The need to scale up HIV indicator condition-guided testing for early case-finding: a case-control study in primary care.

Ivo K Joore,Suzanne E Geerlings,Ann M Vanrolleghem,Ingrid V Van Den Broek,Maria De Ridder,Jan E A M Van Bergen,Denise E Twisk

doi:10.1186/s12875-016-0556-2

Abstract

BackgroundEuropean guidelines recommend offering an HIV test to individuals who display HIV indicator conditions (ICs). We aimed to investigate the incidence of ICs in primary care reported in medical records prior to HIV diagnosis.MethodsWe did a cross-sectional search in an electronic general practice database using a matched case-control design to identify which predefined ICs registered by Dutch GPs were most associated with an HIV-positive status prior to the time of diagnosis.ResultsWe included 224 HIV cases diagnosed from 2009 to 2013, which were matched with 2,193 controls. Almost two thirds (n = 136, 60.7%) of cases were diagnosed with one or more ICs in the period up to five years prior to the index date compared to 18.7% (n = 411) of controls. Cases were more likely to have an IC than controls: in the one year prior to the index date, the odds ratio (OR) for at least one condition was 11.7 (95% CI: 8.3 to 16.4). No significant differences were seen in the strength of the association between HIV diagnosis and ICs when comparing genders, age groups or urbanisation levels. There is no indication that subgroups require a different testing strategy.ConclusionsOur study shows that there are opportunities for IC-guided testing in primary care. We recommend that IC-guided testing be more integrated in GPs’ future guidelines and that education strategies be used to facilitate its implementation in daily practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0556-2) contains supplementary material, which is available to authorized users.

Highlights

European guidelines recommend offering an HIV test to individuals who display HIV indicator conditions (ICs)
224 cases from 135 general practices were matched with 2,193 controls (HIV-negative individuals)
Our findings strengthen the evidence for implementation of this new strategy as we showed that ICs were more commonly diagnosed in HIV-positive persons than in matched controls, in a period up to five years prior to HIV diagnosis

Summary

Introduction

European guidelines recommend offering an HIV test to individuals who display HIV indicator conditions (ICs). UNAIDS stated that worldwide in 2020, 90% of all people living with HIV should be aware of their HIV status, 90% of all diagnosed HIV infected people should receive antiretroviral therapy, and of that group 90% should achieve viral suppression [1]. By the end of 2014, 19,382 persons in the Netherlands, or 88% of the estimated total number of persons living with HIV, had been diagnosed with the infection. 16,821 had started treatment, and of these 15,463 had achieved viral suppression [2]. Our country is close to achieving the UNAIDS ’90-90-90’ target of 73% of all people with HIV virally suppressed [1]. In recent years there are still approximately 1000 newly diagnosed HIV infections in the Netherlands each year [2]. In 2014, 44% of newly diagnosed persons presented late for care (CD4 count < 350 cells/mm or with an AIDS-defining event regardless of CD4 count) [2]

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