Revealing geographical and population heterogeneity in <scp>HIV</scp> incidence, undiagnosed <scp>HIV</scp> prevalence and time to diagnosis to improve prevention and care: estimates for France

Marty, Lise; Cazein, Françoise; Panjo, Henri; Pillonel, Josiane; Costagliola, Dominique; Supervie, Virginie

doi:10.1002/jia2.25100

Cited by 56 publications

(58 citation statements)

References 32 publications

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“…Early access to care and treatment is known to limit morbidity, mortality, and further transmission (Cohen et al, ; Lundgren et al, ). In countries where the epidemic is concentrated, 10%–20% of HIV‐positive individuals are unaware of their HIV status (Brown et al, ; Centers for Disease Control & Prevention, ; Marty et al, ; Public Health Agency Canada, ). In France, a quarter of new diagnoses occur at an advanced stage of infection.…”

Section: Introductionmentioning

confidence: 99%

Implementation of Nurse‐Driven HIV Screening Targeting Key Populations in Emergency Departments: A Multilevel Analysis From the DICI‐VIH Trial

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et al. 2019

Worldviews Ev Based Nurs

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Background: In countries with concentrated HIV epidemics, optimizing screening to reach individuals with undiagnosed infection is essential. The DICI-VIH study, a cluster-randomized crossover trial conducted in eight French emergency departments (EDs), found that a strategy combining nurse-driven targeted HIV screening with routine diagnostic testing was effective.Aim: The aim was to investigate factors associated with the implementation of HIV screening targeting key populations in EDs.Methods: A self-administered questionnaire was distributed at registration to patients aged 18-64 years and able to give consent during the DICI-VIH intervention. Based on their responses, those belonging to key populations were offered a rapid test by triage nurses. Two key stages of the process were evaluated: questionnaire distribution by providers and test acceptance by patients. Patient information, daily workload, and ED characteristics were collected. The associations between these variables and (a) the proportion of questionnaires distributed and (b) the proportion of tests accepted were evaluated using multilevel modeling in order to examine differences in screening implementation between EDs.Results: Questionnaire distribution proportions varied from 23% to 48% across EDs. They were higher on weekdays than weekends (odds ratio, OR: 3.77; 95% CI: 3.57-3.99) and when research staff participated (OR: 1.31; 95% CI: 1.26-1.37). They decreased over time (OR: 0.76; 95% CI: 0.71-0.82; 4th [Q3] vs. 1st quartile [Q0] of intervention days) and with increased patient flow (OR: 0.61; 95% CI: 0.56-0.67; Q3 vs. Q0 of eligible patients). Test acceptance varied from 64% to 77% across EDs, increased with research staff participation (OR 1.20; 95% CI: 1.03-1.40), and decreased over time (OR: 0.75; 95% CI: 0.60-0.92; Q3 vs. Q0). Patients who accepted were more likely to be younger (OR: 0.76; 95% CI: 0.61-0.96; 50-64-year-old vs. 30-39-year-old patients).Linking Evidence to Action: Patient flow, intervention duration, weekdays, and research staff participation were important determinants of targeted screening implementation. These findings could help guide future implementation in similar settings.

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Section: Introductionmentioning

confidence: 99%

Implementation of Nurse‐Driven HIV Screening Targeting Key Populations in Emergency Departments: A Multilevel Analysis From the DICI‐VIH Trial

Leblanc

Côté

Pagé

et al. 2019

Worldviews Ev Based Nurs

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“…Our findings show that, in Belgium, heterogeneity exists in how geographic areas and populations are affected by HIV and emphasizes the need to tailor prevention programs and develop a comprehensive HIV testing strategy. It shows that the Sub‐Saharan African population is at high risk of undiagnosed HIV infection, as observed in surrounding countries , and particularly highlights that MSM with foreign nationality are disproportionately affected by HIV. MSM with foreign nationality may combine several HIV vulnerabilities related to migration (e.g.…”

Section: Discussionmentioning

confidence: 88%

“…Over 2010 to 2015, newly diagnosed MSM with foreign nationality were originating from Europe (52%), Latin America (17%), Sub‐Saharan Africa (15%), Asia (10%), North Africa (4%) and North America (2%). In the French aforementioned study, born‐abroad MSM were originating from Haiti or the Americas (28%), Europe (26%), Sub‐Saharan Africa (19%), North Africa, Asia or Oceania (26%) . In Spain, the population of MSM born in Latin America was found to be particularly vulnerable to both HIV and other sexually transmitted infections .…”

