Review of HIV testing recommendations in Australian specialty guidelines for HIV indicator conditions: a missed opportunity for recommending testing?

Abstract

Background Australian National human immunodeficiency virus (HIV) Testing policy recommends HIV indicator condition‐based testing, adapted from the European AIDS Clinical Society (EACS) guidelines. Aim To evaluate the extent that Australian non‐HIV specialty guidelines mention and recommend HIV testing in HIV indicator conditions. Methods EACS guidelines were reviewed to produce a list of 24 AIDS‐defining conditions (ADC) and 31 indicator conditions (IC) where HIV prevalence >0.1%, and 5 IC where HIV non‐diagnosis would have adverse effect on patients' management. Australian guidelines for these conditions were identified from websites of specialty societies, electronic Therapeutic Guidelines, National Health and Medical Research Council (NHMRC), state governments, MEDLINE and Google searches. We identified eight key IC as that were part of the HIDES I study. Results Overall, 51 ADC and IC had Australian guidelines: 24/51(47%) mention association with HIV and 14/51 (27%) recommend HIV testing. Twenty‐five out of 51 (49%) Australian guidelines were for ADC: 18/25(72%) mention association with HIV and 5/25 (20%) recommend testing. Twenty‐five out of 51 (49%) were guidelines IC with HIV prevalence of 0.1%: 6/25 (24%) mention HIV association and 8/25 (32%) recommend HIV testing. Two of eight (25%) key IC had no Australian guidelines and 3/8 (38%) do not mention HIV association or recommend HIV testing. Conclusions Although almost half of HIV non‐HIV guidelines for ADC and IC mention HIV association, only 27% specifically recommend HIV testing. This suggests partnership with guideline development and specialist groups may be useful to ensure patients diagnosed with ADC/IC are tested for HIV.

Missed opportunities for HIV testing persist despite a single educational intervention: how can we close this evidence‐practice gap?

“…Multiple barriers to testing have been identified including lack of knowledge of IC, lack of guidelines, low‐risk perception and perceived lack of knowledge around HIV . Studies reviewing non‐HIV specialty guidelines for IC found that many of these guidelines do not consider HIV testing as part of the investigations for IC . Thus, specialist clinicians managing IC may not be aware of the prevalence of undiagnosed HIV among their patients with such conditions.…”

“…6,13,16 Studies reviewing non-HIV specialty guidelines for IC found that many of these guidelines do not consider HIV testing as part of the investigations for IC. 10,17,18 Thus, specialist clinicians managing IC may not be aware of the prevalence of undiagnosed HIV among their patients with such conditions. This study aimed to determine whether patients with an IC admitted to an acute General Medicine Unit (GMU) at a tertiary centre were being tested for HIV and to evaluate the effectiveness of an educational intervention focused on HIV testing recommendations to improve testing rates.…”

Underutilised human immunodeficiency virus testing in the setting of invasive pneumococcal disease

“…Despite this, interestingly, there is no specific suggestion within some guidelines to test for HIV in those with IPD 3,12 . This could additionally be embedded in other Australian specialty guidelines 13 …”

HIV: almost gone, but still forgotten

“…Many of the reviews of late diagnoses find multiple missed opportunities for testing prior to the positive test – potentially allowing treatment when immune status was still relatively normal. Two papers in this issue of the Internal Medicine Journal address the issue of HIV testing in other diseases that, while not AIDS‐defining, may be associated with HIV infection . Lin and colleagues review Australian specialty guidelines for these indicator conditions and find room for improvement in the recommendations around HIV testing.…”

“…Two papers in this issue of the Internal Medicine Journal address the issue of HIV testing in other diseases that, while not AIDS‐defining, may be associated with HIV infection . Lin and colleagues review Australian specialty guidelines for these indicator conditions and find room for improvement in the recommendations around HIV testing. The second paper by King and colleagues finds that a simple educational intervention is effective at increasing the rate of HIV testing in a general medical unit, but that rates of testing are still far too low, and calls for new strategies to boost these low testing rates.…”