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Abstract

Background

Adequate identification and testing of people at risk for HIV is fundamental for the HIV care continuum. A key strategy to improve timely testing is HIV indicator condition (IC) guided testing.

Aim

To evaluate the uptake of HIV testing recommendations in HIV IC-specific guidelines in European countries.

Methods

Between 2019 and 2021, European HIV experts reviewed guideline databases to identify all national guidelines of 62 HIV ICs. The proportion of HIV IC guidelines recommending HIV testing was reported, stratified by subgroup (HIV IC, country, eastern/western Europe, achievement of 90–90–90 goals and medical specialty).

Results

Of 30 invited European countries, 15 participated. A total of 791 HIV IC guidelines were identified: median 47 (IQR: 38–68) per country. Association with HIV was reported in 69% (545/791) of the guidelines, and 46% (366/791) recommended HIV testing, while 42% (101/242) of the AIDS-defining conditions recommended HIV testing. HIV testing recommendations were observed more frequently in guidelines in eastern (53%) than western (42%) European countries and in countries yet to achieve the 90–90–90 goals (52%) compared to those that had (38%). The medical specialties internal medicine, neurology/neurosurgery, ophthalmology, pulmonology and gynaecology/obstetrics had an HIV testing recommendation uptake below the 46% average. None of the 62 HIV ICs, countries or medical specialties had 100% accurate testing recommendation coverage in all their available HIV IC guidelines.

Conclusion

Fewer than half the HIV IC guidelines recommended HIV testing. This signals an insufficient adoption of this recommendation in non-HIV specialty guidelines across Europe.

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/content/10.2807/1560-7917.ES.2022.27.48.2200338
2022-12-01
2023-02-07
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2022.27.48.2200338
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References

