TY - JOUR
T1 - Who is providing HIV diagnostic testing? Comparing HIV testing by general practitioners and sexual health centres in five regions in the Netherlands, 2011-2018
AU - Bogers, Saskia J.
AU - Twisk, Denise E.
AU - Beckers, Loes M.
AU - Götz, Hannelore M.
AU - Meima, Bram
AU - Kroone, Michelle
AU - Hoornenborg, Elske
AU - Ott, Alewijn
AU - Luning-Koster, Marleen N.
AU - Dukers-Muijrers, Nicole H. T. M.
AU - Hoebe, Christian J. P. A.
AU - Kampman, Carolina J. G.
AU - Bosma, Froukje
AU - Schim van der Loeff, Maarten
AU - Geerlings, Suzanne
AU - van Bergen, Jan
N1 - Funding Information: Funding This project is funded by Aids Fonds (grant number: P-42702) and the H-TEAM. The H-TEAM initiative is supported by Aids Fonds (grant number: 2013169), Stichting Amsterdam Dinner Foundation, Bristol-Myers Squibb International (study number: AI424-541), Gilead Sciences Europe (grant number: PA-HIV-PREP-16–0024), Gilead Sciences (protocol numbers: CO-NL-276-4222, CO-US-276–1712), Janssen Pharmaceutica (reference number: PHNL/JAN/0714/0005b/1912fde), MAC AIDS Fund, ViiV Healthcare (PO numbers: 3000268822 and 3000747780) and ZonMw (grant number: 522002003). Publisher Copyright: © 2022 Author(s) (or their employer(s)). Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2022/6/1
Y1 - 2022/6/1
N2 - Objectives General practitioners (GPs) and sexual health centres (SHCs) are the main providers of HIV testing and diagnose two-thirds of HIV infections in the Netherlands. We compared regional HIV testing and positivity by GPs versus SHCs to gain insight into strategies to improve HIV testing, to enable timely detection of HIV infections. Methods Laboratory data (2011-2018) on HIV testing by GPs and SHCs in five Dutch regions with varying levels of urbanisation were evaluated. Regional HIV testing rates per 10 000 residents ≥15 years (mean over period and annual) were compared between providers using negative binomial generalised additive models and additionally stratified by sex and age (15-29 years, 30-44 years, 45-59 years, ≥60 years). χ 2 tests were used to compare positivity percentage between the two groups of providers. Results In the study period, 505 167 HIV tests (GP 36%, SHC 64%) were performed. The highest HIV testing rates were observed in highly urbanised regions, with large regional variations. The HIV testing rates ranged from 28 to 178 per 10 000 residents by GPs and from 30 to 378 per 10 000 by SHCs. Testing rates by GPs were lower than by SHCs in three regions and comparable in two. In all regions, men were tested less by GPs than by SHCs; for women, this varied by region. Among those aged 15-29 years old, GPs' testing rates were lower than SHCs', while this was reversed in older age categories in four out of five regions. The overall mean HIV positivity was 0.4%. In contrast to other regions, positivity in Amsterdam was significantly higher among individuals tested by GPs than by SHCs. Conclusions This retrospective observational study shows that besides SHCs, who perform opt-out testing for key groups, GPs play a prominent role in HIV testing, especially in non-key populations, such as women and older individuals. Large regional variation exists, requiring region-specific interventions to improve GPs' HIV testing practices.
AB - Objectives General practitioners (GPs) and sexual health centres (SHCs) are the main providers of HIV testing and diagnose two-thirds of HIV infections in the Netherlands. We compared regional HIV testing and positivity by GPs versus SHCs to gain insight into strategies to improve HIV testing, to enable timely detection of HIV infections. Methods Laboratory data (2011-2018) on HIV testing by GPs and SHCs in five Dutch regions with varying levels of urbanisation were evaluated. Regional HIV testing rates per 10 000 residents ≥15 years (mean over period and annual) were compared between providers using negative binomial generalised additive models and additionally stratified by sex and age (15-29 years, 30-44 years, 45-59 years, ≥60 years). χ 2 tests were used to compare positivity percentage between the two groups of providers. Results In the study period, 505 167 HIV tests (GP 36%, SHC 64%) were performed. The highest HIV testing rates were observed in highly urbanised regions, with large regional variations. The HIV testing rates ranged from 28 to 178 per 10 000 residents by GPs and from 30 to 378 per 10 000 by SHCs. Testing rates by GPs were lower than by SHCs in three regions and comparable in two. In all regions, men were tested less by GPs than by SHCs; for women, this varied by region. Among those aged 15-29 years old, GPs' testing rates were lower than SHCs', while this was reversed in older age categories in four out of five regions. The overall mean HIV positivity was 0.4%. In contrast to other regions, positivity in Amsterdam was significantly higher among individuals tested by GPs than by SHCs. Conclusions This retrospective observational study shows that besides SHCs, who perform opt-out testing for key groups, GPs play a prominent role in HIV testing, especially in non-key populations, such as women and older individuals. Large regional variation exists, requiring region-specific interventions to improve GPs' HIV testing practices.
KW - Epidemiology
KW - General practice
KW - HIV
KW - Primary health care
KW - Sexual health
UR - http://www.scopus.com/inward/record.url?scp=85130644558&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/record.url?scp=85111421328&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/sextrans-2021-055109
DO - https://doi.org/10.1136/sextrans-2021-055109
M3 - Article
C2 - 34315804
SN - 1368-4973
VL - 98
SP - 262
EP - 268
JO - Sexually transmitted infections
JF - Sexually transmitted infections
IS - 4
M1 - 055109
ER -