1887
  1. Home
  2. Eurosurveillance
  3. Volume 30, Issue 18, 08/May/2025
  4. Article
Research Open Access
Like 0
Download

SDG 3: HIV/AIDS

Abstract

Background

HIV testing based on indicator conditions is recommended to diagnose HIV earlier.

Aim

Our aim was to assess opportunities for earlier diagnosis of HIV.

Method

This is a retrospective study on people living with HIV (PLWH) included in the national HIV register. We collected data on public primary outpatient healthcare (PHC) (2011–2019), secondary and tertiary outpatient healthcare (STHC), and all inpatient care (1996–2019) from the Care Register for Health Care from the presumed acquisition, estimated by CD4+ T-cell count at diagnosis, until the diagnosis of HIV.

Results

Of 907 PLWH diagnosed between 2011 and 2019, 522 (58%) had ≥ 1 healthcare contact at any level between HIV acquisition and > 30 days before diagnosis. At least one European Centre for Disease Prevention and Control (ECDC) indicator condition was recorded for 119 (23% of 522), and 112 (21%) were born in a high-prevalence country. In total, 384 of 907 (42%) had visited a PHC physician, and 58% of those with CD4+ T-cell count < 200 cells/μL at diagnosis. Of 2,082 PLWH diagnosed between 1996 and 2019, 869 (42%) had STHC outpatient contacts > 30 days before diagnosis, 18% with ≥ 1 ECDC indicator condition, and 367 (18%) had been hospitalised, 20% with ≥ 1 ECDC indicator condition. The most common ECDC indicator conditions > 30 days before diagnosis at all levels of healthcare were pneumonia, sexually transmitted infections, unexplained fever, herpes zoster, pregnancy and lymphadenopathy.

Conclusion

We recommend enhancing indicator condition-based HIV testing by all healthcare providers, particularly for gonorrhoea, syphilis and, for persons younger than 50 years, also herpes zoster and lymphadenopathy.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2025.30.18.2400610
2025-05-08
2025-05-08
/content/10.2807/1560-7917.ES.2025.30.18.2400610
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/30/18/eurosurv-30-18-2.html?itemId=/content/10.2807/1560-7917.ES.2025.30.18.2400610&mimeType=html&fmt=ahah

