The importance of registration of sexual orientation and recognition of indicator conditions for an adequate HIV risk-assessment

Ivo K Joore,Suzanne E Geerlings,Jan M Prins,Kees Brinkman,Jan E A M Van Bergen

doi:10.1186/s12879-017-2279-y

Ivo K Joore, Suzanne E Geerlings + Show 3 more

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https://doi.org/10.1186/s12879-017-2279-y

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Abstract

BackgroundHIV testing among risk groups and guided by HIV indicator conditions (IC) is widely recommended by European guidelines. In this study we investigated how these strategies are used by general practitioners (GP) and in other healthcare settings. The objectives of our study were to describe: 1) the proportion of consultations in primary care and other healthcare settings in the five years prior to diagnosis; 2) patient and GP perspectives on the primary healthcare providers’ awareness and registration of sexual orientation and ethnicity in the electronic medical record (EMR); and 3) the proportion of HIV-infected patients who had been diagnosed with an IC prior to HIV diagnosis.MethodsA survey study (2014–2016) was conducted among newly diagnosed HIV-infected patients presenting at two HIV outpatient clinics in Amsterdam. We collected information on the number of consultations and extent of HIV testing in healthcare settings in the 5 years prior to HIV diagnosis; on patient and GP perspectives on the primary healthcare providers’ awareness of sexual orientation and ethnicity; and on preselected ICs and symptoms of acute HIV infection prior to diagnosis. GPs were also approached for further information.ResultsIn the 5 years prior to HIV diagnosis, 82.9% of the 111 patients had one or more consultations with their GP, but only 34.8% had one or more HIV tests performed in general practice during this period. In more than 50% of cases the patients took the initiative for the positive HIV test. GPs stated that they were aware of the sexual orientation of 59.6% of their patients who were men who have sex with men (MSM); however, sexual orientation was only documented in the EMR in 34.0% of these cases. GPs also reported that they were aware that a patient was from an HIV endemic country in more than half of the cases. GPs diagnosed 48.3% of all ICs and 39.5% of this group was offered an HIV test at that time.ConclusionsDocumentation of sexual orientation and ethnicity, and IC-guided testing by GPs could be the starting point for more proactive provider-initiated HIV testing.

Highlights

Human Immunodeficiency Virus (HIV) testing among risk groups and guided by HIV indicator conditions (IC) is widely recommended by European guidelines
The objectives of our study were to describe: 1) the proportion of consultations in primary care and other healthcare settings in the 5 years prior to diagnosis; 2) patient and General practitioners (GPs) perspectives on the primary healthcare providers’ awareness and registration of sexual orientation and ethnicity in the electronic medical record (EMR); and 3) the proportion of HIV-infected patients with an IC diagnosed by their GP prior to HIV diagnosis
Sociodemographic characteristics at HIV diagnosis In total, 111 people were included in the study

Summary

Introduction

HIV testing among risk groups and guided by HIV indicator conditions (IC) is widely recommended by European guidelines. The objectives of our study were to describe: 1) the proportion of consultations in primary care and other healthcare settings in the five years prior to diagnosis; 2) patient and GP perspectives on the primary healthcare providers’ awareness and registration of sexual orientation and ethnicity in the electronic medical record (EMR); and 3) the proportion of HIV-infected patients who had been diagnosed with an IC prior to HIV diagnosis. In 2014, 44% of those newly diagnosed with HIV in the Netherlands had presented late for care (CD4 count < 350 cells/mm or with an AIDS-defining event) [1]. Provider-initiated HIV testing among risk groups is widely recommended by guidelines on sexually transmitted infections (STIs)/HIV [6, 7]. A Dutch study showed that 75% of the HIV-infected patients presenting late for care had one or more risk factors for HIV recorded in. General practitioners (GPs) do not always collect this information from their patients [9]

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