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

Abstract

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.

Underutilised human immunodeficiency virus testing in the setting of invasive pneumococcal disease

“…It is imperative to aim to reduce late diagnoses of HIV, as often these are associated with increased morbidity and increased risk of further HIV transmission 14 . This study suggests that HIV testing may not be a consideration in the majority of patients presenting with IPD and, as also demonstrated in the paper by King et al ., 16 that perhaps more awareness and education are required within hospital networks. It is our opinion that all patients presenting with IPD should undergo HIV testing, and this is emphasised by the identification of one patient with HIV subsequent to their IPD presentation.…”

Missed Opportunities in HIV Testing in Turkiye: Implications for Late Diagnoses

“…Several training interventions were tested to increase IC-guided testing in health care settings with only temporary and inadequate increases in testing rates underscoring the necessity of sustainable education programs and regular reinforcement of knowledge. 49,50 Other interventions such as electronic screening strategies by automatically generated test requests proved to be effective by significantly increasing the number of tests offered and providing a significant reduction in the number of MOs and late diagnoses. 51 The strengths of this study are the inclusion of all eligible patients at 3 different hospitals during the defined study period, the high number of visits included in the analyses, and the simultaneous use of electronic medical records.…”

Enhancing indicator condition–guided HIV testing in Taiwan: a nationwide case–control study from 2009 to 2015

“…In 2014, during the HIV in Europe Initiative, a set of guidelines were published regarding IC-HIVT for adults [18]. Although IC-HIVT is a cost-effective approach to identifying undiagnosed HIV [19][20][21], its implementation remains a major challenge in Australia [22], the United States [23,24], and Europe [25][26][27][28].…”