULTS CD4 cell count results were available for 111 (89.5%) of the 124 newly diagnosed individuals during the study period. The prevalence of late diagnosis was 53.2% (n = 59). Those infected via heterosexual mode of transmission had a 2.83 times higher odds of late diagnosis (OR 2.83 [95% CI: 1.10-7.32]) than men who have sex with men (MSM) and those with no previous HIV testing had a 5.46 increased odds of late diagnosis (OR 5.46 [95% CI: 1.89-15.81]) compared to those who had previously been tested. Missed opportunities for HIV diagnosis were identified in 16.3% (n = 15) of participants. CONCLUSION Heterosexual individuals and those with no previous HIV testing were more likely to be diagnosed late. Targeted initiatives to increase perception of HIV risk and uptake of testing in these risk groups are recommended.
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Affiliation(s)
- G Noble
- Institute of Applied Health Sciences, Postgraduate Education Department, University of Aberdeen, Aberdeen, Scotland, UK
| | - E Okpo
- Institute of Applied Health Sciences, Postgraduate Education Department, University of Aberdeen, Aberdeen, Scotland, UK; Public Health Department, NHS Grampian, Summerfield House, 2 Eday Road, Aberdeen, AB15 6RE, UK.
| | - I Tonna
- Aberdeen Royal Infirmary, Infectious Diseases Department, Emergency Care Centre, Aberdeen, UK
| | - S Fielding
- Institute of Applied Health Sciences, Medical Statistics Department, University of Aberdeen, Aberdeen, Scotland, UK
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Gullón A, Verdejo J, de Miguel R, Gómez A, Sanz J. Factors associated with late diagnosis of HIV infection and missed opportunities for earlier testing. AIDS Care 2016; 28:1296-300. [PMID: 27144427 DOI: 10.1080/09540121.2016.1178700] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Late diagnosis (LD) of human immunodeficiency virus (HIV) infection continues to be a significant problem that increases disease burden both for patients and for the public health system. Guidelines have been updated in order to facilitate earlier HIV diagnosis, introducing "indicator condition-guided HIV testing". In this study, we analysed the frequency of LD and associated risk factors. We retrospectively identified those cases that could be considered missed opportunities for an earlier diagnosis. All patients newly diagnosed with HIV infection who attended Hospital La Princesa, Madrid (Spain) between 2007 and 2014 were analysed. We collected epidemiological, clinical and immunological data. We also reviewed electronic medical records from the year before the HIV diagnosis to search for medical consultations due to clinical indicators. HIV infection was diagnosed in 354 patients. The median CD4 count at presentation was 352 cells/mm(3). Overall, 158 patients (50%) met the definition of LD, and 97 (30.7%) the diagnosis of advanced disease. LD was associated with older age and was more frequent amongst immigrants. Heterosexual relations and injection drug use were more likely to be the reasons for LD than relations between men who have sex with men. During the year preceding the diagnosis, 46.6% of the patients had sought medical advice owing to the presence of clinical indicators that should have led to HIV testing. Of those, 24 cases (14.5%) were classified as missed opportunities for earlier HIV diagnosis because testing was not performed. According to these results, all health workers should pursue early HIV diagnosis through the proper implementation of HIV testing guidelines. Such an approach would prove directly beneficial to the patient and indirectly beneficial to the general population through the reduction in the risk of transmission.
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Affiliation(s)
- Alejandra Gullón
- a Internal Medicine and Infectious Diseases Department , University Hospital La Princesa , Madrid , Spain
| | - José Verdejo
- b Epidemiological surveillance of HIV/AIDS. Epidemiology Department , General Directorate of Public Health of the Community of Madrid , Madrid , Spain
| | - Rosa de Miguel
- a Internal Medicine and Infectious Diseases Department , University Hospital La Princesa , Madrid , Spain
| | - Ana Gómez
- a Internal Medicine and Infectious Diseases Department , University Hospital La Princesa , Madrid , Spain
| | - Jesús Sanz
- a Internal Medicine and Infectious Diseases Department , University Hospital La Princesa , Madrid , Spain
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Joore IK, Arts DL, Kruijer MJP, Moll van Charante EP, Geerlings SE, Prins JM, van Bergen JE. HIV indicator condition-guided testing to reduce the number of undiagnosed patients and prevent late presentation in a high-prevalence area: a case-control study in primary care. Sex Transm Infect 2015; 91:467-72. [PMID: 26126531 DOI: 10.1136/sextrans-2015-052073] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/13/2015] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Recent guidelines advocate accelerated provider-initiated HIV testing by general practitioners (GPs). We aimed to identify the number of patient consultations in six general practices in the South-East of Amsterdam, and the incidence of HIV indicator conditions reported in their medical files prior to diagnosis. METHODS A cross-sectional search in an electronic general practice database. We used a case-control design to identify those conditions most associated with an HIV-positive status. RESULTS We included 102 HIV cases diagnosed from 2002 to 2012, and matched them with 299 controls. In the year prior to HIV diagnosis, 61.8% of cases visited their GP at least once, compared with 38.8% of controls. In the 5 years prior to HIV diagnosis, 58.8% of HIV cases had exhibited an HIV indicator condition, compared with 7.4% of controls. The most common HIV-related conditions were syphilis and gonorrhoea. The most common HIV-related symptoms were weight loss, lymphadenopathy and peripheral neuropathy. During this period, average HIV prevalence among people aged 15-59 years increased from 0.4% to 0.9%. CONCLUSIONS This study revealed many opportunities for HIV indicator condition-guided testing in primary care. As yet, however, HIV indicator conditions are not exploited as triggers for early HIV testing.
