title: HIV indicator condition-guided testing to reduce the number of undiagnosed patients and prevent late presentation in a high-prevalence area: a case-control study in primary care.
abstract: OBJECTIVE
  Recent guidelines advocate accelerated provider-initiated HIV testing by general practitioners (GPs). We aimed to identify the number of patient consultations in six general practices in the South-East of Amsterdam, and the incidence of HIV indicator conditions reported in their medical files prior to diagnosis.
  
  
  METHODS
  A cross-sectional search in an electronic general practice database. We used a case-control design to identify those conditions most associated with an HIV-positive status.
  
  
  RESULTS
  We included 102 HIV cases diagnosed from 2002 to 2012, and matched them with 299 controls. In the year prior to HIV diagnosis, 61.8% of cases visited their GP at least once, compared with 38.8% of controls. In the 5 years prior to HIV diagnosis, 58.8% of HIV cases had exhibited an HIV indicator condition, compared with 7.4% of controls. The most common HIV-related conditions were syphilis and gonorrhoea. The most common HIV-related symptoms were weight loss, lymphadenopathy and peripheral neuropathy. During this period, average HIV prevalence among people aged 15-59 years increased from 0.4% to 0.9%.
  
  
  CONCLUSIONS
  This study revealed many opportunities for HIV indicator condition-guided testing in primary care. As yet, however, HIV indicator conditions are not exploited as triggers for early HIV testing.
authors.affiliation: Department of General Practice, Division of Clinical Methods and Public Health, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Ivo K
authors.initials: IK
authors.lastname: Joore
authors.affiliation: Department of General Practice, Division of Clinical Methods and Public Health, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Derk L
authors.initials: DL
authors.lastname: Arts
authors.affiliation: Department of General Practice, Division of Clinical Methods and Public Health, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marjan J P
authors.initials: MJ
authors.lastname: Kruijer
authors.affiliation: Department of General Practice, Division of Clinical Methods and Public Health, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Eric P
authors.initials: EP
authors.lastname: Moll van Charante
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Geerlings
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Prins
authors.affiliation: Department of General Practice, Division of Clinical Methods and Public Health, Academic Medical Center, Amsterdam, The Netherlands STI AIDS Netherlands (Soa Aids Nederland), Amsterdam, The Netherlands Epidemiology & Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: Jan Eam
authors.initials: JE
authors.lastname: van Bergen
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D003661:Decision Support Techniques; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000458:organization & administration*; D008875:Middle Aged; D009426:Netherlands; D011320:Primary Health Care / Q000379:methods*; D055815:Young Adult
keywords: GENERAL PRACTICE; HIV; PREVENTION; PRIMARY CARE; PUBLIC HEALTH