title: Missed opportunities to offer HIV tests to high-risk groups during general practitioners' STI-related consultations: an observational study.
abstract: OBJECTIVE
  Prior research has shown that Dutch general practitioners (GPs) do not always offer HIV testing and the number of undiagnosed HIV patients remains high. We aimed to further investigate the frequency and reasons for (not) testing for HIV and the contribution of GPs to the diagnosis of HIV infections in the Netherlands.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  (1) Dutch primary care network of 42-45 sentinel practices where report forms during sexually transmitted infection (STI)-related consultations were routinely collected, 2008-2013. (2) Dutch observational cohort with medical data of HIV-positive patients in HIV care, 2008-2013.
  
  
  METHODS
  The proportion of STI-related consultations in patients from high-risk groups tested for HIV, with additional information requested from GPs on HIV testing preconsultation or postconsultation for whom HIV testing was indicated, but not performed. Next, information was collected on the profile of HIV-positive patients entering specialised HIV care following diagnosis by GPs.
  
  
  RESULTS
  Initially, an HIV test was reported (360/907) in 40% of STI-related consultations in high-risk groups. Additionally, in 26% of consultations an HIV test had been performed in previous or follow-up consultations or at different STI-care facilities. The main reasons for not testing were perceived insignificant risk; 'too' recent risk according to GPs or the reluctance of patients. The initiative of the patient was a strong determinant for HIV testing. GPs diagnosed about one third of all newly found cases of HIV. Compared with STI clinics, HIV-positive patients diagnosed in general practice were more likely to be older, female, heterosexual male or sub-Saharan African.
  
  
  CONCLUSIONS
  In one-third of the STI-related consultations of persons from high-risk groups, no HIV test was performed in primary care, which is lower than previously reported. Risk-based testing has intrinsic limitations and implementation of new additional strategies in primary care is warranted.
authors.affiliation: Department of General Practice, Division Clinical Methods and Public Health, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: I K
authors.initials: IK
authors.lastname: Joore
authors.affiliation: Epidemiology & Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: D F M
authors.initials: DF
authors.lastname: Reukers
authors.affiliation: Department of Sentinel Practices, NIVEL Primary Care Database, Utrecht, The Netherlands.
authors.forename: G A
authors.initials: GA
authors.lastname: Donker
authors.affiliation: Stichting HIV Monitoring, Amsterdam, The Netherlands On behalf of the ATHENA National Observational HIV Cohort, Amsterdam, The Netherlands.
authors.forename: A I
authors.initials: AI
authors.lastname: van Sighem
authors.affiliation: Epidemiology & Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: E L M
authors.initials: EL
authors.lastname: Op de Coul
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Prins
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: S E
authors.initials: SE
authors.lastname: Geerlings
authors.affiliation: On behalf of the ATHENA National Observational HIV Cohort, Amsterdam, The Netherlands University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: R E
authors.initials: RE
authors.lastname: Barth
authors.affiliation: Department of General Practice, Division Clinical Methods and Public Health, Academic Medical Center, Amsterdam, The Netherlands Epidemiology & Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands STI AIDS Netherlands (Soa Aids Nederland), Amsterdam, The Netherlands.
authors.forename: J E A M
authors.initials: JE
authors.lastname: van Bergen
authors.affiliation: Epidemiology & Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: I V
authors.initials: IV
authors.lastname: van den Broek
mesh_terms: D005260:Female; D058005:General Practitioners; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008499:Medical Records / Q000592:standards; D009426:Netherlands; D010819:Physician's Role; D012017:Referral and Consultation; D012309:Risk-Taking; D011795:Surveys and Questionnaires; D047568:Unsafe Sex
keywords: INFECTIOUS DISEASES; PUBLIC HEALTH