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Affiliation(s)
- Ivo K Joore
- Department of General Practice, Division of Clinical Methods and Public Health, Academic Medical Center, Amsterdam, The Netherlands
| | - Derk L Arts
- Department of General Practice, Division of Clinical Methods and Public Health, Academic Medical Center, Amsterdam, The Netherlands
| | - Marjan J P Kruijer
- Department of General Practice, Division of Clinical Methods and Public Health, Academic Medical Center, Amsterdam, The Netherlands
| | - Eric P Moll van Charante
- Department of General Practice, Division of Clinical Methods and Public Health, Academic Medical Center, Amsterdam, The Netherlands
| | - Suzanne E Geerlings
- Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan M Prins
- Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan Eam van Bergen
- Department of General Practice, Division of Clinical Methods and Public Health, Academic Medical Center, Amsterdam, The Netherlands STI AIDS Netherlands (Soa Aids Nederland), Amsterdam, The Netherlands Epidemiology & Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Pernas B, Mena A, Cañizares A, Grandal M, Castro-Iglesias A, Pértega S, Pedreira JD, Poveda E. Trends on epidemiological, virological, and clinical features among newly diagnosed HIV-1 persons in Northwest Spain over the last 10 years. J Med Virol 2015; 87:1319-26. [PMID: 25777786 DOI: 10.1002/jmv.24185] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2015] [Indexed: 12/21/2022]
Abstract
To describe temporal trend and characteristics of newly HIV-diagnosed patients in a medical care area in Northwest Spain over the last 10 years. All newly diagnosed patients for HIV-infection from 2004 to 2013 at a reference medical care area in Northwest of Spain were identified. Epidemiological, virological, immunological, and clinical data, as well as HIV genotype and drug resistance information were recorded. A total of 565 newly HIV-diagnosed patients were identified. The number of new cases increased in the last 5 years (66 cases/year). Overall, 53.1% had a median CD4 counts < 350 cells/µl and 33.6% had an AIDS defining criteria. Non-B variants were found in 34.4% of patients being subtype F (25.8%) the most common non-B subtype. The rate of transmitted drug resistance (TDR) over the study period was 3.7%, but a decreased to 2.6% was observed in the last 5 years. The most prevalent TDR mutations were: T215 revertants (1.5%), K219QENR (1.2%), for NRTIs; K103N (1.9%), for NNRTIs; L90M (0.3%), for PIs. Overall, 73.2% of patients started antiretroviral treatment and 9.9% of patients died during follow-up. The number of newly HIV diagnosed patients increased since year 2009. There is a high prevalence of late diagnosis (53%) and 33% had an AIDS defining criteria. Interestingly, the most prevalent non-B subtype in our population was F (25.8%). These findings support the need to facilitate the access for HIV testing to reduce the rate of late HIV diagnosis, improve the clinical outcome and prevent HIV transmission.
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Affiliation(s)
- B Pernas
- Division of Clinical Virology, INIBIC-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain
| | - A Mena
- Division of Clinical Virology, INIBIC-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain
| | - A Cañizares
- Service of Microbiology, INIBIC-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain
| | - M Grandal
- Division of Clinical Virology, INIBIC-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain
| | - A Castro-Iglesias
- Division of Clinical Virology, INIBIC-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain
| | - S Pértega
- Clinical Epidemiology and Biostatistics Unit, INIBIC-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain
| | - J D Pedreira
- Division of Clinical Virology, INIBIC-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain
| | - E Poveda
- Division of Clinical Virology, INIBIC-Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña, A Coruña, Spain
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Elmahdi R, Gerver SM, Gomez Guillen G, Fidler S, Cooke G, Ward H. Low levels of HIV test coverage in clinical settings in the U.K.: a systematic review of adherence to 2008 guidelines. Sex Transm Infect 2014; 90:119-24. [PMID: 24412996 PMCID: PMC3945742 DOI: 10.1136/sextrans-2013-051312] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives To quantify the extent to which guideline recommendations for routine testing for HIV are adhered to outside of genitourinary medicine (GUM), sexual health (SH) and antenatal clinics. Methods A systematic review of published data on testing levels following publication of 2008 guidelines was undertaken. Medline, Embase and conference abstracts were searched according to a predefined protocol. We included studies reporting the number of HIV tests administered in those eligible for guideline recommended testing. We excluded reports of testing in settings with established testing surveillance (GUM/SH and antenatal clinics). A random effects meta-analysis was carried out to summarise level of HIV testing across the studies identified. Results Thirty studies were identified, most of which were retrospective studies or audits of testing practice. Results were heterogeneous. The overall pooled estimate of HIV test coverage was 27.2% (95% CI 22.4% to 32%). Test coverage was marginally higher in patients tested in settings where routine testing is recommended (29.5%) than in those with clinical indicator diseases (22.4%). Provider test offer was found to be lower (40.4%) than patient acceptance of testing (71.5%). Conclusions Adherence to 2008 national guidelines for HIV testing in the UK is poor outside of GUM/SH and antenatal clinics. Low levels of provider test offer appear to be a major contributor to this. Failure to adhere to testing guidelines is likely to be contributing to late diagnosis with implications for poorer clinical outcomes and continued onwards transmission of HIV. Improved surveillance of HIV testing outside of specialist settings may be useful in increasing adherence testing guidelines.
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Affiliation(s)
- Rahma Elmahdi
- Department of Infectious Disease Epidemiology, Imperial College London, , London, UK
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