References

  1. Gbadamosi SO, Trepka MJ, Dawit R, Jebai R, Sheehan DM. A systematic review and meta-analysis to estimate the time from HIV infection to diagnosis for people with HIV. AIDS Rev. 2022;24(1):32-40.  https://doi.org/10.24875/AIDSRev.21000007  PMID: 34077404 
  2. 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 
  3. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493-505.  https://doi.org/10.1056/NEJMoa1105243  PMID: 21767103 
  4. European Centre for Disease Prevention and Control (ECDC). Public health guidance on HIV, hepatitis B and C testing in the EU/EEA An integrated approach. Stockholm: ECDC; 2018. Available from: https://www.ecdc.europa.eu/en/publications-data/public-health-guidance-hiv-hepatitis-b-and-c-testing-eueea
  5. 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 
  6. Paltiel AD, Weinstein MC, Kimmel AD, Seage GR 3rd, Losina E, Zhang H, et al. Expanded screening for HIV in the United States--an analysis of cost-effectiveness. N Engl J Med. 2005;352(6):586-95.  https://doi.org/10.1056/NEJMsa042088  PMID: 15703423 
  7. Yazdanpanah Y, Sloan CE, Charlois-Ou C, Le Vu S, Semaille C, Costagliola D, et al. Routine HIV screening in France: clinical impact and cost-effectiveness. PLoS One. 2010;5(10):e13132.  https://doi.org/10.1371/journal.pone.0013132  PMID: 20976112 
  8. Brummer-Korvenkontio H, Hiltunen-Back E, Liitsola K, Salminen M. Hiv-testauksen periaatteita: Suositus perusterveydenhuollon toimipisteille ja matalan kynnyksen palvelupisteille. [Principles of HIV testing: Recommendation for primary health care facilities and low-threshold service points]. Helsinki: Finnish Institute for Health and Welfare; 2010. Finnish. Available from: http://www.julkari.fi/handle/10024/79951
  9. Sosiaali- ja terveysministeriö. Pakolaisten ja turvapaikanhakijoiden infektio-ongelmien ehkäisy. [Prevention of infection problems among refugees and asylum seekers]. Helsinki: Ministry of Social Affairs and Health; 2009:21. Finnish. Available from: http://urn.fi/URN:ISBN:978-952-00-2939-5
  10. Mutru M, Isosomppi S, Aho I, Liitsola K, Brummer-Korvenkontio H, Ollgren J, et al. Finnish HIV Quality of Care Register (FINHIV). BMJ Open. 2022;12(1):e053287.  https://doi.org/10.1136/bmjopen-2021-053287  PMID: 35063958 
  11. Official Statistics of Finland. Population structure. Helsinki: Statistics Finland; 2020. ISSN: 1797-5395. Available from: http://www.stat.fi/til/vaerak/2019/vaerak_2019_2020-03-24_tie_001_en.html
  12. European Centre for Disease Prevention and Control (ECDC), World Health Organization (WHO). HIV/AIDS surveillance in Europe 2020 – 2019 data. Luxembourg: Publications Office of the European Union; 2020.  https://doi.org/10.2900/073965 
  13. Digital and Population Data Services Agency. The personal identity code. Helsinki: Digital and Population Data Services Agency. [Accessed: 12 Sep 2024]. Available from: https://dvv.fi/en/personal-identity-code2
  14. Sosiaali- ja terveysministeriö. Sosiaali- ja terveysministeriön asetus Terveyden ja hyvinvoinnin laitoksen laaturekistereistä. 801/2022. [Decree on quality registers under the Finnish Institute for Health and Welfare issued by the Ministry of Health and Social Affairs]. Helsinki: Ministry of Social Affairs and Health; 2022. Finnish. Available from: https://stm.fi/en/project?tunnus=STM059:00/2021
  15. Sosiaali- ja terveysministeriö . Tartuntatautilaki. 1227/2016. [Communicable Diseases Act]. Helsinki: Ministry of Social Affairs and Health; 2016. Finnish. Available from: https://finlex.fi/fi/lainsaadanto/saadoskaannokset/2016/eng/1227
  16. Sosiaali- ja terveysministeriö. Laki Terveyden ja hyvinvoinnin laitoksesta. 668/2008. [Act on the National Institute for Health and Welfare]. Helsinki: Ministry of Social Affairs and Health; 2008. Finnish. Available from: https://finlex.fi/eli?uri=http://data.finlex.fi/eli/sd/2008/668/ajantasa/2024-06-07/fin
  17. Finnish Institute for Health and Welfare (THL). Care Register for Health Care - Register description. Helsinki: THL. [Accessed: 12 Sep 2024]. Available from: https://thl.fi/en/statistics-and-data/data-and-services/register-descriptions/care-register-for-health-care
