Abstract
BackgroundHIV transmission remains a major concern in Eastern Europe, and too many people are diagnosed late. Expanded testing strategies and early and appropriate access to care are required. Infectious disease departments might be targets for expanded HIV testing owing to the intense passage of key patient populations that carry indicators of HIV disease. Our objective was to evaluate the feasibility and clinical effectiveness of a fully integrated, opt-out routine, rapid HIV testing program.MethodsA retrospective four-year study of a screening program was conducted from 2010 through 2014. The program was divided into two periods: from 2010 to 2012 (pilot study) and from 2013 to 2014. The pilot study consisted of routine HIV testing of patients aged 18–55 that were hospitalized in one department. In the second period, all inpatients aged 18–65 were eligible. Targeted testing was conducted in the other inpatient department during the pilot study and the outpatient department during both periods.ResultsDuring the pilot study, 2203 patients were hospitalized, 1314 (59.6%) were eligible, 954 (72.6%) were tested, and 3 (0.31%) were newly diagnosed HIV-positive. In the second period, 4911 patients were hospitalized, 3727 (75.9%) were eligible, 3303 (88.6%) were tested, and 7 (0.21%) were HIV-positive. In total, 2800 targeted tests were performed, and 4 (0.14%) patients tested positive with newly discovered HIV. All 14 newly diagnosed patients were provided with care. Comparing cumulative groups of routine and targeted testing, the HIV prevalence was 0.23% vs. 0.14% (p = 0.40) and was above the reported cost-effectiveness threshold of 0.1% (p = 0.012). A lower proportion of advanced disease and a higher proportion of heterosexually transmitted infection were found in the routine testing group.ConclusionRoutine HIV testing in admissions of infectious diseases is acceptable, feasible, sustainable and clinically effective. Compared to targeted testing, routine testing helped to discover more patients in earlier stages and those with heterosexually transmitted HIV infection.
Highlights
Human immunodeficiency virus (HIV) transmission remains a major concern in Eastern Europe, and too many people are diagnosed late
Despite the general decline in AIDS in the European Union/European Economic Area (EU/EEA) since 2007, an increase was reported in both Lithuania as well as neighboring Latvia [1]
During the pilot study period (27 months), there were 5827 hospitalized patients; 2203 patients were hospitalized in the second department, 1314 (59.6%) were eligible for routine HIV testing and 954 (72.6%) were offered a rapid test
Summary
HIV transmission remains a major concern in Eastern Europe, and too many people are diagnosed late. In Eastern Europe, where the numbers of new HIV infections continue to grow, too many people are diagnosed late, with implications for greater risk for ill health, death and continued HIV transmission [1,2,3,4,5]. Expanded testing strategies and appropriate and early access to care are required in order to decrease the number of late diagnoses and to support timely linkage to integrated HIV care [3, 7,8,9,10]. Almost half of all AIDS cases in 2015 and 2016 presented with tuberculosis, and this percentage was the highest in the EU/EEA [1, 6]
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