title: The need to scale up HIV indicator condition-guided testing for early case-finding: a case-control study in primary care.
abstract: European guidelines recommend offering an HIV test to individuals who display HIV indicator conditions (ICs). We aimed to investigate the incidence of ICs in primary care reported in medical records prior to HIV diagnosis.
  
  
  
  We did a cross-sectional search in an electronic general practice database using a matched case-control design to identify which predefined ICs registered by Dutch GPs were most associated with an HIV-positive status prior to the time of diagnosis.
  
  
  
  We included 224 HIV cases diagnosed from 2009 to 2013, which were matched with 2,193 controls. Almost two thirds (n = 136, 60.7%) of cases were diagnosed with one or more ICs in the period up to five years prior to the index date compared to 18.7% (n = 411) of controls. Cases were more likely to have an IC than controls: in the one year prior to the index date, the odds ratio (OR) for at least one condition was 11.7 (95% CI: 8.3 to 16.4). No significant differences were seen in the strength of the association between HIV diagnosis and ICs when comparing genders, age groups or urbanisation levels. There is no indication that subgroups require a different testing strategy.
  
  
  
  Our study shows that there are opportunities for IC-guided testing in primary care. We recommend that IC-guided testing be more integrated in GPs' future guidelines and that education strategies be used to facilitate its implementation in daily practice.
authors.affiliation: Department of General Practice, Division Clinical Methods and Public Health, Academic Medical Center, Meibergdreef 9, 1100, DE, Amsterdam, The Netherlands. i.k.joore@amc.uva.nl.
authors.forename: Ivo K
authors.initials: IK
authors.lastname: Joore
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Epidemiology & Surveillance Unit, Centre for Infectious Disease Control, Bilthoven, The Netherlands.
authors.forename: Denise E
authors.initials: DE
authors.lastname: Twisk
authors.affiliation: Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Vanrolleghem
authors.affiliation: Department of Medical Informatics, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Maria
authors.initials: M
authors.lastname: de Ridder
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 General Practice, Division Clinical Methods and Public Health, Academic Medical Center, Meibergdreef 9, 1100, DE, Amsterdam, The Netherlands.|STI AIDS Netherlands (SOA AIDS Nederland), Amsterdam, The Netherlands.
authors.forename: Jan E A M
authors.initials: JE
authors.lastname: van Bergen
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Epidemiology & Surveillance Unit, Centre for Infectious Disease Control, Bilthoven, The Netherlands.
authors.forename: Ingrid V
authors.initials: IV
authors.lastname: van den Broek
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D057286:Electronic Health Records; D005260:Female; D058006:General Practice; D006069:Gonorrhea / Q000453:epidemiology; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008219:Lymphogranuloma Venereum / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011320:Primary Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015231:Sexually Transmitted Diseases, Bacterial / Q000453:epidemiology*; D013587:Syphilis / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Case-control studies; General practice; HIV infections/epidemiology; HIV infections/prevention & control; Primary healthcare