Late presenters and significance of screening tests in early diagnosis of HIV infection in Istanbul (2025)

Emergency department based HIV screening: An opportunity for early diagnosis in high prevalent areas

Indian Journal of Medical Microbiology, 2008

The Emergency Medicine Department (EMD) is an ideal place for public health interventions and provides ready access to the health care system, offering a great opportunity for HIV testing and counselling. Between 2003 and 2005, rapid test was requested for 59.39% of 10,752 cases from EMD, where as ELISA was requested for 40.61%. Of the 317 HIV reactive cases, available medical records of 249 were reviewed for epidemiological and clinical information. Nearly 42% of total reactive cases detected in our Institute were from EMD. Three percent (317/10,752) were diagnosed as HIV reactive, 1.52% of the total samples were reactive by rapid test and the other 1.43% by ELISA. Two and half percent (163/6386) of those who had rapid testing and 3.53% (154/4366) who had ELISA testing, were identiÞ ed as HIV reactive. All these cases were diagnosed within a mean EMD stay of 2.5 days. Eighty-Þ ve percent of HIV reactive individuals were unaware of their reactive status. Additional 53 cases of asymptomatic spouses were diagnosed as HIV reactive, thus making it possible to seek early treatment for HIV infection. The study emphasizes the importance of offering HIV testing to all patients who present to emergency department.

Are physicians aware of current HIV / AIDS diagnostic practices? A study from a tertiary centre in Turkey

The Journal of Infection in Developing Countries, 2018

Introduction: Early diagnosis of HIV infection is essential for the reduction of morbidity/mortality rates, health expenditures and the prevention of infection spread. In this study we aimed to test the knowledge of physicians regarding HIV risk groups, AIDS indicator diseases and their current practices about screening. Methodology: A questionnaire was used to collect data from physicians working in a multidisciplinary 170-bed tertiary university hospital in Istanbul, Turkey. The questionnaire measured physician knowledge of the above-mentioned points. Results: Ninety-six physicians replied to the questionnaire. "Preoperative screening" was found to be the most common (65.6%) indication for HIV testing. A large portion of physicians (72.9%) felt comfortable with an HIV test and 71.9% of the physicians had no impeding condition for HIV testing. Physicians were mostly (67.7%) unaware of the current guidelines for HIV testing. Conclusions: Teaching programs are essential to increase knowledge of HIV screening for physicians as this is an essential part of early diagnosis and therefore important for decreasing morbidity and mortality.

A Model for Routine Hospital-wide HIV Screening: Lessons Learned and Public Health Implications

Journal of the National Medical Association, 2010

HIV Screening in the Health Care Setting: Status, Barriers, and Potential Solutions

Mayo Clinic Proceedings, 2012

Thirty years into the human immunodeficiency virus (HIV) epidemic in the United States, an estimated 50,000 persons become infected each year: highest rates are in black and Hispanic populations and in men who have sex with men. Testing for HIV has become more widespread over time, with the highest rates of HIV testing in populations most affected by HIV. However, approximately 55% of adults in the United States have never received an HIV test. Because of the individual and community benefits of treatment for HIV, in 2006 the Centers for Disease Control and Prevention recommended routine screening for HIV infection in clinical settings. The adoption of this recommendation has been gradual owing to a variety of issues: lack of awareness and misconceptions related to HIV screening by physicians and patients, barriers at the facility and legislative levels, costs associated with testing, and conflicting recommendations concerning the value of routine screening. Reducing or eliminating these barriers is needed to increase the implementation of routine screening in clinical settings so that more people with unrecognized infection can be identified, linked to care, and provided treatment to improve their health and prevent new cases of HIV infection in the United States.

Assessing missed opportunities for HIV testing in medical settings

Journal of General Internal Medicine, 2004

BACKGROUND: Many HIV-infected persons learn about their diagnosis years after initial infection. The extent to which missed opportunities for HIV testing occur in medical evaluations prior to one's HIV diagnosis is not known.

Modest Public Health Impact of Nontargeted Human Immunodeficiency Virus Screening in 29 Emergency Departments

Archives of Internal Medicine, 2012

To lower the number of undiagnosed infections and to improve early detection, international health agencies have promoted nontargeted human immunodeficiency virus (HIV) screening in health care settings, including emergency departments (EDs). This strategy remains controversial and has yet to be tested on a large scale. We assessed the public health impact of nontargeted HIV-rapid test (RT) screening among ED patients in the metropolitan area of Paris (11.7 million inhabitants), where half of France's new HIV cases are diagnosed annually.

