Impact of a structured medical staff education program on the effect of HIV testing in four multi-specialist hospitals of the mazowieckie voivodeship as a part of the „Stop late presenters” – project

Abstract

In half of newly detected cases of HIV infection in Europe, the diagnosis is made late. This has significant impact on the effects of antiretroviral therapy, long-term consequences of the disease, mortality, and the risk of HIV transmission in the environment. As part of the large “STOP Late Presenters” project, the number of HIV tests was assessed in four multi-specialist hospitals in the Mazowieckie voivodeship, which generally carry out over 112,000 hospitalizations per year. First, under the structured research program, the training of medical personnel was carried out in these hospitals, and then the number of HIV tests ordered was evaluated 2 months and 4 months after the training. 459 HIV tests were performed after the training in all hospitals, which is 2.44% of hospitalizations. It is interesting to note that after 4 months, the number of performed tests fell significantly. Staff training resulted in the number of tests higher by 5.8 %, compared to the same period of previous year. Four positive results were confirmed, which is 0.87% of all tests done. This is almost twice higher than in other European countries. Tests for HIV infection are most often ordered by doctors of infectious diseases, gynecologists and the staff of dialysis departments. We found that there is little interest in HIV testing among other specialists, despite reporting patients with clinical symptoms that suggest the likelihood of this infection. The improvement in HIV testing is of great importance for public health in our country and requires modification of diagnostic algorithms in hospital wards to reduce the number of late diagnoses of HIV / AIDS.

Systematic Review: Strategies for Improving HIV Testing and Detection Rates in European Hospitals

“…The studies were published between 2012 and 2023. The majority of the studies were conducted in the United Kingdom (n = 14) [ 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ], followed by France (n = 4) [ 48 , 49 , 50 , 51 ], Italy [ 52 , 53 ], Spain [ 32 , 54 ], the Netherlands [ 33 , 55 ], and Ireland [ 56 , 57 ] (each n = 2), while the other countries (Poland [ 58 ], Portugal [ 59 ], and Switzerland [ 60 ]) contributed one study each. The study settings primarily revolved around capitals or major teaching hospitals.…”

“…The studies were conducted in the emergency department (ED; n = 14) [ 32 , 34 , 35 , 41 , 42 , 48 , 49 , 50 , 54 , 55 , 56 , 57 , 59 , 60 ], inpatient department (IPD; n = 8) [ 33 , 37 , 39 , 40 , 45 , 46 , 52 , 53 ], outpatient department (OPD; n = 5) [ 37 , 43 , 44 , 47 , 51 ], or a combination of OPD with ED or IPD (n = 2) [ 36 , 58 ]. The primary strategy studied was a test-all strategy (n = 15), of which over half were conducted in the ED (n = 9) [ 32 , 34 , 35 , 48 , 49 , 55 , 56 , 57 , 59 ], followed by IPD (n = 3) [ 38 , 39 , 40 ] or OPD settings (n = 3) [ 36 , 37 , 58 ]. Another key strategy used was indicator-condition-based testing (n = 8) [ 33 , …”

“…In IPD settings, HIV testing rates ranged from 22% to 46% [ 38 , 39 , 40 ]. Six studies reported changes compared to a control group or baseline data [ 32 , 37 , 39 , 40 , 58 , 59 ]. Where evaluated, testing rates significantly increased [ 32 , 37 , 40 ], resulting in a rise from 0.5 to 2.6% in a Spanish ED [ 32 ], from 3 to 45% in an OPD in London for returning travelers [ 37 ], and from 4 to 23% among acute medical admissions in Leicester [ 40 ].…”

“…The ED test-all strategy found HIV detection rates ranging from 0.06% in the Netherlands and England to 0.86% in France [ 34 , 48 , 55 ]. IPD test-all strategies reported detection rates ranging from 0.42% to 2.2% [ 38 , 39 , 40 , 58 ]. Three studies were able to evaluate case-finding [ 32 , 40 , 59 ].…”

“…Nurse-driven strategies by risk assessment and rapid testing [ 50 ], or by having nurse practitioners aid with indicator-based testing [ 32 ], increased the testing rates. Although almost all interventions incorporated teaching efforts, only three studies used teaching as a primary intervention, which led to increased HIV testing rates when used in indicator condition strategies in the abovementioned Spanish and Dutch studies [ 32 , 33 ], but not in a Polish study with a test-all strategy [ 58 ]. Plan–do–check–act (PDCA) cycle interventions in two ED-based studies increased testing rates and found 0.30% and 0.08% HIV prevalence, respectively, after implementing the addition of blood testing and incorporation of nursing staff into the HIV testing services [ 42 ], and through teaching, appointing an HIV advocate nurse, and adding HIV testing to a predefined care set [ 41 ].…”