@article{0758c66b0a4246c3a86f1f1f47bb27b8,
title = "Improving indicator-condition guided testing for HIV in the hospital setting (PROTEST 2·0): A multicenter, interrupted time-series analysis",
abstract = "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).",
keywords = "Cervical carcinoma, Cervical dysplasia, Diagnostics, HIV, HIV testing, Hepatitis B, Hepatitis C, Indicator condition, Intervention, Lymphoma, Medical education, Neuropathy, Tuberculosis, Vulvar carcinoma, Vulvar dysplasia",
author = "{HIV Transmission Elimination Amsterdam (H-TEAM) Initiative} and Bogers, {Saskia J} and {Schim van der Loeff}, {Maarten F} and Anders Boyd and Udi Davidovich and {van der Valk}, Marc and Kees Brinkman and Kim Sigaloff and Judith Branger and Nejma Bokhizzou and {de Bree}, {Godelieve J} and Peter Reiss and {van Bergen}, {Jan E A M} and Geerlings, {Suzanne E} and {HIV Transmission Elimination AMsterdam (H-TEAM) Initiative, The H-TEAM members are} and {van Benthem}, T. and D. Bons and P. Brokx and F. Deug and M. Heidenrijk and E. Hoornenborg and M. Prins and {van Sighem}, A. and {de Wit}, J. and W. Zuilhof and {H-TEAM Project Management} and N. Schat and D. Smith and {H-TEAM additional collaborators} and {van Agtmael}, M. and J. Ananworanich and {de Beek}, {D. Van} and {van den Berk}, {G. E. L.} and M. Bomers and {de Bruin}, M. and M. Dijkstra and Geijtenbeek, {T. B. H.} and A. Goorhuis and Hovius, {J. W.} and {de Jong}, K. and Nellen, {F. J.} and E. Peters and {van der Poll}, T. and J. Schouten and {de Vocht}, J. and {de Vries}, {H. J.} and {van Vugt}, M. and Wiersinga, {W. J.} and Woittiez, {L. R.}",
note = "Funding Information: The authors thank all members and collaborators of the HIV Transmission Elimination Amsterdam (H-TEAM) initiative and Aidsfonds (grant number: P-42702). We thank all participating physicians from the study hospitals Amsterdam UMC location AMC, Amsterdam UMC location VUmc, BovenIJ ziekenhuis Amsterdam, Flevoziekenhuis Almere and Onze Lieve Vrouwe Gasthuis Amsterdam. We thank all junior researchers who helped with data collection: Amie Ndong, Britney Chen, Elise Welberg, Gulsum Nasim, Kany Hadi, Koen Wessels, Marcel van Dijk, Margreet Schonwetter and Tjiemen Ahmad. This study was funded by Aidsfonds (grant number: P-42702) and the HIV Transmission Elimination Amsterdam (H-TEAM) initiative. The H-TEAM initiative is being supported by Aidsfonds (grant number: 2013169), Stichting Amsterdam Dinner Foundation, Bristol-Myers Squibb International Corp. (study number: AI424-541), Gilead Sciences Europe Ltd (grant number: PA-HIV-PREP-16-0024), Gilead Sciences (protocol numbers: CO-NL-276-4222, CO-US-276-1712), M.A.C AIDS Fund. None of the funders had any role in the design, data collection, analysis or interpretation of data in this study. The funders were not involved in the writing of the manuscript or the decision to submit for publication. Publisher Copyright: {\textcopyright} 2022 The Author(s)",
year = "2022",
month = dec,
day = "1",
doi = "https://doi.org/10.1016/j.lanepe.2022.100515",
language = "English",
volume = "23",
journal = "The Lancet Regional Health - Europe",
issn = "2666-7762",
publisher = "Elsevier Ltd",
}