Comparison of two HIV testing strategies in primary care centres: indicator‐condition‐guided testing vs. testing of those with non‐indicator conditions

Abstract

, patients aged from 18 to 65 years old who attended a PCC for a new herpes zoster infection, seborrhoeic eczema, mononucleosis syndrome or leucopenia/ thrombopenia were included in the IC group, and one in every 10 randomly selected patients consulting for other reasons were included in the NIC group. A proportion of patients in each group were offered an HIV test; those who agreed to be tested were given a rapid finger-stick HIV test (€6 per test). Epidemiological and clinical data were collected and analysed. ResultsDuring the study period, 775 patients attended with one of the four selected ICs, while 66 043 patients presented with an NIC. HIV screening was offered to 89 patients with ICs (offer rate 11.5%), of whom 85 agreed to and completed testing (94.4 and 100% acceptance and completion rates, respectively). In the NIC group, an HIV test was offered to 344 persons (offer rate 5.2%), of whom 313 accepted (90.9%) and 304 completed (97.1%) testing. HIV tests were positive in four persons [prevalence 4.7%; 95% confidence interval (CI) 1.3-11.6%] in the IC group and in one person in the NIC group (prevalence 0.3%; 95% CI 0.01-1.82%; P < 0.009). If every eligible person had taken an HIV test, we would have spent €4650 in the IC group and €396 258 in the NIC group, and an estimated 36 (95% CI 25-49) and 198 persons (95% CI 171-227), respectively, would have been diagnosed with HIV infection. The estimated cost per new HIV diagnosis would have been €129 (95% CI €107-153) in the IC group and €2001 (95% CI €1913-2088) in the NIC group. ConclusionsAlthough the number of patients included in the study was small and the results should be treated with caution, IC-guided HIV testing, based on four selected ICs, in PCCs seems to be a more feasible and less expensive strategy to improve diagnosis of HIV infection in Spain than a nontargeted HIV testing strategy. With the aim of improving the detection of HIV infection in the general population, we undertook a prospective study in PCCs to compare the outcomes of two HIV testing strategies. The proportion of PCC attendees who were offered screening, the acceptance rate, the HIV prevalence and the numbers and characteristics of newly diagnosed individuals were evaluated.One of the approaches was based on screening patients attending the PCCs with four selected indicator diseases/ conditions (ICs) [herpes zoster (HZ), seborrhoeic eczema (SE), mononucleosis syndrome (MNS) and leucopenia/ thrombocytopenia (L/T)] (the IC approach) and the other approach was to test nontargeted patients attending these centres for any other reason [the non-indicator condition (NIC) approach]. MethodsFrom October 2009 to February 2011, a multicentre, prospective study was carried out, without the involvement of additional staff, in four PCCs in Barcelona, Spain, which were identified as C1, C2, C3 and C4. Centres C1, C2 and C3 serve populations of medium to high economic status with low rates of immigration, while centre C4 serves a population of low to very low socioeconomic status with a high r...

HIV testing strategies employed in health care settings in the European Union/European Economic Area (EU/EEA): evidence from a systematic review

“…Novel HIV testing technologies were employed by 40 studies in a wide range of clinical settings to increase testing coverage; the majority utilized rapid testing (n = 36) [18,19,22,24,25,34,36,45,46,[48][49][50]56,57,59,65,75,77,81,83,85,88,89,[99][100][101]107,113,117,129,132,134,137,139,141] while four utilized self-sampling (n = 3) [44,52,102] and self-testing strategies (n = 1) [108]. Two of the four self-sampling studies used oral fluid sampling while the self-test required a blood sample.…”

“…Routine testing was most commonly implemented in hospital departments including emergency departments (n = 15) [20,21,25,35,36,64,69,78,92,93,[115][116][117]137,147], inpatient units (n = 10) [24,43,61,95,98,104,111,125,130,135] and outpatient departments (n = 4) [21,74,113,116]. Similarly, IC testing programmes were predominantly instigated in hospitals (n = 8) [109,114,116,[125][126][127][128]135] and primary care (n = 10) [26,38,47,57,88,110,114,116,127,128]. In contrast, integrated testing for HIV with other infections such as hepatitis B and C and STIs was adopted in diverse settings including prisons (n = 3)…”

Use and Effectiveness of HIV Indicator Conditions in Guiding HIV Testing: A Review of the Evidence

“…Data from the HIDES II audit in patients accessing care for a number of HIV ICs highlighted that testing rates in those with ICs remained low across Europe [23] with poor adherence to European guidelines recommending routine testing [21]. High HIV positivity rates were observed in individuals with AIDS defining and non-AIDS defining ICs within the HIDES study [23] and have also been reported in other studies [24]. Therefore, interventions are needed that prompt HCPs to offer a test when patients present with HIV ICs.…”

“…Two studies used more targeted approaches to HIV testing using preselected ICs [24,63]. Elias and colleagues developed an HIV risk exposure and ICs questionnaire using 14 preselected ICs to support targeted screening.…”

Indicator condition-guided HIV testing with an electronic prompt in primary healthcare: a before and after evaluation of an intervention

“…Our group compared the direct cost of diagnosis of a previously unknown HIV infection in screening of the general population and screening guided by four ICs, and found the cost was €2001 and €129, respectively 8. These studies led to national and international recommendations to encourage IC-guided HIV test requests in PHC, based on the prevalence of HIV in these pathologies, their cost-effectiveness and healthcare sustainability 3 8.…”