Indicator condition-guided HIV testing in Europe: a step forward to HIV control

Blasi, Francesco; Matteelli, Alberto

doi:10.1183/09031936.00179412

Cited by 3 publications

(3 citation statements)

References 14 publications

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“…Increased HIV-related morbidity and mortality, poorer response to treatment and increased healthcare costs are the consequences of late HIV diagnosis. Moreover, delayed diagnosis is one of the most important determinants of increased rates of HIV transmission [22]. Our data confirms that many HIV-infected patients in Estonia make numerous visits to healthcare services before being tested.…”

Section: Discussionsupporting

confidence: 80%

Missed opportunities for HIV testing in people diagnosed with HIV, Estonia, 2014 to 2015

2019

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Background Studies of missed opportunities for earlier diagnosis of HIV have shown that patients with undiagnosed HIV often present to healthcare settings numerous times before eventually receiving their diagnosis. Aim The aim of the study was to assess missed opportunities for HIV testing among people newly diagnosed with HIV. Methods In this observational retrospective study, we collected data from the Estonian Health Board on new HIV cases in people aged 16–49 years diagnosed in 2014–15 and from the Estonian Health Insurance Fund database for treatment invoices on their contacts with healthcare services in the 2 years preceding diagnosis. Diagnoses on treatment invoices were categorised as HIV indicator conditions using ICD-10 codes. Results Of 538 newly diagnosed HIV cases (62.5%; 336 men), 82% had visited healthcare services at least once during the 2 years before HIV diagnosis; the mean number of visits was 9.1. Of these, 16% had been tested for HIV and 31% had at least one ICD-10 code for an HIV indicator condition on at least one of their treatment invoices. In 390 cases of HIV indicator conditions, only 5% were tested for HIV. Of all new HIV cases aged 20–49 years from high-incidence regions (defined as priority groups in national testing guidance), 18% had been tested. Conclusions The HIV testing rate in the 2 years before an HIV diagnosis was very low, even in the presence of an HIV indicator condition. This emphasises the importance of implementing the Estonian HIV testing guidelines.

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Section: Discussionsupporting

confidence: 80%

Missed opportunities for HIV testing in people diagnosed with HIV, Estonia, 2014 to 2015

2019

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“…These include kidney and liver function, blood sugar, hemoglobin, white cell and differential counts, platelet count, and C-reactive protein (or ESR). It is recommended that routine HIV and hepatitis B and C testing be performed and vitamin D blood levels measured, as patients are invariably deficient (Blasi and Matteelli 2013).…”

Section: Postprimary Pulmonary Tbmentioning

confidence: 99%

Clinical Aspects of Adult Tuberculosis

Loddenkemper

Lipman

Zumla

2015

Cold Spring Harb Perspect Med

103

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Tuberculosis (TB) in adults can present in a large number of ways. The lung is the predominant site of TB. Primary pulmonary TB should be distinguished from postprimary pulmonary TB, which is the most frequent TB manifestation in adults (70%-80% cases). Cough is common, although the chest radiograph often raises suspicion of disease. Sputum sampling is a key step in the diagnosis of TB, and invasive procedures such as bronchoscopy may be necessary to achieve adequate samples for diagnosis. Extrapulmonary involvement, which may present many years after exposure, occurs in a variable proportion of cases (20%-45%). This reflects the country of origin of patients and also the frequency of associated human immunodeficiency virus (HIV) coinfection. In the latter case, the presentation of TB is often nonspecific, and care needs to be taken to not miss the diagnosis. Anti-TB therapy should be given in line with proven (or assumed) drug resistance. In extrapulmonary TB, adjunctive therapeutic measures may be indicated; although in all cases, support is often required to ensure that people are able to complete treatment with minimal adverse events and maximal adherence to the prescribed regimen, and so reduce risk of future disease for themselves and others.

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“…However, significantly fewer BBV tests were performed in this group, suggesting that we are missing opportunities to diagnose new HIV, Hepatitis B and C infections. 1,3 Although older, and hence not as frequently tested, the majority of the Others group were non-UK born and from areas with a higher population prevalence of BBV. 8,12,13 All new diagnoses of Hepatitis B were in people of African, Chinese or South Asian ethnicity and all were born abroad (Web Appendix Table 2).…”

Section: Discussionmentioning

confidence: 99%