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Tan R, Hugli O, Cavassini M, Darling K. Non-targeted HIV testing in the emergency department: not just how but where. Expert Rev Anti Infect Ther 2018; 16:893-905. [PMID: 30406726 DOI: 10.1080/14787210.2018.1545575] [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: 10/27/2022]
Abstract
INTRODUCTION The emergency department (ED) has the potential to enhance early HIV diagnosis through HIV testing programs. How these are implemented is a subject of debate. Areas covered: We describe the main HIV testing approaches: diagnostic testing, targeted screening, and non-targeted screening, and review ED-based non-targeted HIV screening studies conducted after 2006 among ≥5000 patients. As well as examining how testing is offered, we focus on where it is offered, through the patient's journey from registration, via triage and the waiting room, to the bedside. Barriers to the testing offer, acceptance and performance were examined at each location. While testing offer rates were higher at registration and triage, compared to the waiting room and bedside, this was sometimes at the expense of testing acceptance and performance. Variables affecting testing rates included type of consent, employment of external staff and type of testing: fourth generation serological testing versus rapid testing. Expert commentary: These large studies shed light on the importance of where as well as how HIV testing is performed, and the ways in which the 'where' can influence non-targeted screening yields. This perspective enables testing approaches to be tailored to specific ED settings in order to maximize testing rates.
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Affiliation(s)
- Rainer Tan
- a Infectious Diseases Service , Lausanne University Hospital , Lausanne , Switzerland
| | - Olivier Hugli
- b Emergency Department , Lausanne University Hospital , Lausanne , Switzerland
| | - Matthias Cavassini
- a Infectious Diseases Service , Lausanne University Hospital , Lausanne , Switzerland
| | - Katharine Darling
- a Infectious Diseases Service , Lausanne University Hospital , Lausanne , Switzerland
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Hwang JP, Granwehr BP, Torres HA, Suarez-Almazor ME, Giordano TP, Barbo AG, Lin HY, Fisch MJ, Chiao EY. HIV Testing in Patients With Cancer at the Initiation of Therapy at a Large US Comprehensive Cancer Center. J Oncol Pract 2015; 11:384-90. [PMID: 26243649 DOI: 10.1200/jop.2015.005116] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the rates of HIV testing and infection among patients with cancer at initiation of systemic cancer therapy. METHODS We conducted a retrospective cohort study of adults with cancer who registered at a comprehensive cancer center from January 2004 through April 2011 and received systemic cancer therapy. We determined rates of HIV-1/2 and/or Western blot testing and HIV positivity at initiation of systemic cancer therapy. Multivariable logistic regression was used to determine predictors of HIV testing. RESULTS Of 18,874 patients with cancer who received systemic cancer therapy during the study period, 3,514 (18.6%) were tested for HIV at initiation of cancer therapy. The prevalence of positive HIV test results was 1.2% (41 of 3,514), and the prevalence of newly diagnosed HIV was 0.3% (12 of 3,514). The HIV testing rate was lower in black than in white patients (13.7% v 19.2%), but the prevalence of positive test results was higher in black patients (4.5%) than in any other racial/ethnic group. Among patients with AIDS-defining cancers (eg, non-Hodgkin lymphoma and cervical cancer), predictors of HIV testing were history of non-Hodgkin lymphoma, younger age, and registration after 2006. Among patients with non-AIDS-defining cancers, predictors of HIV testing were younger age, registration after 2006, male sex, history of illicit drug use or sexually transmitted disease, having a hematologic malignancy, and black race. CONCLUSION The prevalence of HIV infection among patients with cancer was 1.2%, higher than the 0.1% prevalence threshold above which national guidelines recommend routine opt-out testing; however, the overall HIV testing rate was low.
