title: Auditing HIV Testing Rates across Europe: Results from the HIDES 2 Study.
abstract: European guidelines recommend the routine offer of an HIV test in patients with a number of AIDS-defining and non-AIDS conditions believed to share an association with HIV; so called indicator conditions (IC). Adherence with this guidance across Europe is not known. We audited HIV testing behaviour in patients accessing care for a number of ICs. Participating centres reviewed the case notes of either 100 patients or of all consecutive patients in one year, presenting for each of the following ICs: tuberculosis, non-Hodgkins lymphoma, anal and cervical cancer, hepatitis B and C and oesophageal candidiasis. Observed HIV-positive rates were applied by region and IC to estimate the number of HIV diagnoses potentially missed. Outcomes examined were: HIV test rate (% of total patients with IC), HIV test accepted (% of tests performed/% of tests offered) and new HIV diagnosis rate (%). There were 49 audits from 23 centres, representing 7037 patients. The median test rate across audits was 72% (IQR 32-97), lowest in Northern Europe (median 44%, IQR 22-68%) and highest in Eastern Europe (median 99%, IQR 86-100). Uptake of testing was close to 100% in all regions. The median HIV+ rate was 0.9% (IQR 0.0-4.9), with 29 audits (60.4%) having an HIV+ rate >0.1%. After adjustment, there were no differences between regions of Europe in the proportion with >0.1% testing positive (global p = 0.14). A total of 113 patients tested HIV+. Applying the observed rates of testing HIV+ within individual ICs and regions to all persons presenting with an IC suggested that 105 diagnoses were potentially missed. Testing rates in well-established HIV ICs remained low across Europe, despite high prevalence rates, reflecting missed opportunities for earlier HIV diagnosis and care. Significant numbers may have had an opportunity for HIV diagnosis if all persons included in IC audits had been tested.
authors.affiliation: CHIP, Rigshospitalet, Copenhagen, Denmark.
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authors.initials: D
authors.lastname: Raben
authors.affiliation: University College London, London, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Mocroft
authors.affiliation: Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom.
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authors.lastname: Rayment
authors.affiliation: Gomel State Medical University, Gomel, Belarus.
authors.forename: V M
authors.initials: VM
authors.lastname: Mitsura
authors.affiliation: Clinical Center University of Sarajevo, Infectious Diseases Clinic, Sarajevo, Bosnia.
authors.forename: V
authors.initials: V
authors.lastname: Hadziosmanovic
authors.affiliation: Ben Ari Institute of Clinical Immunology, Rehovot, Israel.
authors.forename: Z M
authors.initials: ZM
authors.lastname: Sthoeger
authors.affiliation: University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
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authors.initials: A
authors.lastname: Palfreeman
authors.affiliation: Western General Hospital, Edinburgh, United Kingdom.
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authors.initials: S
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authors.affiliation: Luhansk AIDS Center, Luhansk, Ukraine.
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authors.lastname: Kutsyna
authors.affiliation: Belarusian State Medical University, Minsk, Belarus.
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authors.initials: A
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authors.affiliation: St James's University Hospital, Leeds, United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: Minton
authors.affiliation: Saint-Pierre University Hospital, Brussels, Belgium.
authors.forename: C
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authors.lastname: Necsoi
authors.affiliation: Hospital Universitario San Carlos, Madrid, Spain.
authors.forename: V P
authors.initials: VP
authors.lastname: Estrada
authors.affiliation: Medical University of Bialystok, Department of Infectious Diseases and Hepatology, Bialystok, Poland.
authors.forename: A
authors.initials: A
authors.lastname: Grzeszczuk
authors.affiliation: Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: V Svedhem
authors.initials: VS
authors.lastname: Johansson
authors.affiliation: University Hospital of Infectious Diseases, Zagreb, Croatia.
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authors.lastname: Begovac
authors.affiliation: The Newcastle upon Tyne Hospital, Newcastle, United Kingdom.
authors.forename: E L C
authors.initials: EL
authors.lastname: Ong
authors.affiliation: Centre Hospitalier Universitaire de Fort de France, Fort de France, Martinique.
authors.forename: A
authors.initials: A
authors.lastname: Cabié
authors.affiliation: Centre Hospitalier de Tourcoing, Tourcoing, France.
authors.forename: F
authors.initials: F
authors.lastname: Ajana
authors.affiliation: Unit of Infectious Diseases University of Catania, ARNAS Garibaldi, Catania, Italy.
authors.forename: B M
authors.initials: BM
authors.lastname: Celesia
authors.affiliation: Hospital Curry Cabral, Lisbon, Portugal.
authors.forename: F
authors.initials: F
authors.lastname: Maltez
authors.affiliation: Medical University of Innsbruck Innsbruck, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Kitchen
authors.affiliation: Unit of Infectious Diseases, San Paolo Hospital, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Comi
authors.affiliation: Roskilde Hospital, Roskilde, Denmark.
authors.forename: U B
authors.initials: UB
authors.lastname: Dragsted
authors.affiliation: Saint-Pierre University Hospital, Brussels, Belgium.
authors.forename: N
authors.initials: N
authors.lastname: Clumeck
authors.affiliation: Hospital Clinic de Barcelona, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Gatell
authors.affiliation: Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: B
authors.initials: B
authors.lastname: Gazzard
authors.affiliation: Unit of Infectious Diseases, San Paolo Hospital, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: d'Arminio Monforte
authors.affiliation: University of Bonn, Bonn, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Rockstroh
authors.affiliation: IAME, UMR 1137, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.|IAME, UMR 1137, INSERM, Paris, France.|AP-HP, Hôpital Bichat, Service de Biostatistique, Paris, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Yazdanpanah
authors.affiliation: IAME, UMR 1137, INSERM, Paris, France.
authors.forename: K
authors.initials: K
authors.lastname: Champenois
authors.affiliation: CHIP, Rigshospitalet, Copenhagen, Denmark.
authors.forename: M L
authors.initials: ML
authors.lastname: Jakobsen
authors.affiliation: Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Sullivan
authors.affiliation: CHIP, Rigshospitalet, Copenhagen, Denmark.
authors.forename: J D
authors.initials: JD
authors.lastname: Lundgren
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D005060:Europe / Q000453:epidemiology; D017408:Guidelines as Topic; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D012189:Retrospective Studies