Auditing HIV Testing Rates across Europe: Results from the HIDES 2 Study

PLoS One. 2015 Nov 11;10(11):e0140845. doi: 10.1371/journal.pone.0140845. eCollection 2015.

Abstract

European guidelines recommend the routine offer of an HIV test in patients with a number of AIDS-defining and non-AIDS conditions believed to share an association with HIV; so called indicator conditions (IC). Adherence with this guidance across Europe is not known. We audited HIV testing behaviour in patients accessing care for a number of ICs. Participating centres reviewed the case notes of either 100 patients or of all consecutive patients in one year, presenting for each of the following ICs: tuberculosis, non-Hodgkins lymphoma, anal and cervical cancer, hepatitis B and C and oesophageal candidiasis. Observed HIV-positive rates were applied by region and IC to estimate the number of HIV diagnoses potentially missed. Outcomes examined were: HIV test rate (% of total patients with IC), HIV test accepted (% of tests performed/% of tests offered) and new HIV diagnosis rate (%). There were 49 audits from 23 centres, representing 7037 patients. The median test rate across audits was 72% (IQR 32-97), lowest in Northern Europe (median 44%, IQR 22-68%) and highest in Eastern Europe (median 99%, IQR 86-100). Uptake of testing was close to 100% in all regions. The median HIV+ rate was 0.9% (IQR 0.0-4.9), with 29 audits (60.4%) having an HIV+ rate >0.1%. After adjustment, there were no differences between regions of Europe in the proportion with >0.1% testing positive (global p = 0.14). A total of 113 patients tested HIV+. Applying the observed rates of testing HIV+ within individual ICs and regions to all persons presenting with an IC suggested that 105 diagnoses were potentially missed. Testing rates in well-established HIV ICs remained low across Europe, despite high prevalence rates, reflecting missed opportunities for earlier HIV diagnosis and care. Significant numbers may have had an opportunity for HIV diagnosis if all persons included in IC audits had been tested.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • AIDS Serodiagnosis / statistics & numerical data*
  • Europe / epidemiology
  • Guidelines as Topic*
  • HIV Infections / diagnosis
  • HIV Infections / epidemiology
  • Humans
  • Retrospective Studies

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 AIDS Fonds Netherlands and CHIP, Rigshospitalet. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.