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Missed opportunities for HIV testing among patients newly presenting for HIV care at a Swiss university hospital: a retrospective analysis.
- Source :
-
BMJ open [BMJ Open] 2018 Jun 12; Vol. 8 (6), pp. e019806. Date of Electronic Publication: 2018 Jun 12. - Publication Year :
- 2018
-
Abstract
- Objectives: To determine the frequency of missed opportunities (MOs) among patients newly diagnosed with HIV, risk factors for presenting MOs and the association between MOs and late presentation (LP) to care.<br />Design: Retrospective analysis.<br />Setting: HIV outpatient clinic at a Swiss tertiary hospital.<br />Participants: Patients aged ≥18 years newly presenting for HIV care between 2010 and 2015.<br />Measures: Number of medical visits, up to 5 years preceding HIV diagnosis, at which HIV testing had been indicated, according to Swiss HIV testing recommendations. A visit at which testing was indicated but not performed was considered an MO for HIV testing.<br />Results: Complete records were available for all 201 new patients of whom 51% were male and 33% from sub-Saharan Africa. Thirty patients (15%) presented with acute HIV infection while 119 patients (59%) were LPs (CD4 counts <350 cells/mm <superscript>3</superscript> at diagnosis). Ninety-four patients (47%) had presented at least one MO, of whom 44 (47%) had multiple MOs. MOs were more frequent among individuals from sub-Saharan Africa, men who have sex with men and patients under follow-up for chronic disease. MOs were less frequent in LPs than non-LPs (42.5% vs 57.5%, p=0.03).<br />Conclusions: At our centre, 47% of patients presented at least one MO. While our LP rate was higher than the national figure of 49.8%, LPs were less likely to experience MOs, suggesting that these patients were diagnosed late through presenting late, rather than through being failed by our hospital. We conclude that, in addition to optimising provider-initiated testing, access to testing must be improved among patients who are unaware that they are at HIV risk and who do not seek healthcare.<br />Competing Interests: Competing interests: None declared.<br /> (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
- Subjects :
- Adolescent
Adult
Africa South of the Sahara ethnology
Aged
Ambulatory Care
Female
HIV Infections ethnology
Hospitals, University
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Retrospective Studies
Risk Factors
Switzerland
Young Adult
Delayed Diagnosis statistics & numerical data
HIV Infections diagnosis
Homosexuality, Male statistics & numerical data
Mass Screening methods
Subjects
Details
- Language :
- English
- ISSN :
- 2044-6055
- Volume :
- 8
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- BMJ open
- Publication Type :
- Academic Journal
- Accession number :
- 29895647
- Full Text :
- https://doi.org/10.1136/bmjopen-2017-019806