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  • Indicator condition-guided HIV testing with an electronic prompt in primary healthcare: a before and after evaluation of an intervention

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Clinical
Original article
Indicator condition-guided HIV testing with an electronic prompt in primary healthcare: a before and after evaluation of an intervention
  1. Laia Cayuelas Redondo1,
  2. Marina Ruíz1,
  3. Belchin Kostov2,
  4. Ethel Sequeira1,
  5. Pablo Noguera1,
  6. Maria Alba Herrero1,
  7. Ignacio Menacho3,
  8. Olga Barba4,
  9. Thaïs Clusa5,
  10. Benet Rifa6,
  11. Eva María González de la Fuente7,
  12. Eva González Redondo7,
  13. Felipe García7,
  14. Antoni Sisó Almirall2,3,
  15. Agathe León7
  1. 1 Centro de Atención Primaria Casanova, Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
  2. 2 Primary Healthcare Transversal Research Group, IDIBAPS, Barcelona, Spain
  3. 3 Centro de Atención Primaria Les Corts, Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
  4. 4 Centro de Atención Primaria Comte Borrell, Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
  5. 5 Centro de Atención Primaria Raval Sud, Institut Català de la Salut, Barcelona, Spain
  6. 6 Public Health Agency of Catalonia, Generalitat of Catalonia, Barcelona, Spain
  7. 7 Hospital Clínico y Provincial de Barcelona, Unidad de Enfermedades Infecciosas, Barcelona, Spain
  1. Correspondence to Dr Laia Cayuelas Redondo, Centro de Atención Primaria Casanova, Consorci d'Atenció Primària de SalutBarcelona Esquerra (CAPSBE), Barcelona 08036, Spain; laiacayuelas{at}hotmail.com

Abstract

Objective Indicator condition (IC)-guided HIV testing is a strategy for the diagnosis of patients with HIV. The aim of this study was to assess the impact on the proportion of HIV tests requested after the introduction of an electronic prompt instructing primary healthcare (PHC) physicians to request an HIV test when diagnosing predefined IC.

Methods A prospective interventional study was conducted in 2015 in three PHC centres in Barcelona to assess the number of HIV test requests made during the implementation of an electronic prompt. Patients aged 18–65 years without HIV infection and with a new diagnosis of predefined IC were included. The results were compared with preprompt (2013) and postprompt data (2016).

Results During the prompt period, 832 patients presented an IC (median age 41.6 years [IQR 30–54], 48.2% female). HIV tests were requested in 296 individuals (35, 6%) and blood tests made in 238. Four HIV infections were diagnosed (positivity rate 1.7%, 95% CI 0.5% to 4.4%). The number of HIV tests requested based on IC increased from 12.6% in 2013 to 35.6% in 2015 (p<0.001) and fell to 17.9% after removal of the prompt in 2016 (p<0.001). Younger patient age (OR 0.97, 95% CI 0.96 to 0.98), birth outside Spain (OR 1.53, 95% CI 1.06 to 2.21) and younger physician age (OR 0.97, 95% CI 0.96 to 0.99) were independent predictive factors for an HIV test request during the prompt period. The electronic prompt (OR 3.36, 95% CI 2.70 to 4.18) was the factor most closely associated with HIV test requests. It was estimated that 10 (95% CI 3.0 to 26.2) additional new cases would have been diagnosed if an HIV test had been performed in all patients presenting an IC.

Conclusions A significant increase in HIV test requests was observed during the implementation of the electronic prompt. The results suggest that this strategy could be useful in increasing IC-guided HIV testing in PHC centres.

  • HIV testing
  • primary care
  • screening
  • testing
  • HIV

https://doi.org/10.1136/sextrans-2018-053792

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    Footnotes

    • Handling editor Claudia S Estcourt

    • Contributors LCR, AL and FG conceived the design of the study. LCR managed the study. LCR, MR, ES, PN, MAH, IM, OB, TC, EMGdlF, EGR and BR contributed to data acquisition. BK, AL, LC and AS-A contributed to data analysis and interpretation. LCR, AL, BK and AS-A were involved in drafting the manuscript. LCR and AL revised and finalised this manuscript. All authors read and approved the final version.

    • Funding This study was funded by the 2014 Beca Fin de Residencia, awarded by the Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by the Hospital Clinic Ethics Committee in May 2014 (Ref HCB/2014/0429). Due to the removal of the prompt, the study required a new version that was approved in July 2016. The data were processed anonymously in accordance with the current Spanish legislation.

    • Provenance and peer review Not commissioned; externally peer reviewed.