2021 European guideline on HIV testing in genito‐urinary medicine settings

Gökengin, Deniz; Wilson-Davies, Eleri; Zeka, Arzu Nazlı; Palfreeman, Adrian; Begovać, Josip; Dedes, Nikos; Tarashenko, O; Stevanović, Milena; Patel, Raj

doi:10.1111/jdv.17139

Cited by 7 publications

(4 citation statements)

References 135 publications

(280 reference statements)

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“…22,23 European guidelines have been recommending the IC-guided strategy since 2014. 24,25 However, a very recent meta-analysis suggests that in Western countries, there is a high amount of variation in HIV test ratios per IC, and overall HIV testing is low with the highest testing rates for tuberculosis, HCV, HBV, and malignant lymphoma. 26 The percentage of not being offered an HIV test among those presenting with an IC shows great variations between European countries ranging between 14.5% and 95%.…”

Section: Discussionmentioning

confidence: 99%

“…10,14,40 KPs are recommended to test for HIV regularly. 25 Thus, questioning sexual history in every visit to a health care setting would create a golden opportunity for early diagnosis of HIV even when an IC is not present. However, implementing this strategy is highly challenging considering that the recent regulations in Turkiye expect clinicians at public outpatient clinics to complete health care appointments within 5 minutes.…”

Section: Discussionmentioning

confidence: 99%

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

Özkaya,

Elazab,

Turan

et al. 2024

JAIDS Journal of Acquired Immune Deficiency Syndromes

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Özkaya,

Elazab,

Turan

et al. 2024

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…According to the US Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV, in the presence of compatible symptoms or exposure history, a low HIV RNA concentration is consistent with acute HIV infection, the previously proposed threshold is 3,000 copies/ mL [ 7 ]. According to the 2021 European guideline on HIV testing in genito-urinary medicine settings, low HIV RNA concentrations (< 1,000 copies/mL) should be interpreted with caution, and HIV infection should be confirmed by providing evidence of ongoing seroconversion in a follow-up specimen 1–2 weeks later [ 8 ]. The incorporation of nucleic acid amplification testing into HIV testing is beneficial for diagnosing acute HIV infection and decreasing HIV transmission [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Real-world performance of HIV low viral load values in diagnosing acute HIV infection in a tertiary care hospital in Beijing, China

Li,

Feng,

Zhao

et al. 2024

BMC Infect Dis

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Background Early diagnosis of HIV infection decreases the time from HIV diagnosis to viral suppression and reduces further HIV transmission. The Chinese Guidelines for the Diagnosis and Treatment of HIV/AIDS (2021 edition) state that an HIV RNA level > 5,000 copies/mL is the threshold for diagnosing HIV infection. The impact of low viral load values on HIV diagnosis needs to be investigated. Methods There were 3455 human immunodeficiency virus (HIV1 + 2) antibody results (immunoblotting method) and 65,129 HIV viral load values at Beijing Youan Hospital from 2019 to 2022. A total of 2434 patients had both antibody confirmatory results and viral load results. The confirmatory antibody results and HIV viral load results of 2434 patients were analyzed to investigate the impact of low viral load values on HIV diagnosis. Results Of the 2434 patients who had both confirmatory antibody results and viral load results, the viral load values of 140 patients (5.8%) had viral loads ranging from 40 copies/mL to 5,000 copies/mL before positive confirmatory antibody result, and of these 140 patients, the sample receipt time for the viral load tests of 96 (66.7%) individuals was 1 to 6 days earlier than the corresponding sample receipt time for the confirmatory antibody test. In addition, 34 patients (1.4%) had low viral loads ranging from 40 copies/mL to 1,000 copies/mL before positive confirmatory antibody result. Conclusion This study revealed that there is a risk of missed diagnosis if a threshold of 5000 copies/mL is used for the diagnosis of HIV infection. These data provide valuable information for the early diagnosis of HIV infection, and our findings have potential benefits for decreasing HIV transmission.

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“…However, these testing opportunities can vary across the UK; in England, opportunities and types of HIV tests are dependent on local authorities' funding allocations to SSHS [86], that is, local context shapes the types of HIV tests (online, point of care, in person) and HIV testing strategies (opt‐in vs. opt‐out testing in accident and emergency and when registering with a new GP) offered to patients [87]. HIV‐testing protocols should therefore integrate PrEP conversations to normalize PrEP, share knowledge, and identify potential PrEP candidates [87, 88]. This integration should be further extended to other services providing tests, treatment, and management of sexually transmitted infections and further supports the argument to make PrEP available in non‐SSHS services.…”

Section: Discussionmentioning

confidence: 99%

Barriers and facilitators to HIV Pre‐Exposure Prophylaxis (PrEP) in Specialist Sexual Health Services in the United Kingdom: A systematic review using the PrEP Care Continuum

et al. 2023

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Objectives HIV pre‐exposure prophylaxis (PrEP) delivery in the UK is inequitable; over 95% of PrEP users were men who have sex with men (MSM) despite making up less than 50% of new HIV diagnoses. We conducted a systematic review to identify modifiable barriers and facilitators to PrEP delivery in the UK among underserved populations. Methods We searched bibliographic/conference databases using the terms HIV, PrEP, barriers, facilitators, underserved populations, and UK. Modifiable factors were mapped along the PrEP Care Continuum (PCC) to identify targets for interventions. Results In total, 44 studies were eligible: 29 quantitative, 12 qualitative and three mixed‐methods studies. Over half (n = 24 [54.5%]) exclusively recruited MSM, whereas 11 were in mixed populations (all included MSM as a sub‐population) and the other nine were in other underserved populations (gender and ethnicity minorities, women, and people who inject drugs). Of the 15 modifiable factors identified, two‐thirds were at the PrEP contemplation and PrEParation steps of the PCC. The most reported barriers were lack of PrEP awareness (n = 16), knowledge (n = 19), willingness (n = 16), and access to a PrEP provider (n = 16), whereas the more reported facilitators were prior HIV testing (n = 8), agency and self‐care (n = 8). All but three identified factors were at the patient rather than provider or structural level. Conclusions This review highlights that the bulk of the scientific literature focuses on MSM and on patient‐level factors. Future research needs to ensure underserved populations are included and prioritized (e.g. ethnicity and gender minorities, people who inject drugs) and provider and structural factors are investigated.

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2021 European guideline on HIV testing in genito‐urinary medicine settings

Cited by 7 publications

References 135 publications

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

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

Real-world performance of HIV low viral load values in diagnosing acute HIV infection in a tertiary care hospital in Beijing, China

Barriers and facilitators to HIV Pre‐Exposure Prophylaxis (PrEP) in Specialist Sexual Health Services in the United Kingdom: A systematic review using the PrEP Care Continuum

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