European guidelines recommend
the routine offer of an HIV test in patients with a number of AIDS-defining and
non-AIDS conditions believed to share an association with HIV; so called
indicator conditions (IC). Adherence with this guidance across Europe is not
known.
We audited HIV testing behaviour in patients accessing care for a number
of ICs. Participating centres reviewed the case notes of either 100 patients or
of all consecutive patients in one year, presenting for each of the following
ICs: tuberculosis, non-Hodgkins lymphoma, anal and cervical cancer, hepatitis B
and C and oesophageal candidiasis. Observed HIV-positive rates were applied by
region and IC to estimate the number of HIV diagnoses potentially missed.
Outcomes examined were: HIV test rate (% of total patients with IC), HIV test
accepted (% of tests performed/% of tests offered) and new HIV diagnosis rate
(%). There were 49 audits from 23 centres, representing 7037 patients. The
median test rate across audits was 72% (IQR 32–97), lowest in Northern Europe
(median 44%, IQR 22–68%) and highest in Eastern Europe (median 99%, IQR
86–100). Uptake of testing was close to 100% in all regions. The median HIV+
rate was 0.9% (IQR 0.0–4.9), with 29 audits (60.4%) having an HIV+ rate
>0.1%. After adjustment, there were no differences between regions of Europe
in the proportion with >0.1% testing positive (global p = 0.14). A total of
113 patients tested HIV+. Applying the observed rates of testing HIV+ within
individual ICs and regions to all persons presenting with an IC suggested that
105 diagnoses were potentially missed. Testing rates in well-established HIV
ICs remained low across Europe, despite high prevalence rates, reflecting
missed opportunities for earlier HIV diagnosis and care.
Significant numbers
may have had an opportunity for HIV diagnosis if all persons included in IC
audits had been tested.
Below: Proportion with high HIV+ rate (>0.1%) across regions and
ICs. The figure shows the audits with HIV positive rate < and >0.1% by
region and by Indicator Condition (IC).
Full article at: http://goo.gl/jezp9R
By:
D. Raben, M. L. Jakobsen, J. D. Lundgren
CHIP, Rigshospitalet,
Copenhagen, Denmark
A. Mocroft
University College London,
London, United Kingdom
M. Rayment, B. Gazzard, A. Sullivan
Chelsea and Westminster Hospital
NHS Foundation Trust, London, United Kingdom
V. M. Mitsura
Gomel State Medical University,
Gomel, Belarus
V. Hadziosmanovic
Clinical Center University of
Sarajevo, Infectious Diseases Clinic, Sarajevo, Bosnia
Z. M. Sthoeger
Ben Ari Institute of Clinical
Immunology, Rehovot, Israel
A. Palfreeman
University Hospitals of
Leicester NHS Trust, Leicester, United Kingdom
S. Morris
Western General Hospital,
Edinburgh, United Kingdom
G. Kutsyna
Luhansk AIDS Center, Luhansk,
Ukraine
A. Vassilenko
Belarusian State Medical
University, Minsk, Belarus
J. Minton
St James’s University Hospital,
Leeds, United Kingdom
C. Necsoi, N. Clumeck
Saint-Pierre University
Hospital, Brussels, Belgium
V. P. Estrada
Hospital Universitario San
Carlos, Madrid, Spain
A. Grzeszczuk
Medical University of Bialystok,
Department of Infectious Diseases and Hepatology, Bialystok, Poland
V. Svedhem Johansson
Department of Infectious
Diseases, Karolinska University Hospital, Stockholm, Sweden
J. Begovac
University Hospital of
Infectious Diseases, Zagreb, Croatia
E. L. C. Ong
The Newcastle upon Tyne
Hospital, Newcastle, United Kingdom
A. Cabié
Centre Hospitalier Universitaire
de Fort de France, Fort de France, Martinique
F. Ajana
Centre Hospitalier de Tourcoing,
Tourcoing, France
B. M. Celesia
Unit of Infectious Diseases
University of Catania, ARNAS Garibaldi, Catania, Italy
F. Maltez
Hospital Curry Cabral, Lisbon,
Portugal
M. Kitchen
Medical University of Innsbruck
Innsbruck, Austria
L. Comi, A. d’Arminio Monforte
Unit of Infectious Diseases, San
Paolo Hospital, Milan, Italy
U. B. Dragsted
Roskilde Hospital, Roskilde,
Denmark
J. Gatell
Hospital Clinic de Barcelona,
Barcelona, Spain
J. Rockstroh
University of Bonn, Bonn,
Germany
Y. Yazdanpanah
IAME, UMR 1137, Univ Paris
Diderot, Sorbonne Paris Cité, Paris, France
Y. Yazdanpanah, K. Champenois
IAME, UMR 1137, INSERM, Paris,
France
Y. Yazdanpanah
AP-HP, Hôpital Bichat, Service
de Biostatistique, Paris, France
More at: https://twitter.com/hiv_insight
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