Missed opportunities within healthcare for an earlier diagnosis of HIV

Powell, Maria; Krentz, HB; Eagles, Matthew E; Gill, M John

doi:10.1177/0956462420945948

Cited by 9 publications

(12 citation statements)

References 40 publications

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“…Any clinical encounter potentially represents a relatively easy opportunity for HIV testing in that patients attending these encounters are neither ‘hard to reach’ nor are they declining to engage in healthcare; in fact they are already within a clinical setting where HIV testing should be offered. Lack of testing within healthcare, especially when risk or presence of an HIV clinical indicator condition (HCIC) is present, represents a significant oversight in providing quality healthcare [22]. HIV clinical indicator conditions are those that are more common in undiagnosed people with HIV (PWH) than in the general population and may be indicative of underlying yet undiagnosed HIV infection [23].…”

Section: Introductionmentioning

confidence: 99%

Economic impact on direct healthcare costs of missing opportunities for diagnosing HIV within healthcare settings

et al. 2021

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Background The economic consequences of a missed opportunity for HIV testing at an earlier stage of infection within a healthcare setting are poorly described. Methods For all newly diagnosed HIV patients followed at the Southern Alberta HIV/AIDS Clinic (SAC), Calgary, Canada, between 1 April 2011 and 1 April 2016, all clinical encounters occurring < 3 years prior to diagnosis within the region were obtained. The direct costs of HIV care after diagnosis to 31 March 2019 were determined from a payers’ perspective and reported as mean cost per patient per month (PPPM) in 2019 Canadian dollars (CDN$). Patients with no encounters for 3 years prior to diagnosis were compared with patients with encounters, with special attention to patients with HIV clinical indicator conditions (HCICs). Results Of 388 patients, 60% had one or more prior encounter without HIV testing; 14% had been treated for an HCIC. Females, older patients and heterosexuals were more likely to have prior encounters. At diagnosis, patients with previous encounters presented with lower CD4 counts and higher rates of AIDS. The mean PPPM costs for patients with any prior encounter or for an HCIC‐based encounter were 16% and 33% higher, respectively, than for patients with no prior encounters. While mean PPPM costs for antiretroviral drugs and outpatient visits were slightly higher, in‐patient costs were 10 times higher for people with HIV who had a previous HCIC encounter vs. those with no encounters (CDN$316 vs. $31, respectively). Conclusions Any healthcare visit, especially for an HCIC, represents relatively easy opportunities for HIV testing. Not testing can result in poorer health and higher costs. Targeted clinical testing and novel interventions to correct overlooked testing opportunities within healthcare settings may be an easy way to implement cost savings.

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Section: Introductionmentioning

confidence: 99%

Economic impact on direct healthcare costs of missing opportunities for diagnosing HIV within healthcare settings

et al. 2021

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“…The majority of new HIV diagnoses in the US continue to be among gay and bisexual men, and physicians likely have awareness of this sexual behavior as a “can’t-miss” indication for HIV testing. 14,15,17,30 However, failure to accurately obtain and/or document MSM sexual behavior in the EMR is a barrier to appropriate testing, as encounters in persons who were identified as MSM only after HIV diagnosis had higher odds of a missed opportunity. Sexual history taking remains a major weakness, 31 and some patients may also be reluctant to disclose sexual orientation, activity, and behaviors, 32 all of which may hinder understanding of current need for initial and repeat testing.…”

Section: Discussionmentioning

confidence: 99%

“…17 Routine screening helps improve rates of HIV testing, but may not be fully implemented in healthcare settings or may not capture those who may need repeat testing over time due to changing or ongoing potential exposure. 5,11,13,15 Routine HIV screening was initiated at University of Chicago Medicine (UCM) in 2011 as part of the public health-funded Expanded HIV Testing and Linkage to Care (xTLC) program, which has been described previously. [18][19][20] The xTLC program supports routine healthcare-based HIV testing and timely linkage to care.…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10] Several studies have identified socioeconomic, agerelated, and comorbidity-related factors that are associated with missed opportunities for diagnosis of HIV in resource-rich settings in North America. 5,6,[11][12][13][14][15] One factor that has been shown to contribute to missed opportunities is the lack of concurrent HIV testing in individuals being tested for other sexually transmitted infections (STIs). 16 In one study of patients presenting to an academic emergency department (ED), less than 4% of individuals tested for chlamydia or gonorrhea were concurrently tested for HIV.…”