  18. Finnish Institute for Health and Welfare (THL). Register of Primary Health Care visits - Register description. Helsinki: THL. [Accessed: 12 Sep 2024]. Available from: https://thl.fi/en/statistics-and-data/data-and-services/register-descriptions/register-of-primary-health-care-visits
  19. Lodi S, Phillips A, Touloumi G, Geskus R, Meyer L, Thiébaut R, et al. Time from human immunodeficiency virus seroconversion to reaching CD4+ cell count thresholds <200, <350, and <500 Cells/mm3: assessment of need following changes in treatment guidelines. Clin Infect Dis. 2011;53(8):817-25.  https://doi.org/10.1093/cid/cir494  PMID: 21921225 
  20. Finnish Institute for Health and Welfare (THL). Avohilmo: Käyntisyyt ja niiden kirjausasteet kuukausittain [Avohilmo: Reasons for visits and their recording rate by month]. Helsinki: THL. [Accessed: 15 Apr 2024]. Finnish. Available from: https://sampo.thl.fi/pivot/prod/fi/avopika/pikarap02/summary_kayntisyyt
  21. Burns FM, Johnson AM, Nazroo J, Ainsworth J, Anderson J, Fakoya A, et al. Missed opportunities for earlier HIV diagnosis within primary and secondary healthcare settings in the UK. AIDS. 2008;22(1):115-22.  https://doi.org/10.1097/QAD.0b013e3282f1d4b6  PMID: 18090399 
  22. Champenois K, Cousien A, Cuzin L, Le Vu S, Deuffic-Burban S, Lanoy E, et al. Missed opportunities for HIV testing in newly-HIV-diagnosed patients, a cross sectional study. BMC Infect Dis. 2013;13(1):200.  https://doi.org/10.1186/1471-2334-13-200  PMID: 23638870 
  23. Marih L, Sawras V, Pavie J, Sodqi M, Malmoussi M, Tassi N, et al. Missed opportunities for HIV testing in patients newly diagnosed with HIV in Morocco. BMC Infect Dis. 2021;21(1):48.  https://doi.org/10.1186/s12879-020-05711-2  PMID: 33430783 
  24. Scognamiglio P, Chiaradia G, De Carli G, Giuliani M, Mastroianni CM, Aviani Barbacci S, et al. The potential impact of routine testing of individuals with HIV indicator diseases in order to prevent late HIV diagnosis. BMC Infect Dis. 2013;13(1):473.  https://doi.org/10.1186/1471-2334-13-473  PMID: 24112129 
  25. Damery S, Nichols L, Holder R, Ryan R, Wilson S, Warmington S, et al. Assessing the predictive value of HIV indicator conditions in general practice: a case-control study using the THIN database. Br J Gen Pract. 2013;63(611):e370-7.  https://doi.org/10.3399/bjgp13X668159  PMID: 23735407 
  26. Joore IK, Arts DL, Kruijer MJ, Moll van Charante EP, Geerlings SE, Prins JM, et al. HIV indicator condition-guided testing to reduce the number of undiagnosed patients and prevent late presentation in a high-prevalence area: a case-control study in primary care. Sex Transm Infect. 2015;91(7):467-72.  https://doi.org/10.1136/sextrans-2015-052073  PMID: 26126531 
  27. Joore IK, Twisk DE, Vanrolleghem AM, de Ridder M, Geerlings SE, van Bergen JE, et al. The need to scale up HIV indicator condition-guided testing for early case-finding: a case-control study in primary care. BMC Fam Pract. 2016;17(1):161.  https://doi.org/10.1186/s12875-016-0556-2  PMID: 27855639 
  28. Agustí C, Montoliu A, Mascort J, Carrillo R, Almeda J, Elorza JM, et al. Missed opportunities for HIV testing of patients diagnosed with an indicator condition in primary care in Catalonia, Spain. Sex Transm Infect. 2016;92(5):387-92.  https://doi.org/10.1136/sextrans-2015-052328  PMID: 26888659 
  29. van den Bogaart L, Ranzani A, Oreni L, Giacomelli A, Corbellino M, Rusconi S, et al. Overlooked cases of HIV infection: An Italian tale of missed diagnostic opportunities. Eur J Intern Med. 2020;73:30-5.  https://doi.org/10.1016/j.ejim.2019.09.006  PMID: 31635999 
  30. Ortega E, Ocete MD, Martínez-Roma M, Gimeno C, Gómez N, Diago M, et al. Reassessing HIV detection strategies: an analysis of opportunistic screening vs. indicator-condition-driven diagnosis in Valencia, Spain. J Community Health. 2024;49(4):748-54.  https://doi.org/10.1007/s10900-024-01326-9  PMID: 38409627 
  31. Lourinho J, Miguel MJ, Gonçalves F, Vale F, Franco CS, Marques N. Missed opportunities for HIV diagnosis and their clinical repercussions in the Portuguese population-A cohort study. Pathogens. 2024;13(8):683.  https://doi.org/10.3390/pathogens13080683  PMID: 39204283 