Missed opportunities for earlier HIV-testing in patients with HIV infection referred to a tertiary hospital, a cross-sectional study

The Medical journal of Malaysia, 2017

INTRODUCTION In Malaysia, the prevalence of missed opportunities for HIV-testing is unknown. Missed opportunities have been linked to late diagnosis of HIV and poorer outcome for patients. We describe missed opportunities for earlier HIV-testing in newly-HIV-diagnosed patients. METHODS Cross sectional study. Adult patients diagnosed with HIV infection and had at least one medical encounter in a primary healthcare setting during three years prior to diagnosis were included. We collected data on sociodemographic characteristics, patient characteristics at diagnosis, HIV-related conditions and whether they were subjected to risk assessment and offered HIV testing during the three years prior to HIV diagnosis. RESULTS 65 newly HIV-diagnosed patients (male: 92.3%; Malays: 52.4%; single: 66.7%; heterosexual: 41%; homosexual 24.6%; CD4 <350 at diagnosis: 63%). 93.8% were unaware of their HIV status at diagnosis. Up to 56.9% had presented with HIV-related conditions at a primary healthca...

Missed opportunities for HIV testing in newly-HIV-diagnosed patients, a cross sectional study

BMC Infectious Diseases, 2013

Background: In France, 1/3 HIV-infected patients is diagnosed at an advanced stage of the disease. We describe missed opportunities for earlier HIV testing in newly-HIV-diagnosed patients. Methods: Cross sectional study. Adults living in France for ≥1 year, diagnosed with HIV-infection ≤6 months earlier, were included from 06/2009 to 10/2010. We collected information on patient characteristics at diagnosis, history of HIV testing, contacts with healthcare settings, and occurrence of HIV-related events 3 years prior to HIV diagnosis. During these 3 years, we assessed whether or not HIV testing had been proposed by the healthcare provider upon first contact in patients notifying that they were MSM or had HIV-related conditions. Results: 1,008 newly HIV-diagnosed patients (mean age: 39 years; male: 79%; MSM: 53%; diagnosed with an AIDSdefining event: 16%). During the 3-year period prior to HIV diagnosis, 99% of participants had frequented a healthcare setting and 89% had seen a general practitioner at least once a year. During a contact with a healthcare setting, 91/191 MSM (48%) with no HIV-related conditions, said being MSM; 50 of these (55%) did not have any HIV test proposal. Only 21% (41/191) of overall MSM who visited a healthcare provider received a test proposal. Likewise, 299/364 patients (82%) who sought care for s had a missed opportunity for HIV testing. Conclusions: Under current screening policies, missed opportunities for HIV testing remain unacceptably high. This argues in favor of improving risk assessment, and HIV-related conditions recognition in all healthcare facilities.

Incidence of Late Presentation and Advanced disease in Newly Diagnosed Patients of HIV infection in Dhofar region of Oman

https://www.ijhsr.org/IJHSR_Vol.10_Issue.7_July2020/IJHSR_Abstract.027.html, 2020

Objectives: Globally half of the patients with new HIV infection are diagnosed late. This study was carried out to assess incidence of late diagnosis and its impact in newly-diagnosed HIV patients in Dhofar region of Oman. Methods: The medical records of the patients diagnosed to have new HIV infection during the years2018 and 2019 were scanned to find out incidence of late (CD4<350) or advanced disease (CD4<200) on presentation and whether diagnosed by screening or related symptoms. Results: Among 46 new HIV infections during 2018-2019, 63% (29/46) were between age 31-50 years, 23.9% (11/46) were females, 37% (17/46) were unmarried and 37% (17/46) were MSM. Only 8 (17.4%) had CD4 count >350, while 38 (82.6%) were in late categories including 13 (28.3%) late-presenters and25 (54.3%) with advanced disease. The unmarried and those above 50 had a tendency to present late. Twenty-eight (60.9%) patients were asymptomatic. The patients presenting with HIV-related symptoms had either late or advanced disease, but the probability of being diagnosed in an advanced state was statistically significant (p 0.003; OR 9; 95% CI 2.09-38.79). Patients with advanced disease required 352 days of hospitalization including 72 days in ICU, and 20% (5/25)of them who had CD4<20 died. Nineteen (41.3%) patients had missed opportunity for early diagnosis when they attended the hospital in last 2 years; 28.3% (13/46) had multiple visits. Conclusion: Late diagnosis in HIV infection is common. Screening strategies for HIV should be revised.

HIV Screening in Health Care Settings in the United States

The virtual mentor : VM, 2009

Thirty years into the human immunodeficiency virus (HIV) epidemic in the United States, an estimated 50,000 persons become infected each year: highest rates are in black and Hispanic populations and in men who have sex with men. Testing for HIV has become more widespread over time, with the highest rates of HIV testing in populations most affected by HIV. However, approximately 55% of adults in the United States have never received an HIV test. Because of the individual and community benefits of treatment for HIV, in 2006 the Centers for Disease Control and Prevention recommended routine screening for HIV infection in clinical settings. The adoption of this recommendation has been gradual owing to a variety of issues: lack of awareness and misconceptions related to HIV screening by physicians and patients, barriers at the facility and legislative levels, costs associated with testing, and conflicting recommendations concerning the value of routine screening. Reducing or eliminating these barriers is needed to increase the implementation of routine screening in clinical settings so that more people with unrecognized infection can be identified, linked to care, and provided treatment to improve their health and prevent new cases of HIV infection in the United States.