Missed opportunities for earlier diagnosis of HIV in British Columbia, Canada: A retrospective cohort study

Abstract

BackgroundLate HIV diagnosis is associated with increased AIDS-related morbidity and mortality as well as an increased risk of HIV transmission. In this study, we quantified and characterized missed opportunities for earlier HIV diagnosis in British Columbia (BC), Canada.DesignRetrospective cohort.MethodsA missed opportunity was defined as a healthcare encounter due to a clinical manifestation which may be caused by HIV infection, or is frequently present among those with HIV infection, but no HIV diagnosis followed within 30 days. We developed an algorithm to identify missed opportunities within one, three, and five years prior to diagnosis. The algorithm was applied to the BC STOP HIV/AIDS population-based cohort. Eligible individuals were ≥18 years old, and diagnosed from 2001–2014. Multivariable logistic regression identified factors associated with missed opportunities.ResultsOf 2119 individuals, 7%, 12% and 14% had ≥1 missed opportunity during one, three and five years prior to HIV diagnosis, respectively. In all analyses, individuals aged ≥40 years, heterosexuals or people who ever injected drugs, and those residing in Northern health authority had increased odds of experiencing ≥1 missed opportunity. In the three and five-year analysis, individuals with a CD4 count <350 cells/mm3 were at higher odds of experiencing ≥1 missed opportunity. Prominent missed opportunities were related to recurrent pneumonia, herpes zoster/shingles among younger individuals, and anemia related to nutritional deficiencies or unspecified cause.ConclusionsBased on our newly-developed algorithm, this study demonstrated that HIV-diagnosed individuals in BC have experienced several missed opportunities for earlier diagnosis. Specific clinical indicator conditions and population sub-groups at increased risk of experiencing these missed opportunities were identified. Further work is required in order to validate the utility of this proposed algorithm by establishing the sensitivity, specificity, positive and negative predictive values corresponding to the incidence of the clinical indicator conditions among both HIV-diagnosed and HIV-negative populations.

Missed opportunities within healthcare for an earlier diagnosis of HIV

“…Similar results are reported elsewhere. 19–21,23,31–33 We found that not testing for HIV at a clinical encounter often resulted in a significantly lower CD4 cell count at the time of eventual HIV diagnosis and a very high (80%) rate of PLHIV who had experienced an HCIC becoming late presenters. A high proportion of late presenters with prior missed indicator conditions has also been reported by others.…”

“…21,22 In British Columbia, Canada, 14% of individuals living with undiagnosed HIV between 2001 and 2014 had a clinical encounter for a condition associated with a high HIV prevalence without being tested, resulting in a missed opportunity for an earlier HIV diagnosis. 23 Despite decade-old recommendations, routine testing for HIV in a clinical setting has still not been achieved especially in those individuals who were perceived to be at lower HIV risk even when presenting with illnesses suggestive of HIV infection. 24 One study identified 41 factors reported by physicians as being barriers to enhanced routine HIV testing including insufficient time, burdensome consent processes, lack of patient acceptance, lack of knowledge and training regarding testing, and competing priorities.…”

Evaluating a pilot process for reviewing late HIV diagnoses in England and Wales

“…[15][16][17][18] In this pilot, PLWH for whom MO were identified were more likely to be white, and UK-born, consistent with other studies suggesting that individuals born in high-income countries may be inaccurately presumed to be low risk for HIV by healthcare providers when they present without apparent risk factors. 19,20 Data on the nature of MO were not specifically collected, however the most common indicator conditions identified were mononucleosis-like illness, recurrent leukopenia or thrombocytopenia, recurrent shingles, candidiasis, lymphadenopathy and weight loss. Specific training programmes to increase HIV testing awareness should address this misconception, particularly in high prevalence regions.…”

Сучасний Стан Ведення Віл-Інфікованих Пацієнтів Із Супутньою Патологією Органів Травної Системи: Аналіз Результатів Анкетування Лікарів

“…Так, за результатами опитувань лікарів загальної практики та лікарів -інфекціоністів відмічалось, що лікарі загальної практики з великим досвідом управління ВІЛ-інфекцією надавали якісну допомогу цим складним пацієнтам [13]. Особливо важливо, що саме сімейні лікарі можуть знизити так звані втрачені можливості для раннього діагностування ВІЛ, до яких відносяться вчасний контакт із системою охорони здоров'я через клінічний прояв, який може бути спричинений ВІЛ-інфекцією, або часто виникає серед людей, що мають ВІЛ-інфекцію, але без встановлення діагнозу ВІЛ упродовж 30 днів [14]. Підкреслюється важливість в умовах широкого розповсюдження ВІЛ-інфекції та інших гемоконтактних інфекцій посилення поглибленої підготовки сімейних лікарів з питань ведення пацієнтів з ВІЛ-інфекцією та необхідність проведення постійного їх навчання щодо сучасних керівництв, протоколів, настанов з різних питань ВІЛ-інфекції [15] [16].…”