  32. Roussos S, Pantazis N, Protopapas K, Antoniadou A, Papadopoulos A, Lourida G, et al. Missed opportunities for early HIV diagnosis in Greece: The MORFEAS study, 2019 to 2021. Euro Surveill. 2024;29(48):2400138.  https://doi.org/10.2807/1560-7917.ES.2024.29.48.2400138  PMID: 39611208 
  33. Finnish Institute for Health and Welfare (THL). Maahanmuuttajien tartuntatautien seulonta sekä lasten tuberkuloosi- ja hepatiitti B – rokotukset. [Screening of infectious diseases among migrants, and tuberculosis and hepatitis B vaccinations for children]. Helsinki: THL. [Accessed: 1 Jun 2022]. Finnish.
  34. Rüütel K, Lemsalu L, Lätt S, Epštein J, OptTEST by HiE. Missed opportunities for HIV testing in people diagnosed with HIV, Estonia, 2014 to 2015. Euro Surveill. 2019;24(15):1800382.  https://doi.org/10.2807/1560-7917.ES.2019.24.15.1800382  PMID: 30994106 
  35. Søgaard OS, Lohse N, Østergaard L, Kronborg G, Røge B, Gerstoft J, et al. Morbidity and risk of subsequent diagnosis of HIV: a population based case control study identifying indicator diseases for HIV infection. PLoS One. 2012;7(3):e32538.  https://doi.org/10.1371/journal.pone.0032538  PMID: 22403672 
  36. Koskinen S, Lundqvist A, Ristiluoma N, editors. Terveys, toimintakyky ja hyvinvointi Suomessa 2011. Raportti 68/2012. [Health, functional capacity and well-being in Finland 2011]. Helsinki: Finnish Institute for Health and Welfare; 2012. ISBN 978-952-245-769-1. Finnish. Available from: https://urn.fi/URN:ISBN:978-952-245-769-1
  37. Martin-Iguacel R, Pedersen C, Llibre JM, Søndergaard J, Jensen J, Omland LH, et al. Primary health care: an opportunity for early identification of people living with undiagnosed HIV infection. HIV Med. 2019;20(6):404-17.  https://doi.org/10.1111/hiv.12735  PMID: 31016849 
  38. Agustí C, Cunillera O, Almeda J, Mascort J, Carrillo R, Olmos C, et al. Efficacy of an electronic reminder for HIV screening in primary healthcare based on indicator conditions in Catalonia (Spain). HIV Med. 2022;23(8):868-79.  https://doi.org/10.1111/hiv.13270  PMID: 35285143 
  39. Finnish Institute for Health and Welfare (THL). Avohilmo: Terveydenhuollon avohoidon ICD-10-diagnoosit ikäryhmittäin ja sukupuolittain hyvinvointialueilla. [Avohilmo: ICD-10 diagnoses in outpatient health care by age, sex and county]. Helsinki: THL. [Accessed: 11 Jan 2024]. Finnish. Available from: https://sampo.thl.fi/pivot/prod/fi/avo/perus15/summary_icd1001
  40. Finnish Institute for Health and Welfare (THL). Potilasmääriä hyvinvointialueilla päädiagnooseittain. [Number of patients by county and main diagnosis]. Helsinki: THL. [accessed 15 Jan 2024]. Finnish. Available from: https://sampo.thl.fi/pivot/prod/fi/thilpalaute/hvaseur2/fact_thilpalaute_hvaseur2
  41. Finnish Institute for Health and Welfare (THL). Tartuntatautirekisterin tilastotietokanta – tapaukset. [Finnish National Infectious Diseases Register, statistical database - cases]. Helsinki: THL. [Accessed: 15 Jan 2024]. Finnish. Available from: https://sampo.thl.fi/pivot/prod/fi/ttr/cases/fact_ttr_cases
  42. Tiittala P, Tuomisto K, Puumalainen T, Lyytikäinen O, Ollgren J, Snellman O, et al. Public health response to large influx of asylum seekers: implementation and timing of infectious disease screening. BMC Public Health. 2018;18(1):1139.  https://doi.org/10.1186/s12889-018-6038-9  PMID: 30249224 
  43. Brännström J, Sönnerborg A, Svedhem V, Neogi U, Marrone G. A high rate of HIV-1 acquisition post immigration among migrants in Sweden determined by a CD4 T-cell decline trajectory model. HIV Med. 2017;18(9):677-84.  https://doi.org/10.1111/hiv.12509  PMID: 28444865 
  44. Yin Z, Brown AE, Rice BD, Marrone G, Sönnerborg A, Suligoi B, et al. Post-migration acquisition of HIV: Estimates from four European countries, 2007 to 2016. Euro Surveill. 2021;26(33):2000161.  https://doi.org/10.2807/1560-7917.ES.2021.26.33.2000161  PMID: 34414881 
