Improving indicator-condition guided testing for HIV in the hospital setting (PROTEST 2·0): A multicenter, interrupted time-series analysis

HIV Transmission Elimination Amsterdam (H-TEAM) Initiative, HIV Transmission Elimination AMsterdam (H-TEAM) Initiative, The H-TEAM members are, H-TEAM Project Management, H-TEAM additional collaborators

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Scopus)


BACKGROUND: Indicator-condition (IC) guided HIV testing is a feasible and cost-effective strategy to identify undiagnosed people living with HIV (PLHIV), but remains insufficiently implemented. We aimed to promote IC-guided HIV testing in seven ICs.

METHODS: Relevant departments in five hospitals of the Amsterdam region participated. HIV testing among adult patients without known HIV infection but with an IC was assessed using electronic health records during pre-intervention (January 2015-June 2020) and intervention (July 2020-June 2021) periods. The multifaceted intervention included audit and feedback. The primary endpoint was HIV testing ≤3 months before or after IC diagnosis and the effect of the intervention was evaluated using segmented Poisson regression.

FINDINGS: Data from 7986 patients were included, of whom 6730 (84·3%) were diagnosed with an IC in the pre-intervention period and 1256 (15·7%) in the intervention period. The proportion HIV tested ≤3 months before or after IC diagnosis increased from 36.8% to 47.0% (adjusted risk ratio [RR]= 1.16, 95% CI=1.03-1.30, p=0.02). For individual ICs, we observed significant increases in HIV testing among patients with cervical cancer or intraepithelial neoplasia grade 3 (adjusted RR=3.62, 95% CI=1.93-6.79) and peripheral neuropathy (adjusted RR=2.27 95% CI=1.48-3.49), but not the other ICs. Eighteen of 3068 tested patients were HIV positive (0.6%).

INTERPRETATION: Overall IC-guided testing improved after the intervention, but not for all ICs. Variations in effect by IC may have been due to variations in implemented developments, but the effect of separate elements could not be assessed.

FUNDING: HIV Transmission Elimination Amsterdam (H-TEAM) initiative, Aidsfonds (grant number: P-42702).

Original languageEnglish
Article number100515
Pages (from-to)100515
JournalThe Lancet Regional Health - Europe
Publication statusPublished - 1 Dec 2022


  • Cervical carcinoma
  • Cervical dysplasia
  • Diagnostics
  • HIV
  • HIV testing
  • Hepatitis B
  • Hepatitis C
  • Indicator condition
  • Intervention
  • Lymphoma
  • Medical education
  • Neuropathy
  • Tuberculosis
  • Vulvar carcinoma
  • Vulvar dysplasia

Cite this