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

Abstract

Background: Late diagnosis of HIV infection is a major global problem. In Turkiye, only 41% - 50% of people living with HIV (PLWH) are diagnosed, suggesting that many opportunities for HIV testing might be missed. Setting: The aim of this study is to determine the missed testing opportunities for HIV in healthcare settings in Turkiye and the predictors for missed opportunities (MOs). Methods: The study included patients with a new HIV diagnosis, presenting to care between January 2018 and December 2020. They were given a verbal questionnaire face to face, by a telephone call or an online meeting for visits to a healthcare setting within the year prior to their diagnosis. Electronic medical records were also examined. Results: The sample included 198 patients with at least one visit to any healthcare setting, with a total of 1677 visits. Patients had an indication for HIV testing in 51.3% (861/1677) of the visits; an HIV test was not offered in 77.9% (671/861) and was considered a MO. The highest number of MOs was in emergency departments (EDs) (59.8%) (180/301).The most common reason for visiting was constitutional symptoms and indicator conditions (ICs) (55.4%) (929/1677). University graduates and those with a CD4+T cell count <200/mm3 were more likely to have a MO. Conclusions: Many opportunities to diagnose HIV at an early stage are missed in healthcare settings in Turkiye. Considering the rapidly increasing number of new diagnoses in the last decade, urgent action needs to be taken.