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Affiliation(s)
- Jessica P Hwang
- The University of Texas MD Anderson Cancer Center; Houston Veterans Affairs (VA) Health Sciences Research and Development, Michael E. DeBakey VA Medical Center; and Baylor College of Medicine, Houston, TX
| | - Bruno P Granwehr
- The University of Texas MD Anderson Cancer Center; Houston Veterans Affairs (VA) Health Sciences Research and Development, Michael E. DeBakey VA Medical Center; and Baylor College of Medicine, Houston, TX
| | - Harrys A Torres
- The University of Texas MD Anderson Cancer Center; Houston Veterans Affairs (VA) Health Sciences Research and Development, Michael E. DeBakey VA Medical Center; and Baylor College of Medicine, Houston, TX
| | - Maria E Suarez-Almazor
- The University of Texas MD Anderson Cancer Center; Houston Veterans Affairs (VA) Health Sciences Research and Development, Michael E. DeBakey VA Medical Center; and Baylor College of Medicine, Houston, TX
| | - Thomas P Giordano
- The University of Texas MD Anderson Cancer Center; Houston Veterans Affairs (VA) Health Sciences Research and Development, Michael E. DeBakey VA Medical Center; and Baylor College of Medicine, Houston, TX
| | - Andrea G Barbo
- The University of Texas MD Anderson Cancer Center; Houston Veterans Affairs (VA) Health Sciences Research and Development, Michael E. DeBakey VA Medical Center; and Baylor College of Medicine, Houston, TX
| | - Heather Y Lin
- The University of Texas MD Anderson Cancer Center; Houston Veterans Affairs (VA) Health Sciences Research and Development, Michael E. DeBakey VA Medical Center; and Baylor College of Medicine, Houston, TX
| | - Michael J Fisch
- The University of Texas MD Anderson Cancer Center; Houston Veterans Affairs (VA) Health Sciences Research and Development, Michael E. DeBakey VA Medical Center; and Baylor College of Medicine, Houston, TX
| | - Elizabeth Y Chiao
- The University of Texas MD Anderson Cancer Center; Houston Veterans Affairs (VA) Health Sciences Research and Development, Michael E. DeBakey VA Medical Center; and Baylor College of Medicine, Houston, TX
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Sengayi M, Babb C, Egger M, Urban MI. HIV testing and burden of HIV infection in black cancer patients in Johannesburg, South Africa: a cross-sectional study. BMC Cancer 2015; 15:144. [PMID: 25884599 PMCID: PMC4434805 DOI: 10.1186/s12885-015-1171-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 03/06/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND HIV infection is a known risk factor for cancer but little is known about HIV testing patterns and the burden of HIV infection in cancer patients. We did a cross-sectional analysis to identify predictors of prior HIV testing and to quantify the burden of HIV in black cancer patients in Johannesburg, South Africa. METHODS The Johannesburg Cancer Case-control Study (JCCCS) recruits newly-diagnosed black cancer patients attending public referral hospitals for oncology and radiation therapy in Johannesburg . All adult cancer patients enrolled into the JCCCS from November 2004 to December 2009 and interviewed on previous HIV testing were included in the analysis. Patients were independently tested for HIV-1 using a single ELISA test . The prevalence of prior HIV testing, of HIV infection and of undiagnosed HIV infection was calculated. Multivariate logistic regression models were fitted to identify factors associated with prior HIV testing. RESULTS A total of 5436 cancer patients were tested for HIV of whom 1833[33.7% (95% CI=32.5-35.0)] were HIV-positive. Three-quarters of patients (4092 patients) had ever been tested for HIV. The total prevalence of undiagnosed HIV infection was 11.5% (10.7-12.4) with 34% (32.0-36.3) of the 1833 patients who tested HIV-positive unaware of their infection. Men >49 years [OR 0.49(0.39-0.63)] and those residing in rural areas [OR 0.61(0.39-0.97)] were less likely to have been previously tested for HIV. Men with at least a secondary education [OR 1.79(1.11-2.90)] and those interviewed in recent years [OR 4.13(2.62 - 6.52)] were likely to have prior testing. Women >49 years [OR 0.33(0.27-0.41)] were less likely to have been previously tested for HIV. In women, having children <5 years [OR 2.59(2.04-3.29)], hormonal contraceptive use [OR 1.33(1.09-1.62)], having at least a secondary education [OR:2.08(1.45-2.97)] and recent year of interview [OR 6.04(4.45-8.2)] were independently associated with previous HIV testing. CONCLUSIONS In a study of newly diagnosed black cancer patients in Johannesburg, over a third of HIV-positive patients were unaware of their HIV status. In South Africa black cancer patients should be targeted for opt-out HIV testing.
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Affiliation(s)
- Mazvita Sengayi
- NHLS/MRC Cancer Epidemiology Research Group, National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa.
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland.
| | - Chantal Babb
- NHLS/MRC Cancer Epidemiology Research Group, National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa.
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
- Centre for Infectious Disease Epidemiology and Research (CIDER), School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Margaret I Urban
- NHLS/MRC Cancer Epidemiology Research Group, National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa.
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Li J, Thompson TD, Tai E, Zhao G, Oster AM. Testing for human immunodeficiency virus among cancer survivors under age 65 in the United States. Prev Chronic Dis 2014; 11:E200. [PMID: 25393748 PMCID: PMC4232332 DOI: 10.5888/pcd11.140274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Introduction Knowing the human immunodeficiency virus (HIV) serostatus of patients at the time of cancer diagnosis or cancer recurrence is prerequisite to coordinating HIV and cancer treatments and improving treatment outcomes. However, there are no published data about HIV testing among cancer survivors in the United States. We sought to provide estimates of the proportion of cancer survivors tested for HIV and to characterize factors associated with having had HIV testing. Methods We used data from the 2009 Behavioral Risk Factor Surveillance System to calculate the proportion of cancer survivors under age 65 who had undergone HIV testing, by demographic and health-related factors and by state. Adjusted proportion estimates were calculated by multivariable logistic regression. Results Only 41% of cancer survivors in the United States under the age of 65 reported ever having had an HIV test. The highest proportion of survivors tested was among patients aged 25 to 34 years (72.2%), non-Hispanic blacks (59.5%), and cervical cancer survivors (51.2%). The proportion tested was highest in the District of Columbia (68.3%) and lowest in Nebraska (24.1%). Multivariable analysis showed that factors associated with HIV testing included being non-Hispanic black or Hispanic, being younger, having higher education, not being married or living with a partner, not being disabled, and having medical cost concerns. Having an AIDS-related cancer was associated with HIV testing only among females. Conclusion The proportions of HIV testing varied substantially by demographic and health-related factors and by state. Our study points to the need for public health interventions to promote HIV testing among cancer survivors.
