Improving the evidence for indicator condition guided HIV testing in Europe: Results from the HIDES II Study – 2012 – 2015

Abstract

Background It is cost-effective to perform an HIV test in people with specific indicator conditions (IC) with an undiagnosed HIV prevalence of at least 0.1%. Our aim was to determine the HIV prevalence for 14 different conditions across 20 European countries. Methods Individuals aged 18–65 years presenting for care with one of 14 ICs between January 2012 and June 2014 were included and routinely offered an HIV test. Logistic regression assessed factors associated with testing HIV positive. Patients presenting with infectious mononucleosis-like syndrome (IMS) were recruited up until September 2015. Results Of 10,877 patients presenting with an IC and included in the analysis, 303 tested positive (2.8%; 95% CI 2.5–3.1%). People presenting with an IC in Southern and Eastern Europe were more likely to test HIV positive as were people presenting with IMS, lymphadenopathy and leukocytopenia/ thrombocytopenia. One third of people diagnosed with HIV after presenting with IMS reported a negative HIV test in the preceding 12 months. Of patients newly diagnosed with HIV where data was available, 92.6% were promptly linked to care; of these 10.4% were reported lost to follow up or dead 12 months after diagnosis. Conclusion The study showed that 10 conditions had HIV prevalences > 0.1%. These 10 ICs should be adopted into HIV testing and IC specialty guidelines. As IMS presentation can mimic acute HIV sero-conversion and has the highest positivity rate, this IC in particular affords opportunities for earlier diagnosis and public health benefit.

Missed opportunities for HIV testing in patients newly diagnosed with HIV in Morocco

“…During these contacts, an HIV test was rarely offered by the healthcare provider even if the patients reported HIV indicators. Several diseases or clinical symptoms have been highlighted as HIV indicators since the undiagnosed HIV prevalence among the patients who suffer from them was > 0.1%, thus justifying routine HIV testing [10][11][12]. Identifying these missed opportunities to offer a test and quantifying the missed opportunities could guide policy makers in extending HIV testing guidelines.…”

Prevalence of monoclonal gammopathy of undetermined significance (MGUS) at HIV diagnosis in individuals 18–40 years old: a possible HIV indicator condition

“…Among the fourteen indicators condition (IC) identified for an effective strategy to diagnose people living with HIV, the only laboratory hematological parameters included are the unexplained leukocytopenia or thrombocytopenia of at least 4-weeks duration 3 .…”

Increased integrated testing for HIV, hepatitis C and sexually transmitted infections in health care facilities: results from the INTEGRATE Joint Action pilots in Lithuania, Romania and Spain

“…3 Victor Babes' Clinical Hospital of Infectious Diseases and Pneumophtisiology, Craiova, Romania. 4 Republican Centre for Addictive Disordes, Giedraičių g. 8, LT-03147 Lithuania, Kaunas, Lithuania. 5 HIV Clinic, Hospital Clinic Barcelona, Barcelona, Spain.…”

“…ICT is recommended by European HIV testing guidelines and in many national testing guidelines [ 7 , 8 ]. Additionally, several tools to facilitate the practical implementation of ICT have been developed, tested and proved to be very successful in supporting routine ICT [ 3 , 4 , 9 ]. However, ICT is still not systematically and fully implemented across all relevant sectors and health care settings in Europe, resulting in many missed opportunities for diagnosis.…”

“…Additionally, a large proportion of people infected, especially with HIV, HBV and HCV, are unaware of their infection [1,2]-A public health challenge, that continues to fuel onward transmission and jeopardizing individual health. 1 Indicator condition guided HIV testing (ICT) (routine testing for HIV based on presentation with a condition or disease with a proven HIV prevalence of > 0.1%) [3][4][5][6] has proven a feasible, efficient and cost-effective strategy to increase diagnoses of HIV in health care settings, when people present with other health-related issues. ICT is recommended by European HIV testing guidelines and in many national testing guidelines [7,8].…”