title: Low HIV testing uptake following diagnosis of a sexually transmitted infection in Spain: implications for the implementation of efficient strategies to reduce the undiagnosed HIV epidemic.
abstract: Sexually transmitted infections (STIs) are recognized as one of the conditions in which HIV testing is most clearly indicated. We analyse whether people diagnosed with an STI are being tested for HIV according to the experience of participants in an outreach rapid testing programme in Spain. Between 2008 and 2010, 6293 individuals underwent rapid testing and completed a self-administered questionnaire. We calculated the percentage of individuals that were diagnosed with an STI in the last 5 years and identified the setting where the last episode occurred. We then determined the percentage not receiving an HIV test after the last STI diagnosis and estimated the associated factors. Overall, 17.3% (N = 959) of participants reported an STI diagnosis in the last 5 years, of which 81.5% occurred in general medical settings. Sixty-one percent reported not undergoing HIV testing after their last STI diagnosis, 2.2% of whom reported they had refused the test. Not receiving an HIV test after the last STI diagnosis was independently associated with not being a man who has sex with men (MSM), having had fewer sexual partners, being diagnosed in general medical settings and having received a diagnosis other than syphilis. An unacceptably large percentage of people diagnosed with STI are not being tested for HIV because healthcare providers frequently fail to offer the test. Offering routine HIV testing at general medical settings, regardless of the type of STI diagnosed and population group, should be a high priority and is probably a more efficient strategy than universal screening in general healthcare settings.
authors.affiliation: a CIBER of Epidemiology and Public Health , Madrid , Spain.
authors.forename: Sonia
authors.initials: S
authors.lastname: Fernández-Balbuena
authors.affiliation: a CIBER of Epidemiology and Public Health , Madrid , Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Hoyos
authors.affiliation: a CIBER of Epidemiology and Public Health , Madrid , Spain.|b National Centre of Epidemiology , Carlos III Health Institute , Madrid , Spain.
authors.forename: María Elena
authors.initials: ME
authors.lastname: Rosales-Statkus
authors.affiliation: c HIV/STI Department , Public Health England , London , UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Nardone
authors.affiliation: a CIBER of Epidemiology and Public Health , Madrid , Spain.|b National Centre of Epidemiology , Carlos III Health Institute , Madrid , Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Vallejo
authors.affiliation: a CIBER of Epidemiology and Public Health , Madrid , Spain.|b National Centre of Epidemiology , Carlos III Health Institute , Madrid , Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Ruiz
authors.affiliation: d Preventive Medicine Service , University Hospital of Móstoles , Madrid , Spain.
authors.forename: Romina
authors.initials: R
authors.lastname: Sánchez
authors.affiliation: a CIBER of Epidemiology and Public Health , Madrid , Spain.|e National School of Health, Carlos III Health Institute , Madrid , Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: Belza
authors.affiliation: f European Centre for Drugs and Drug Addiction , Lisbon , Portugal.
authors.forename: Blanca Iciar
authors.initials: BI
authors.lastname: Indave
authors.affiliation: g Madrid Positivo Association , Madrid , Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Gutiérrez
authors.affiliation: g Madrid Positivo Association , Madrid , Spain.
authors.forename: Jorge
authors.initials: J
authors.lastname: Álvarez
authors.affiliation: a CIBER of Epidemiology and Public Health , Madrid , Spain.|b National Centre of Epidemiology , Carlos III Health Institute , Madrid , Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Sordo
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D003695:Delivery of Health Care; D058872:Epidemics; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D015438:Health Behavior; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013587:Syphilis / Q000453:epidemiology; D055815:Young Adult
keywords: HIV diagnosis; clinical settings; missed opportunities; testing rates; timely diagnosis; undiagnosed HIV epidemic