  45. Pantazis N, Rosinska M, van Sighem A, Quinten C, Noori T, Burns F, et al. Discriminating between premigration and postmigration HIV acquisition using surveillance data. J Acquir Immune Defic Syndr. 2021;88(2):117-24.  https://doi.org/10.1097/QAI.0000000000002745  PMID: 34138772 
  46. Tiittala PJ, Kivelä PS, Ristola MA, Surcel HM, Koponen PM, Mölsä M, et al. Achieving high acceptability of HIV testing in a population-based survey among immigrants in Finland. Scand J Public Health. 2015;43(4):393-8.  https://doi.org/10.1177/1403494815573604  PMID: 25788469 
  47. Statistics Finland. Country of birth according to age and sex by region, 1990-2022. Helsinki: Statistics Finland. [Accessed: 9 Sep 2023]. Available from: https://pxdata.stat.fi/PxWeb/pxweb/en/StatFin/StatFin__vaerak/statfin_vaerak_pxt_11rp.px
  48. Adedimeji AA, Asibon A, O’Connor G, Carson R, Cowan E, McKinley P, et al. Increasing HIV testing among African immigrants in ireland: challenges and opportunities. J Immigr Minor Health. 2015;17(1):89-95.  https://doi.org/10.1007/s10903-014-9986-x  PMID: 24549490 
  49. Gray C, Lobo R, Narciso L, Oudih E, Gunaratnam P, Thorpe R, et al. Why I can’t, won’t or don’t test for HIV: Insights from Australian migrants born in Sub-Saharan Africa, Southeast Asia and Northeast Asia. Int J Environ Res Public Health. 2019;16(6):1034.  https://doi.org/10.3390/ijerph16061034  PMID: 30901957 
  50. Kaufmann GR, Cunningham P, Zaunders J, Law M, Vizzard J, Carr A, et al. Impact of early HIV-1 RNA and T-lymphocyte dynamics during primary HIV-1 infection on the subsequent course of HIV-1 RNA levels and CD4+ T-lymphocyte counts in the first year of HIV-1 infection. J Acquir Immune Defic Syndr. 1999;22(5):437-44.  https://doi.org/10.1097/00126334-199912150-00003  PMID: 10961604 
  51. Health Protection Agency (HPA) Centre for Infections. Longitudinal analysis of the trajectories of CD4 cell counts. London: HPA. 2011. [archived 14 Jul 2014]. Available from: https://webarchive.nationalarchives.gov.uk/ukgwa/20140714084352/http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317134622608
  52. Eron JJ Jr, Rockstroh JK, Reynes J, Andrade-Villanueva J, Ramalho-Madruga JV, Bekker LG, et al. Raltegravir once daily or twice daily in previously untreated patients with HIV-1: a randomised, active-controlled, phase 3 non-inferiority trial. Lancet Infect Dis. 2011;11(12):907-15.  https://doi.org/10.1016/S1473-3099(11)70196-7  PMID: 21933752 
Use of healthcare services preceding HIV diagnosis – missed opportunities for earlier diagnosis, Finland, 1996 to 2019
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Sanna+Isosomppi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Isosomppi Sanna</a>, <a href="/search?value1=Mikaela+Mutru&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Mutru Mikaela</a>, <a href="/search?value1=Jukka+Ollgren&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ollgren Jukka</a>, <a href="/search?value1=Henrikki+Brummer-Korvenkontio&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Brummer-Korvenkontio Henrikki</a>, <a href="/search?value1=Kirsi+Liitsola&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Liitsola Kirsi</a>, <a href="/search?value1=Jussi+Sutinen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sutinen Jussi</a>, <a href="/search?value1=Inka+Aho&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Aho Inka</a>, <a href="/search?value1=Pia+Kivel%C3%A4&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kivelä Pia</a></span>. Use of healthcare services preceding HIV diagnosis – missed opportunities for earlier diagnosis, Finland, 1996 to 2019. <a href="/content/ecdc">Euro Surveill.</a> 2025;30(18):pii=2400610. <a href="https://doi.org/10.2807/1560-7917.ES.2025.30.18.2400610" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2025.30.18.2400610</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 17 Sept 2024;&nbsp;&nbsp; <span class="generated">Accepted</span>: 10 Jan 2025 </span> </p>
/content/10.2807/1560-7917.ES.2025.30.18.2400610
/content/10.2807/1560-7917.ES.2025.30.18.2400610
Loading

Data & Media loading...

Supplementary data

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error