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

PLoS One. 2013;8(1):e52845. doi: 10.1371/journal.pone.0052845. Epub 2013 Jan 15.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Diagnostic Tests, Routine / methods*
  • Disease*
  • Europe / epidemiology
  • Feasibility Studies
  • Female
  • HIV Infections / diagnosis*
  • HIV Infections / epidemiology
  • HIV Seropositivity / diagnosis
  • HIV Seropositivity / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Odds Ratio
  • Patient Acceptance of Health Care
  • Prevalence
  • Surveys and Questionnaires

Grant support

The HIDES study was funded by the HIV in Europe initiative which has received funding from Gilead Sciences, Merck, Tibotec, Pfizer, Schering-Plough, Abbott, BoehringerIngelheim, Bristol-Myers Squibb, GlaxoSmithKline, ViiVHealthcare. The operational procedures within the initiative include the following in order to maintain the autonomy of the initiative. The Steering Committee is the governing body and sponsors do not have representation on the Steering Committee. Furthermore, data, records, reports, Intellectual Property Rights and Know How generated as result of the initiative shall be deemed vested in and the property of the Steering Committee, represented by the co-chairs affiliations (AIDS Fonds Netherlands and Copenhagen HIV Programme). The funders has no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.