Section: Introductionmentioning

confidence: 99%

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HIV testing in a high prevalence urban area in the US: Identifying missed opportunities two ways

et al. 2022

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Background Routine opt-out HIV testing in healthcare settings is often not implemented to its fullest extent. We assessed factors contributing to missed HIV testing opportunities at an academic medical center in Chicago, Illinois, with a routine HIV screening program. Methods Retrospective analysis of HIV testing in clinical encounters was performed using multivariate regession models. Missed opportunities were defined as 1) an encounter during which an HIV test was not conducted on a patient later diagnosed with HIV, or 2) an encounter in which a bacterial STI test was performed without HIV testing. Results Of 122 people newly diagnosed with HIV from 2011-2018, 98 patients had 1215 prior encounters, of which 82.8% were missed opportunities. Female gender, persons not known to be men who have sex with men, and encounter location other than inpatient had higher odds of a missed opportunity. Nearly half (48.4%) of 104,678 bacterial STI testing encounters were missed opportunities. Female gender, older age, lack of syphilis testing, and location outside the emergency department had higher odds of a missed opportunity. Conclusions We found a high number of missed HIV testing opportunities, which could be reduced by strengthening routine screening and increasing targeted testing concurrent with STI screening.

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“…Missed or late HIV diagnoses, as well as lack of ART use/ adherence are also well known to influence the incidence of AIDS-defining neurologic infections. However, both the incidence and factors associated with non-AIDS defining neurologic infections among PWH remain relatively understudied, particularly during the ART 'treat-all' era [5][6][7][8]. An improved understanding of the current incidence, risk factors, and clinical sequelae for both AIDS-defining and non-AIDS defining neurologic infections may help enhance preventive strategies and prompt earlier diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Neurologic infections in people with HIV: shifting epidemiological and clinical patterns

Wan,

Gill,

Fonseca

et al. 2023

Aids

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Objectives: To define the frequency, risk factors, and clinical outcomes of both AIDS-defining and non-AIDS-defining neurologic infections among people with HIV (PWH). Design: We conducted a retrospective observational cohort study by linking the clinical database at the Southern Alberta HIV Clinic (SAC) with the regional hospital and microbiology databases to identify cases and the associated morbidity and mortality for these neurologic infections from 1995-2018. Methods: Neurologic infections were categorized into AIDS defining and non-AIDS defining. Annual incidence rates (IR) per 1,000 person-years (PY) were calculated. Cox proportional hazards models estimated adjusted hazard ratios (aHR) and 95% confidence intervals of risk factors for neurologic infections in PWH and mortality outcomes. Results: Among 2,910 PWH contributing 24,237 years of follow-up, 133(4.6%) neurologic infections were identified; 107(80%) were AIDS-defining and 26(20%) non-AIDS defining. While the incidence of AIDS-defining neurologic infections declined over time, no change was seen in incidence of non-AIDS defining infections. The risk of having any neurologic infection was greater among Black PWH (aHR = 2.5[1.6–4.0]) (vs. White PWH) and those with a CD4+ T-cell nadir of <200cells/mm3 (aHR = 6.6[4.0–11.1]) (vs. ≥200cells/mm3). More AIDS-defining neurologic infections occurred in PWH with lower CD4+ T-cell counts and higher HIV viral loads. PWH with any neurologic infections experienced more seizures, strokes, all-cause mortality (aHR = 2.2[1.5–3.2] and HIV-related mortality (aHR = 6.4[3.9–10.7 (vs. no neurologic infection). Conclusions: Both AIDS and Non-AIDS defining neurologic infections continue to occur in PWH resulting in significant morbidity and mortality. Early diagnosis and initiation of ART remain crucial in preventing neurological infections in PWH.

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Missed opportunities within healthcare for an earlier diagnosis of HIV

Cited by 9 publications

References 40 publications

Economic impact on direct healthcare costs of missing opportunities for diagnosing HIV within healthcare settings

Economic impact on direct healthcare costs of missing opportunities for diagnosing HIV within healthcare settings

HIV testing in a high prevalence urban area in the US: Identifying missed opportunities two ways

Neurologic infections in people with HIV: shifting epidemiological and clinical patterns

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