Section: Discussionmentioning

confidence: 98%

Estimates of the HIV undiagnosed population in Belgium reveals higher prevalence for MSM with foreign nationality and for geographic areas hosting big cities

et al. 2019

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Introduction Increasing our knowledge on geographic areas and key populations most affected by HIV is essential to improve prevention and care and to ensure a more focused HIV response. Here, we estimated the prevalence of undiagnosed HIV infections in Belgium and its distribution across geographic areas and exposure groups. Methods We used surveillance data on newly diagnosed HIV cases and a previously developed back‐calculation model to estimate number and prevalence rates (per 10000) of undiagnosed HIV infections by exposure group at national and subnational levels. Belgium consists of three regions: Flanders, Brussels‐Capital Region and Wallonia. We produced estimates for Brussels‐Capital Region and Wallonia. For Flanders, we produced estimates for two sub‐regional areas: the province of Antwerp and the other provinces, because Antwerp is the second largest city after Brussels. Population sizes were determined using data from the Belgian Statistical Office and surveys on sexual behaviour and drug use. Results In Belgium, in 2015, an estimated 2818 (95% confidence interval: 2494 to 3208) individuals were living with undiagnosed HIV, that is, 15% of individuals living with HIV. The Brussels‐Capital Region and the province of Antwerp, which host the two biggest cities, accounted for ~60% of the undiagnosed infections, and had the highest undiagnosed prevalence rates per 10000: 12.0 (9.4 to 15.3) and 7.4 (5.6 to 9.8) respectively. Individuals with foreign nationality accounted for 56% of the total number of undiagnosed infections, and were the most affected populations in all areas in terms of undiagnosed prevalence rates. Specifically, men who have sex with men (MSM) with non‐European nationality were the most affected population in the province of Antwerp (853.4 (408.2 to 1641.9) undiagnosed infections per 10000), the Brussels‐Capital Region (543.9 (289.1 to 1019.1)), and the other provinces of Flanders (691.7 (235.5 to 1442.2)), while in Wallonia, it was heterosexual women with Sub‐Saharan African nationality (132.2 (90.6 to 178.5)). Conclusions Geographic areas hosting the biggest cities in Belgium accounted for the vast majority of undiagnosed HIV infections and individuals with foreign nationality were the most affected, especially MSM with non‐European nationality. This should be accounted for when tailoring prevention and testing programs. Furthermore, MSM with foreign nationality require more attention in Belgium, and certainly more generally in Europe.

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“…France has a rate of testing 80.6.) [19]. On the other hand, a large number of the tested persons in Vojvodina belong to BDs.…”

Section: Discussionmentioning

confidence: 99%

A ten-year trend of human immunodeficiency virus infection in voluntary blood donors in the South Backa district of Vojvodina

2019

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Introduction. The first cases of human immunodeficiency virus infection and the first transmission of human immunodeficiency virus infection through blood transfusion in Vojvodina were registered in 1985. The aims of this study were to determine the ten-year trend of human immunodeficiency virus infection among blood donors in South Bačka District of Vojvodina, routes of transmission and risk factors. Material and Methods. A retrospective study was conducted at the Blood Transfusion Institute of Vojvodina during 2009-2018, and human immunodeficijenca antigens and antibodies were analyzed. A total of 300 936 blood donor samples were screened using combined antibody-antigen tests (fourth generation enzyme-linked immunosorbent assay and chemiluminescence). Further testing included confirmatory immunoblot assay and molecular assay. Results. The overall human immunodeficiency virus seroprevalence was 3.7 per 100 000 donations. The number of blood donors found to be human immunodeficiency virus positive has increased during the study period showing a positive trend. The highest number of human immunodeficiency virus positive results was reported among blood donors aged 26-35 (36%) and 46-55 years (27%). The infection was more frequent in males. The leading rout of transmission was through unprotected sexual intercourse. Higher human immunodeficiency virus prevalence was among regular blood donors (73%). Conclusion. This study points to the importance of careful selection of blood donors and their education about risk behavior in order to reduce the risk of human immunodeficiency virus transmission. Concomitant use of sensitive serological and molecular tests is crucial to increase the blood safety.

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Revealing geographical and population heterogeneity in HIV incidence, undiagnosed HIV prevalence and time to diagnosis to improve prevention and care: estimates for France

Cited by 56 publications

References 32 publications

Implementation of Nurse‐Driven HIV Screening Targeting Key Populations in Emergency Departments: A Multilevel Analysis From the DICI‐VIH Trial

Implementation of Nurse‐Driven HIV Screening Targeting Key Populations in Emergency Departments: A Multilevel Analysis From the DICI‐VIH Trial

Estimates of the HIV undiagnosed population in Belgium reveals higher prevalence for MSM with foreign nationality and for geographic areas hosting big cities

A ten-year trend of human immunodeficiency virus infection in voluntary blood donors in the South Backa district of Vojvodina

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