Assessing indicator condition-guided hiv testing in the hospital setting

BackgroundTimely diagnosis of HIV is key in the efforts to end the HIV epidemic. Indicator Condition (IC) guided HIV testing is cost-effective in identifying undiagnosed HIV. It is unknown to what extent hospitals are applying this strategy We assessed baseline findings from an ongoing multicenter interventional study aimed at identifying opportunities for improving IC-guided HIV testing in hospitals in Amsterdam.MethodsThe study involved two university hospitals, two teaching hospitals, and one non-teaching hospital. Seven ICs were selected: tuberculosis (TB), lymphoma, hepatitis B (HBV) and C (HCV), cervical carcinoma or intraepithelial neoplasia grade III (CC/CIN-III), vulvar carcinoma or intraepithelial neoplasia grade III (VC/VIN-III), and peripheral neuropathy (PN). Patients ≥18 years not known to have HIV, diagnosed with one of these ICs during 2015–2020 were eligible. We included all eligible patients in one hospital, and screened a sample of ≤500 patients per IC in the others. Primary outcome was the proportion of patients with an IC tested for HIV ≤3 months around IC diagnosis (i.e. HIV testing ratio). Secondary outcome was the proportion of positive tests.ResultsWe included 4,823 patients. HIV testing ratios were highest amongst TB patients (range 74–94%). The testing ratio varied considerably across ICs and locations, ranging between 56%(50/90)-72%(105/145) in lymphoma patients, 33%(5/15)-65%(113/175) in HBV, 29%(2/7)-73%(24/33) in HCV, 0%(0/68)-4%(16/452) in CC/CIN-III, and 4%(4/97)-16%(16/98) in PN. None of the 198 VC/VIN-III patients were tested for HIV. Eleven patients (0.7%) tested HIV positive ≤3 months around IC diagnosis. Of these, 6(55%) had lymphoma and 10(91%) had a CD4 count <350 cells/mm³.ConclusionIn-hospital IC-guided testing in the selected ICs was variably and often insufficiently practiced, but did identify people with previously undiagnosed HIV. These data show the relevance of tailored interventions to improve IC-guided HIV testing, to contribute to reducing the proportion of people with undiagnosed HIV.