title: Delayed diagnosis of HIV: missed opportunities and triggers for testing in the Australian Capital Territory.
abstract: BACKGROUND
  To determine (i) the rate of delayed HIV diagnosis; (ii) the missed opportunities for HIV diagnosis; and (iii) to identify who initiates HIV testing and what triggers them to do so.
  
  
  METHODS
  An analysis of the case records of all HIV-positive patients who attended Canberra Sexual Health Centre (CSHC) between 1985 and 2005 was conducted.
  
  
  RESULTS
  During the study period, 319/355 CSHC patients diagnosed with HIV had sufficient data to allow analysis regarding the timeliness of their diagnosis. Of these, 52 (16.3%) received a delayed diagnosis. The rate of delayed diagnosis was 9.7% (95% CI 5.1-15.3) in the 1980s and 25.6% (95% CI 13-42.1) between 2000 and 2004. There were no statistically significant differences in sociodemographic or behavioural characteristics between patients with delayed and timely HIV diagnoses. To determine who initiated testing, and if there were missed opportunities for testing, the records of CSHC patients diagnosed with HIV between 1995 and 2005 were examined. Of the 115 people diagnosed in this period, only 71 had documentation concerning missed opportunities for testing. Forty-one of these (58%) had been in contact with a health professional while infected, but before their diagnosis of HIV and 39/41 (95%) had a significant risk factor in their history that could have initiated an HIV test. Clinicians initiated testing for 43.5% of the patients, 11.3% were identified through contact tracing and only 28.7% were self referred for testing.
  
  
  CONCLUSIONS
  Late diagnosis of HIV is common in the Australian Capital Territory and may have increased over time. Clinicians need to be aware of the sometimes-subtle manifestations of early and late HIV infection and have a lower threshold for HIV antibody testing.
authors.affiliation: University of Sydney Medical Program, The Canberra Clinical School, The Canberra Hospital, PO Box 11, Woden, ACT 2606, Australia. mcdonald_elizabeth@hotmail.com
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: McDonald
authors.forename: Marian J
authors.initials: MJ
authors.lastname: Currie
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Bowden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D020958:Australian Capital Territory / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D002648:Child; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors