Barriers and facilitators to HIV testing in people age 50 and above: a systematic review

Youssef, Elaney; Cooper, Vanessa; Delpech, Valérie; Davies, Kevin; Wright, Juliet

doi:10.7861/clinmedicine.17-6-508

Cited by 28 publications

(33 citation statements)

References 29 publications

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“…[23][24][25][26] Low perception of HIV risk as well as preconceived ideas about older people by clinicians contribute to lower testing rates as does clinician discomfort exploring HIV risk factors with older patients. 27 However, HIV testing has consistently been found to be acceptable to older people and this study supports the need to increase awareness and improve testing rates for older people and therefore improve outcomes. 28 The lack of a clinically significant increase in testing following our intervention indicates the inadequacy of a single educational intervention in improving testing rates for IC.…”

Section: Discussionsupporting

confidence: 66%

“…However, HIV is a readily treatable condition with an increasing prevalence in older patients and earlier diagnosis in older patients is associated with lower mortality . Low perception of HIV risk as well as preconceived ideas about older people by clinicians contribute to lower testing rates as does clinician discomfort exploring HIV risk factors with older patients . However, HIV testing has consistently been found to be acceptable to older people and this study supports the need to increase awareness and improve testing rates for older people and therefore improve outcomes…”

Section: Discussionsupporting

confidence: 56%

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

King

Seah

Cheng

et al. 2020

Internal Medicine Journal

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Background In Australia, one‐third of human immunodeficiency virus (HIV) diagnoses occur late, with an estimated 11% of people with HIV unaware of their diagnosis. Undiagnosed and untreated HIV infection increases morbidity in the HIV positive person and allows onward transmission of HIV. Aim To determine the rate of HIV testing in acute general medicine patients with HIV indicator conditions (IC) and evaluate the effectiveness of an educational intervention in improving testing rates. Methods Single‐centre, tertiary hospital, before‐after study of general medicine inpatients with IC for 12 weeks prior and 10 weeks post an educational intervention focusing on recommendations for HIV testing including IC. The REASON Cohort Discovery Tool was used to search for the IC using ICD‐10 codes and laboratory data. The presence of IC was estimated, and HIV testing rates before and after the intervention were compared. Regression analysis was utilised to identify characteristics associated with HIV testing. Results Of 1414 admissions in the baseline period and 946 in the post‐period, 161 (11.4%) and 132 (14.0%) had at least one IC present respectively. There were 18 (11.2%) HIV tests performed for admissions with IC in the pre‐period which increased to 27 (20.5%) (P = 0.028) in the post‐period. Younger patients were more likely to be tested and regression analysis identified the educational intervention (adjusted odds ratio) 2.2 (1.1, 4.4) to be significantly associated with testing. Conclusions Although HIV testing rates for IC doubled following the intervention, they remained unacceptably low. The recently introduced electronic medical record presents opportunities to prompt HIV testing.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionsupporting

confidence: 56%

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

King

Seah

Cheng

et al. 2020

Internal Medicine Journal

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“…In addition to these testing initiatives, there are several other possible reasons for the increasing proportions and rates in those ≥50 years of age, including low rates of condom use among older individuals (21)(22)(23), a lack of prioritization of HIV prevention efforts in older adults (24) and a tendency to a relatively late diagnosis in this population (23), enabling forward transmission. In the United States, older people (≥50 years) are more likely to have late-stage HIV infection at the time of diagnosis, and therefore start treatment later (16).…”

Section: Discussionmentioning

confidence: 99%

Newly diagnosed cases of HIV in those aged 50 years and older and those less than 50: 2008–2017

Haddad

Robert

Popovic

et al. 2019

CCDR

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Background: Canada's population is aging, with nearly forty percent of Canadians aged 50 years or more. As the population ages, unique challenges related to health are becoming evident, including increasing rates of sexually transmitted and bloodborne infections. Understanding the epidemiology of HIV in older adults is important to guide prevention and control programs. Objective: To assess trends in newly diagnosed cases of HIV in Canada among those aged 50 years and older (≥50 years) and those aged less than 50 (<50 years), and to compare their basic demographic characteristics and exposure categories for the period of 2008 to 2017. Methods: National surveillance of HIV is conducted by the Public Health Agency of Canada through voluntary submission of data by provincial/territorial public health authorities. Descriptive analyses were conducted on reported cases of HIV between January 1, 2008, to December 31, 2017 to compare the demographic profiles and exposure category for the two age groups. Results: Between 2008 and 2017, the proportion of newly diagnosed HIV cases among those ≥50 years increased from 15.1% to 22.8%. The HIV diagnosis rates for both older males and older females increased over time, with a relatively higher increase for females. A higher proportion of newly diagnosed HIV cases were male in the older group (81.2%) compared to the younger group (74.6%). Among both older and younger males, the most common exposure category for HIV was being gay, bisexual and other men who have sex with men (gbMSM), followed by heterosexual contact and injection drug use; however, the relative proportions varied by age with the gbMSM category being higher in the <50 group. Conclusion: In Canada, over 20% of all newly diagnosed cases of HIV are now in people 50 years of age and older. HIV testing and prevention initiatives, historically aimed at younger populations, may not have the same impact for older populations. These data can be used to inform future public health actions designed to address HIV in older populations.

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“…During the study visit a semi-structured interview was also conducted by EY, lasting approximately 45 min. The initial interview topic guide was based on results of a systematic review which identified patient and clinician-related barriers and facilitators to HIV testing in people aged ≥50 years [ 27 ]. However, novel factors associated with HIV testing were explored within the semi-structured approach, and incorporated into subsequent versions of the topic guide.…”

Section: Methodsmentioning

confidence: 99%

Factors associated with testing for HIV in people aged ≥50 years: a qualitative study

et al. 2018

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BackgroundDespite a decline in the number of new HIV infections in the UK overall, the number and proportion of new HIV diagnoses in people aged ≥50 years continues to increase. People aged ≥50 years are disproportionately affected by late diagnosis, which is associated with poorer health outcomes, increased treatment complexity and increased healthcare costs. Late HIV diagnosis also has significant public health implications in terms of onward HIV transmission. It is not fully understood what factors affect the decision of an older person to test for HIV. The aim of this study was to identify factors associated with testing for HIV in people aged ≥50 years who tested late for HIV.MethodsWe interviewed 20 people aged ≥50 years diagnosed late with HIV to identify factors associated with HIV testing. Interviews were audio recorded, transcribed verbatim and thematically analysed.ResultsSeven themes associated with HIV testing in people aged ≥50 years were identified: experience of early HIV/AIDS campaigns, HIV knowledge, presence of symptoms and symptom attribution, risk and risk perception, generational approaches to health and sexual health, stigma, and type of testing and testing venue.ConclusionSome factors associated with testing identified in this study were unique to older individuals. People aged ≥50 years often do not perceive themselves to be at risk of HIV. Further, stigma and a lack of knowledge of how to access HIV testing suggest a need for health promotion and suggest current sexual health services may need to adapt to better meet their needs.

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Barriers and facilitators to HIV testing in people age 50 and above: a systematic review

Cited by 28 publications

References 29 publications

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

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

Newly diagnosed cases of HIV in those aged 50 years and older and those less than 50: 2008–2017

Factors associated with testing for HIV in people aged ≥50 years: a qualitative study

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