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Affiliation(s)
- Jun Li
- Epidemiologist, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F76, Atlanta, GA 30341. Telephone: 770-488-3030. E-mail:
| | | | - Eric Tai
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Guixiang Zhao
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Darling KEA, Hugli O, Mamin R, Cellerai C, Martenet S, Berney A, Peters S, Du Pasquier RA, Bodenmann P, Cavassini M. HIV testing practices by clinical service before and after revised testing guidelines in a Swiss University Hospital. PLoS One 2012; 7:e39299. [PMID: 22761757 PMCID: PMC3386253 DOI: 10.1371/journal.pone.0039299] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 05/17/2012] [Indexed: 11/19/2022] Open
Abstract
Objectives To determine 1) HIV testing practices in a 1400-bed university hospital where local HIV prevalence is 0.4% and 2) the effect on testing practices of national HIV testing guidelines, revised in March 2010, recommending Physician-Initiated Counselling and Testing (PICT). Methods Using 2 hospital databases, we determined the number of HIV tests performed by selected clinical services, and the number of patients tested as a percentage of the number seen per service (‘testing rate’). To explore the effect of the revised national guidelines, we examined testing rates for two years pre- and two years post-PICT guideline publication. Results Combining the clinical services, 253,178 patients were seen and 9,183 tests were performed (of which 80 tested positive, 0.9%) in the four-year study period. The emergency department (ED) performed the second highest number of tests, but had the lowest testing rates (0.9–1.1%). Of inpatient services, neurology and psychiatry had higher testing rates than internal medicine (19.7% and 9.6% versus 8%, respectively). There was no significant increase in testing rates, either globally or in the majority of the clinical services examined, and no increase in new HIV diagnoses post-PICT recommendations. Conclusions Using a simple two-database tool, we observe no global improvement in HIV testing rates in our hospital following new national guidelines but do identify services where testing practices merit improvement. This study may show the limit of PICT strategies based on physician risk assessment, compared to the opt-out approach.
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Affiliation(s)
| | - Olivier Hugli
- Emergency Department, University Hospital of Lausanne, Lausanne, Switzerland
| | - Rachel Mamin
- Service of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland
| | - Cristina Cellerai
- Service of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland
| | - Sebastien Martenet
- Information and Management Control, University Hospital of Lausanne, Lausanne, Switzerland
| | - Alexandre Berney
- Service of Psychiatry, University Hospital of Lausanne, Lausanne, Switzerland
| | - Solange Peters
- Service of Oncology, University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Patrick Bodenmann
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Matthias Cavassini
- Infectious Diseases Service, University Hospital of Lausanne, Lausanne, Switzerland
- * E-mail: Matthias
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McNamara C, Davies J, Dyer M, Hoskin P, Illidge T, Lyttelton M, Marcus R, Montoto S, Ramsay A, Wong WL, Ardeshna K. Guidelines on the investigation and management of follicular lymphoma. Br J Haematol 2011; 156:446-67. [PMID: 22211428 DOI: 10.1111/j.1365-2141.2011.08969.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Chiao EY, Dezube BJ, Krown SE, Wachsman W, Brock MV, Giordano TP, Mitsuyasu R, Pantanowitz L. Time for oncologists to opt in for routine opt-out HIV testing? JAMA 2010; 304:334-9. [PMID: 20639567 PMCID: PMC3160789 DOI: 10.1001/jama.2010.752] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Human immunodeficiency virus (HIV)-infected individuals are at high risk of malignancies. However, it is not currently the standard of care to routinely test cancer patients for HIV. In 2006, the Centers for Disease Control and Prevention recommended HIV testing in all health care settings, calling for standard nontargeted "opt-out" HIV screening. For a variety of reasons, routine opt-out HIV testing is still not widely used in the United States. Although many barriers to routine opt-out HIV testing have been addressed, such opt-out HIV testing continues to be conducted primarily in venues that target specific patient populations such as pregnant women. Although opt-out testing has been piloted in emergency departments, less emphasis has been placed on opt-out HIV testing in other clinical settings. In this article, the background, rationale, and evidence for supporting opt-out HIV testing as routine care for cancer patients are presented. In addition, evidence is discussed for the potential of opt-out HIV testing to improve clinical outcomes by facilitating appropriate HIV management during cancer treatment for individuals who are found to be HIV positive.
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Affiliation(s)
- Elizabeth Y Chiao
- Department of Medicine, Baylor College of Medicine, and Health Services Research and Development, Department of Veterans Affairs Medical Center, Houston, Texas 77030, USA.
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