The need to scale up HIV indicator condition-guided testing for early case-finding: a case-control study in primary care

Abstract

BackgroundEuropean guidelines recommend offering an HIV test to individuals who display HIV indicator conditions (ICs). We aimed to investigate the incidence of ICs in primary care reported in medical records prior to HIV diagnosis.MethodsWe did a cross-sectional search in an electronic general practice database using a matched case-control design to identify which predefined ICs registered by Dutch GPs were most associated with an HIV-positive status prior to the time of diagnosis.ResultsWe included 224 HIV cases diagnosed from 2009 to 2013, which were matched with 2,193 controls. Almost two thirds (n = 136, 60.7%) of cases were diagnosed with one or more ICs in the period up to five years prior to the index date compared to 18.7% (n = 411) of controls. Cases were more likely to have an IC than controls: in the one year prior to the index date, the odds ratio (OR) for at least one condition was 11.7 (95% CI: 8.3 to 16.4). No significant differences were seen in the strength of the association between HIV diagnosis and ICs when comparing genders, age groups or urbanisation levels. There is no indication that subgroups require a different testing strategy.ConclusionsOur study shows that there are opportunities for IC-guided testing in primary care. We recommend that IC-guided testing be more integrated in GPs’ future guidelines and that education strategies be used to facilitate its implementation in daily practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0556-2) contains supplementary material, which is available to authorized users.

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

“…Routine testing for HIV in the presence of IC has been demonstrated to be cost effective . Failure to screen for HIV when patients intersect with the healthcare system with an IC represents a missed opportunity for earlier diagnosis . Other studies have demonstrated that among patients presenting with IC, rates of HIV testing are low .…”

“…11 Failure to screen for HIV when patients intersect with the healthcare system with an IC represents a missed opportunity for earlier diagnosis. 10,12,13 Other studies have demonstrated that among patients presenting with IC, rates of HIV testing are low. 10,14,15 Multiple barriers to testing have been identified including lack of knowledge of IC, lack of guidelines, low-risk perception and perceived lack of knowledge around HIV.…”

Assessment of the proportion and the factors associated with partner and family based index case HIV testing in Woliso town, Oromia, Ethiopia: a cross-sectional study

“…Index case HIV testing strategy uses a known HIV-infected person receiving HIV care as an index reference to target partners for HIV testing (5,7). In 2014, UNAIDS set the goal to end the AIDS epidemic by 2030 and also stated that worldwide 95% of all people living with HIV should be aware of their HIV status while an estimated 40% still remain undiagnosed (8). HIV partner noti cation enables to identify people with undiagnosed HIV infection (9,10) and linking clients to ART (11).…”

HIV testing within general practices in Europe: a mixed-methods systematic review

“…A search in the electronic general practice database from 747 GPs in Rotterdam (Netherlands) revealed that for 32% of persons diagnosed with syphilis, no HIV test was reported. For gonorrhoea this was 45%, for chlamydia 54% and for hepatitis B 61% [ 47 ] (see Table 2 for more information).…”