Abstract
BackgroundLate presentation remains a key barrier towards controlling the HIV epidemic. Indicator conditions (ICs) are those that are AIDS-defining, associated with a prevalence of undiagnosed HIV > 0.1%, or whose clinical management would be impeded if an HIV infection were undiagnosed. IC-guided HIV testing is an effective strategy in identifying undiagnosed HIV, but opportunities for earlier HIV diagnosis through IC-guided testing are being missed. We present a protocol for an interventional study to improve awareness of IC-guided testing and increase HIV testing in patients presenting with ICs in a hospital setting.MethodsWe designed a multicentre interventional study to be implemented at five hospitals in the region of Amsterdam, the Netherlands. Seven ICs were selected for which HIV test ratios (proportion of patients with an IC tested for HIV) will be measured: tuberculosis, cervical/vulvar cancer or high-grade cervical/vulvar dysplasia, malignant lymphoma, hepatitis B and C, and peripheral neuropathy. Prior to the intervention, a baseline assessment of HIV test ratios across ICs will be performed in eligible patients (IC diagnosed January 2015 through May 2020, ≥18 years, not known HIV positive) and an assessment of barriers and facilitators for HIV testing amongst relevant specialties will be conducted using qualitative (interviews) and quantitative methods (questionnaires). The intervention phase will consist of an educational intervention, including presentation of baseline results as competitive graphical audit and feedback combined with discussion on implementation and opportunities for improvement. The effect of the intervention will be assessed by comparing HIV test ratios of the pre-intervention and post-intervention periods. The primary endpoint is the HIV test ratio within ±3 months of IC diagnosis. Secondary endpoints are the HIV test ratio within ±6 months of diagnosis, ratio ever tested for HIV, HIV positivity percentage, proportion of late presenters and proportion with known HIV status prior to initiating treatment for their IC.DiscussionThis protocol presents a strategy aimed at increasing awareness of the benefits of IC-guided testing and increasing HIV testing in patients presenting with ICs in hospital settings to identify undiagnosed HIV in Amsterdam, the Netherlands.Trial registrationDutch trial registry: NL7521. Registered 14 February 2019.
Highlights
Late presentation remains a key barrier towards controlling the HIV epidemic
Bogers et al BMC Infectious Diseases (2021) 21:519. This protocol presents a strategy aimed at increasing awareness of the benefits of indicator condition (IC)-guided testing and increasing HIV testing in patients presenting with ICs in hospital settings to identify undiagnosed HIV in Amsterdam, the Netherlands
ICs are defined as conditions that are AIDS-defining, that are associated with a prevalence of undiagnosed HIV > 0.1%, or whose clinical management would be adversely affected if HIV infection were not identified
Summary
Setting and study design We designed a multicentre interventional study that will take place at 5 hospitals (two university hospitals, two non-academic teaching hospitals and one non-teaching hospital) in the region of Amsterdam, the Netherlands. All medical specialists and residents from each involved specialty at the participating hospitals will be invited to complete an online questionnaire on barriers and facilitators for HIV testing in patients with ICs related to their discipline. To this end, a questionnaire was developed based on the Attitude-Social norm-self Efficacy (ASE) model [31, 32], which is an evidence-based instrument to assess behavior and its determinants in healthcare personnel (Supplementary appendix 1). IC indicator condition informed that the effect of the intervention will be assessed through a post-intervention assessment of the HIV test ratio and that these results will be reported back to all participating hospitals. Analyses will be performed using Stata (v15.1, StataCorp, USA)
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