Feasibility and Effectiveness of Indicator Condition-Guided Testing for HIV: Results from HIDES I (HIV Indicator Diseases across Europe Study)

Abstract

Improved methods for targeting HIV testing among patients most likely to be infected are required; HIDES I aimed to define the methodology of a European wide study of HIV prevalence in individuals presenting with one of eight indicator conditions/diseases (ID); sexually transmitted infection, lymphoma, cervical or anal cancer/dysplasia, herpes zoster, hepatitis B/C, mononucleosis-like illness, unexplained leukocytopenia/thrombocytopenia and seborrheic dermatitis/exanthema, and to identify those with an HIV prevalence of >0.1%, a level determined to be cost effective. A staff questionnaire was performed. From October 2009– February 2011, individuals, not known to be HIV positive, presenting with one of the ID were offered an HIV test; additional information was collected on previous HIV testing behaviour and recent medical history. A total of 3588 individuals from 16 centres were included. Sixty-six tested positive for HIV, giving an HIV prevalence of 1.8% [95% CI: 1.42–2.34]; all eight ID exceeded 0.1% prevalence. Of those testing HIV positive, 83% were male, 58% identified as MSM and 9% were injecting drug users. Twenty percent reported previously having potentially HIV-related symptoms and 52% had previously tested HIV negative (median time since last test: 1.58 years); which together with the median CD4 count at diagnosis (400 cell/uL) adds weight to this strategy being effective in diagnosing HIV at an earlier stage. A positive test was more likely for non-white individuals, MSM, injecting drug users and those testing in non-Northern regions. HIDES I describes an effective strategy to detect undiagnosed HIV infection. All eight ID fulfilled the >0.1% criterion for cost effectiveness. All individuals presenting to any health care setting with one of these ID should be strongly recommended an HIV test. A strategy is being developed in collaboration with ECDC and WHO Europe to guide the implementation of this novel public health initiative across Europe.

New HIV Diagnoses among Older Adults in the EU/EEA: Missed Opportunities and Barriers to Testing

“…universal testing) [13,40,75] to automatic pop-up alert for medical charts [37]. Certain testing approaches have been shown to successfully target older adults, such as opt-out testing in primary health care or in emergency departments [30,49,76,77] and the indicator-condition guided testing, a very promising approach [78,79], that may warrant scale-up in this population group [24,26,80].…”

HIV-indicator-condition-driven HIV testing: clinically effective but still rarely implemented

“…22 During this pilot study, HIV tests were routinely offered to patients of unknown HIV status presenting with eight ICs (sexually transmitted infection, lymphoma, cervical or anal cancer or dysplasia, herpes zoster, hepatitis B or C virus infection, mononucleosis-like illness, unexplained leucocytopenia or thrombocytopenia, and seborrhoeic dermatitis) at 17 centres in 14 countries across Europe. The primary outcome was a previously undiagnosed prevalence of HIV infection of greater than 0.1% (the threshold for cost-effectiveness).…”

Rationales for indicator condition-based HIV testing data from the Hospital for Infectious Diseases in Warsaw – one-year observation

“…Since May 2015 in the Hospital of Infectious Diseases in Warsaw an international project regarding the optimisation of the testing for HIV, namely the Optimisation of Testing and Linkage to Care (OptTEST Project) is carried out [9]. The aim of the project is the reduction of the number of persons with non-diagnosed HIV infection and persons with the HIV diagnosis [10].…”

“…The aim of the project is the reduction of the number of persons with non-diagnosed HIV infection and persons with the HIV diagnosis [10]. The study aims at the promotion of the routine performance of the tests for the HIV infection among all persons with specific indicator conditions, the prevalence of which in the population amounts to > 0.1% [9]. The proposed modern testing strategy is based on the results of the European project HIDES (HIV Indicator Disease Across Europe Study), which has shown the effectiveness of the testing of all patients with the specific indicator conditions [11,12].…”

“…One of the crucial indicator condition with the highest prevalence -5.3 (95% CI: 3.7-6.9%) [13] is the mononucleosis-like syndrome which may be the first and only clinical manifestation of the acute retroviral infection [9]. The performance of the HIV test of patient presenting with the indicator condition -with the mononucleosis-like syndrome, gives a possibility of the detection of the HIV infection at an early stage of a disease and fast provision of the specialist care of an ill person [14].…”