  1. The Joint United Nations Programme on HIV/AIDS (UNAIDS). 90-90-90- An ambitious treatment target to help end the AIDS epidemic. Geneva: UNAIDS; 2017. Available from: http://www.unaids.org/en/resources/documents/2014/90-90-90
  2. European Centre for Disease Prevention and Control (ECDC). HIV Continuum of care: Monitoring implementation of the Dublin Declaration on partnership to fight HIV/AIDS in Europe and Central Asia (2020 progress report). Stockholm: ECDC; 2021. Available from: https://www.ecdc.europa.eu/en/publications-data/hiv-continuum-care-monitoring-implementation-dublin-declaration
  3. European Centre for Disease Prevention and Control (ECDC). Continuum of HIV care. Monitoring implementation of the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2017 progress report. Stockholm: ECDC; 2017. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/Continuum-of-HIV-care-2017.pdf
  4. European Centre for Disease Prevention and Control (ECDC). Continuum of HIV care. Monitoring implementation of the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2018 progress report. Stockholm: ECDC; 2018. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/HIV-continuum-of-care-monitoring-dublin-declaration-progress-report-2018.pdf
  5. European Centre for Disease Prevention and Control (ECDC) and World Health Organization. (WHO). HIV/AIDS surveillance in Europe 2020 (2019 data). Stockholm: ECDC; 2020. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/hiv-surveillance-report-2020.pdf
  6. Fleishman JA, Yehia BR, Moore RD, Gebo KA, HIV Research Network. The economic burden of late entry into medical care for patients with HIV infection. Med Care. 2010;48(12):1071-9.  https://doi.org/10.1097/MLR.0b013e3181f81c4a  PMID: 21063228 
  7. Late Presentation Working Groups in EuroSIDA and COHERE. Estimating the burden of HIV late presentation and its attributable morbidity and mortality across Europe 2010-2016. BMC Infect Dis. 2020;20(1):728.  https://doi.org/10.1186/s12879-020-05261-7  PMID: 33028235 
  8. Grabmeier-Pfistershammer K, Rieger A, Schröck T, Schlag M. Economic burden of late presentation in HIV disease in Austria: a comparison of the initial costs imposed by advanced HIV disease vs. non-late presentation. Wien Klin Wochenschr. 2013;125(13-14):402-7.  https://doi.org/10.1007/s00508-013-0392-5  PMID: 23807043 
  9. Bert F, Gualano MR, Biancone P, Brescia V, Camussi E, Martorana M, et al. Cost-effectiveness of HIV screening in high-income countries: A systematic review. Health Policy. 2018;122(5):533-47.  https://doi.org/10.1016/j.healthpol.2018.03.007  PMID: 29606287 
  10. Sullivan AK, Raben D, Reekie J, Rayment M, Mocroft A, Esser S, et al. Feasibility and effectiveness of indicator condition-guided testing for HIV: results from HIDES I (HIV indicator diseases across Europe study). PLoS One. 2013;8(1):e52845.  https://doi.org/10.1371/journal.pone.0052845  PMID: 23341910 
  11. HIV in Europe. HIV indicator conditions: guidance for implementing HIV testing in adults in health care settings. Copenhagen: HIV in Europe. [Accessed: 17 Dec 2021]. Available from: www.eurotest.org/portals/0/Guidance.pdf.pdf
  12. Raben D, Sullivan AK, Mocroft A, Kutsyna G, Hadžiosmanović V, Vassilenko A, et al. Improving the evidence for indicator condition guided HIV testing in Europe: Results from the HIDES II Study - 2012 - 2015. PLoS One. 2019;14(8):e0220108.  https://doi.org/10.1371/journal.pone.0220108  PMID: 31408476 
  13. Cayuelas Redondo L, Ruíz M, Kostov B, Sequeira E, Noguera P, Herrero MA, et al. Indicator condition-guided HIV testing with an electronic prompt in primary healthcare: a before and after evaluation of an intervention. Sex Transm Infect. 2019;95(4):238-43.  https://doi.org/10.1136/sextrans-2018-053792  PMID: 30679391 
  14. Schaefer R, Schmidt HA, Ravasi G, Mozalevskis A, Rewari BB, Lule F, et al. Adoption of guidelines on and use of oral pre-exposure prophylaxis: a global summary and forecasting study. Lancet HIV. 2021;8(8):e502-10.  https://doi.org/10.1016/S2352-3018(21)00127-2  PMID: 34265283 
  15. Rogers AJ, Akama E, Weke E, Blackburn J, Owino G, Bukusi EA, et al. Implementation of repeat HIV testing during pregnancy in southwestern Kenya: progress and missed opportunities. J Int AIDS Soc. 2017;20(4):e25036.  https://doi.org/10.1002/jia2.25036  PMID: 29236362 
  16. Townsend CL, Cliffe S, Tookey PA. Uptake of antenatal HIV testing in the United Kingdom: 2000-2003. J Public Health (Oxf). 2006;28(3):248-52.  https://doi.org/10.1093/pubmed/fdl026  PMID: 16831957 
