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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
  1. Ivo K Joore1,
  2. Derk L Arts1,
  3. Marjan JP Kruijer1,
  4. Eric P Moll van Charante1,
  5. Suzanne E Geerlings2,
  6. Jan M Prins2,
  7. Jan EAM van Bergen1,3,4
  1. 1Department of General Practice, Division of Clinical Methods and Public Health, Academic Medical Center, Amsterdam, The Netherlands
  2. 2Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands
  3. 3STI AIDS Netherlands (Soa Aids Nederland), Amsterdam, The Netherlands
  4. 4Epidemiology & Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
  1. Correspondence to Ivo K Joore, Department of General Practice, Division of Clinical Methods and Public Health, Academic Medical Center, Meibergdreef 9, Amsterdam 1100 DE, The Netherlands; i.k.joore{at}amc.uva.nl

Abstract

Objectives Recent guidelines advocate accelerated provider-initiated HIV testing by general practitioners (GPs). We aimed to identify the number of patient consultations in six general practices in the South-East of Amsterdam, and the incidence of HIV indicator conditions reported in their medical files prior to diagnosis.

Methods A cross-sectional search in an electronic general practice database. We used a case–control design to identify those conditions most associated with an HIV-positive status.

Results We included 102 HIV cases diagnosed from 2002 to 2012, and matched them with 299 controls. In the year prior to HIV diagnosis, 61.8% of cases visited their GP at least once, compared with 38.8% of controls. In the 5 years prior to HIV diagnosis, 58.8% of HIV cases had exhibited an HIV indicator condition, compared with 7.4% of controls. The most common HIV-related conditions were syphilis and gonorrhoea. The most common HIV-related symptoms were weight loss, lymphadenopathy and peripheral neuropathy. During this period, average HIV prevalence among people aged 15–59 years increased from 0.4% to 0.9%.

Conclusions This study revealed many opportunities for HIV indicator condition-guided testing in primary care. As yet, however, HIV indicator conditions are not exploited as triggers for early HIV testing.

  • GENERAL PRACTICE
  • HIV
  • PUBLIC HEALTH
  • PRIMARY CARE
  • PREVENTION

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