Factors associated with presenting late or with advanced HIV disease in the Netherlands, 1996–2014: results from a national observational cohort

Coul, Eline Op de; Sighem, Ard van; Brinkman, Kees; Benthem, Birgit Hb van; Ende, Marchina E. van der; Geerlings, Suzanne E.; Reiss, Peter

doi:10.1136/bmjopen-2015-009688

Cited by 76 publications

(71 citation statements)

References 26 publications

(23 reference statements)

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“…Unfortunately, more than three decades after the HIV epidemic started, many patients all over the world are still diagnosed very late in the course of their disease: in a recent Dutch paper, it was found that more than half of their patients were diagnosed late with HIV disease and 35% of their cohort were diagnosed with AHD 18. Similar rates of late diagnosis are present all over Europe 19.…”

Section: Discussionmentioning

confidence: 99%

Missed opportunities for earlier diagnosis of HIV in patients who presented with advanced HIV disease: a retrospective cohort study

et al. 2016

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ObjectiveTo quantify and characterise missed opportunities for earlier HIV diagnosis in patients diagnosed with advanced HIV.DesignA retrospective observational cohort study.SettingA central tertiary medical centre in Israel.MeasuresThe 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.ResultsBetween 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.ConclusionsMissed 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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Section: Discussionmentioning

confidence: 99%

Missed opportunities for earlier diagnosis of HIV in patients who presented with advanced HIV disease: a retrospective cohort study

et al. 2016

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“…A late‐stage diagnosis of HIV has negative consequences for the individual and society such as increased morbidity and mortality, poorer response to treatment, higher healthcare costs and increased transmission to others . Risk factors for late diagnosis include older age, female gender and identifying as heterosexual . Late‐stage diagnoses are often made in individuals who have presented previously to healthcare services with potential HIV‐related symptoms and signs .…”

Section: Introductionmentioning

confidence: 99%

Missed opportunities for HIV testing persist despite a single educational intervention: how can we close this evidence‐practice gap?

King

Seah

Cheng

et al. 2020

Internal Medicine Journal

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Background In Australia, one‐third of human immunodeficiency virus (HIV) diagnoses occur late, with an estimated 11% of people with HIV unaware of their diagnosis. Undiagnosed and untreated HIV infection increases morbidity in the HIV positive person and allows onward transmission of HIV. Aim To determine the rate of HIV testing in acute general medicine patients with HIV indicator conditions (IC) and evaluate the effectiveness of an educational intervention in improving testing rates. Methods Single‐centre, tertiary hospital, before‐after study of general medicine inpatients with IC for 12 weeks prior and 10 weeks post an educational intervention focusing on recommendations for HIV testing including IC. The REASON Cohort Discovery Tool was used to search for the IC using ICD‐10 codes and laboratory data. The presence of IC was estimated, and HIV testing rates before and after the intervention were compared. Regression analysis was utilised to identify characteristics associated with HIV testing. Results Of 1414 admissions in the baseline period and 946 in the post‐period, 161 (11.4%) and 132 (14.0%) had at least one IC present respectively. There were 18 (11.2%) HIV tests performed for admissions with IC in the pre‐period which increased to 27 (20.5%) (P = 0.028) in the post‐period. Younger patients were more likely to be tested and regression analysis identified the educational intervention (adjusted odds ratio) 2.2 (1.1, 4.4) to be significantly associated with testing. Conclusions Although HIV testing rates for IC doubled following the intervention, they remained unacceptably low. The recently introduced electronic medical record presents opportunities to prompt HIV testing.

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“…8 These barriers result in women being diagnosed later in their infection in countries with a low HIV prevalence among the general population and where women have not traditionally been considered a key risk population. [9][10][11][12] New HIV diagnoses among women in Australia make up approximately 10% of all diagnoses and, among the estimated 26,444 people living with HIV in Australia in 2016, 12% were women. In Australia, a disproportionate rate of HIV diagnosis exists Two decades of surveillance data show late presentation among a diverse group of women diagnosed with HIV in Victoria, Australia among Aboriginal and migrant women compared with non-Aboriginal Australianborn women.…”

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confidence: 99%

Two decades of surveillance data show late presentation among a diverse group of women diagnosed with HIV in Victoria, Australia

Moreira

Boughey

Ryan

et al. 2019

Australian and New Zealand Journal of Public Health

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Objective: To develop an HIV response suited to women and to inform appropriate services, we describe the characteristics of women diagnosed and living with HIV using 22 years of high‐quality surveillance data. Methods: Data on women newly diagnosed with HIV between 1994 and 2016 and women living with diagnosed HIV in Victoria at 31 December 2016 were extracted from the Victorian Public Health Surveillance System. Descriptive analysis by place of birth was performed and Poisson regression used to assess trends over time. Results: There were 465 new diagnoses among women in Victoria between 1994 and 2016 and 613 women living with HIV in 2016. Women were diagnosed late, and frequently reported no HIV testing history, AIDS‐defining illness or other symptoms of HIV at diagnosis. These indicators of delayed diagnosis were even greater for non‐Australian‐born women. Conclusions and implications for public health: For Victoria to reach the ambitious targets for diagnosis, treatment and viral suppression in 95% of people living with HIV, prevention programs and efforts to increase early diagnosis as well as support services must consider the epidemiology and diversity of women.

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Factors associated with presenting late or with advanced HIV disease in the Netherlands, 1996–2014: results from a national observational cohort

Cited by 76 publications

References 26 publications

Missed opportunities for earlier diagnosis of HIV in patients who presented with advanced HIV disease: a retrospective cohort study

Missed opportunities for earlier diagnosis of HIV in patients who presented with advanced HIV disease: a retrospective cohort study

Missed opportunities for HIV testing persist despite a single educational intervention: how can we close this evidence‐practice gap?

Two decades of surveillance data show late presentation among a diverse group of women diagnosed with HIV in Victoria, Australia

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