  17. Ioannidis JPA. Integration of evidence from multiple meta-analyses: a primer on umbrella reviews, treatment networks and multiple treatments meta-analyses. CMAJ. 2009;181(8):488-93.  https://doi.org/10.1503/cmaj.081086  PMID: 19654195 
  18. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
  19. European AIDS Clinical Society (EACS). HIV indicator condition guidelines review. A quick guide on how to start. Brussels: EACS; 2018. Available from: https://www.eacsociety.org/media/ic_guideline_review_guide.pdf
  20. Lord E, Stockdale AJ, Malek R, Rae C, Sperle I, Raben D, et al. British Association of Sexual Health HIV (BASHH)/British HIV Association (BHIVA) guideline review group for the Optimising Testing and Linkage to Care for HIV across Europe (OptTEST) project by HIV in Europeb. Evaluation of HIV testing recommendations in specialty guidelines for the management of HIV indicator conditions. HIV Med. 2017;18(4):300-4.  https://doi.org/10.1111/hiv.12430  PMID: 27535357 
  21. OptTest. Optimising testing and linkage to care for HIV. [Accessed: 2 Feb 2022]. Available from: https://www.opttest.eu/
  22. European Centre for Disease Prevention and Control (ECDC) and World Health Organization. (WHO). HIV/AIDS surveillance in Europe 2018 (2017 data). Stockholm: ECDC; 2018. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/hiv-aids-surveillance-europe-2018.pdf
  23. European Centre for Disease Prevention and Control (ECDC) and World Health Organization. (WHO). HIV/AIDS surveillance in Europe 2017 (2016 data). Stockholm: ECDC; 2017. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/20171127-Annual_HIV_Report_Cover%2BInner.pdf
  24. European Centre for Disease Prevention and Control (ECDC) and World Health Organization. (WHO). HIV/AIDS surveillance in Europe 2015. Stockholm: ECDC; 2015. Available from: https://www.ecdc.europa.eu/sites/default/files/media/en/publications/Publications/HIV-AIDS-surveillance-Europe-2015.pdf
  25. European Centre for Disease Prevention and Control (ECDC) and World Health Organization. (WHO). HIV/AIDS surveillance in Europe 2019 (2018 data). Stockholm: ECDC; 2019. Available from: https://www.ecdc.europa.eu/sites/default/files/documents/hiv-surveillance-report-2019.pdf
  26. European Centre for Disease Prevention and Control (ECDC) and World Health Organization. (WHO). HIV/AIDS surveillance in Europe 2014. Stockholm: ECDC; 2014. Available from: https://www.ecdc.europa.eu/sites/default/files/media/en/publications/Publications/hiv-aids-surveillance-in-Europe-2014.pdf
  27. Hensley KS, Jordans CCE, van Kampen JJA, Mollema FPN, Gisolf EH, El Moussaoui R, et al. Significant impact of COVID-19 on HIV care in hospitals affecting the first pillar of the HIV care continuum. Clin Infect Dis. 2021. PMID: 33993276 
  28. Rodger AJ, Cambiano V, Bruun T, Vernazza P, Collins S, Degen O, et al. Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study. Lancet. 2019;393(10189):2428-38.  https://doi.org/10.1016/S0140-6736(19)30418-0  PMID: 31056293 
  29. Attia S, Egger M, Müller M, Zwahlen M, Low N. Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis. AIDS. 2009;23(11):1397-404.  https://doi.org/10.1097/QAD.0b013e32832b7dca  PMID: 19381076 
  30. Lin YD, Eades L, Nair A, Korman TM, Woolley I. Review of HIV testing recommendations in Australian specialty guidelines for HIV indicator conditions: a missed opportunity for recommending testing? Intern Med J. 2020;50(3):293-8.  https://doi.org/10.1111/imj.14641  PMID: 31566841 
  31. Akinosoglou K, Kostaki EG, Paraskevis D, Gogos CA. Assessment of HIV testing recommendations in Greek specialty guidelines: A missed opportunity and room for improvement for recommending testing. AIDS Care. 2021;33(10):1312-5.  https://doi.org/10.1080/09540121.2021.1876837  PMID: 33678071 
  32. Elgalib A, Fidler S, Sabapathy K. Hospital-based routine HIV testing in high-income countries: a systematic literature review. HIV Med. 2018;19(3):195-205.  https://doi.org/10.1111/hiv.12568  PMID: 29168319 
  33. Mohajer MA, Lyons M, King E, Pratt J, Fichtenbaum CJ. Internal medicine and emergency medicine physicians lack accurate knowledge of current CDC HIV testing recommendations and infrequently offer HIV testing. J Int Assoc Physicians AIDS Care (Chic). 2012;11(2):101-8.  https://doi.org/10.1177/1545109711430165  PMID: 22337704 
  34. Power L, Hows J, Jakobsen SF. OptTEST by HIV in Europe. Key findings on legal and regulatory barriers to HIV testing and access to care across Europe. HIV Med. 2018;19(Suppl 1):58-62.  https://doi.org/10.1111/hiv.12591  PMID: 29488705 
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