Implementing HIV teams to improve HIV indicator condition-guided testing in general practitioner centers in the Netherlands

Background HIV indicator condition-guided testing is recommended by guidelines to identify undiagnosed HIV infections. However, general practitioners (GPs) frequently see patients for indicator conditions without testing them for HIV. The aim of this study was to evaluate whether implementing HIV te...

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Published in:BMC family practice Vol. 25; no. 1; pp. 440 - 8
Main Authors: Jordans, Carlijn C. E., Niemantsverdriet – Rokx, Lotte, Struik, Jan L., van der Waal, Eva C., van der Voorn, Paul V. J. M., Bakker, Nienke, Verbon, Annelies, Bindels, Patrick J. E., Rokx, Casper
Format: Journal Article
Language:English
Published: London BioMed Central 27.12.2024
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
Acquired immune deficiency syndrome
Adult
AIDS
Diplomatic & consular services
Disease transmission
Family Medicine
Feedback
Female
General Practice
General practitioner
General Practitioners
Health care teams
HIV
HIV Infections - diagnosis
HIV Infections - epidemiology
HIV testing
HIV Testing - methods
Human immunodeficiency virus
Humans
Immune system
Indicator condition
Infections
Male
Management
Mass Screening - methods
Medical tests
Medicine
Medicine & Public Health
Middle Aged
Mononucleosis
Netherlands - epidemiology
Patients
Physicians (General practice)
Point-of-Care Testing
Primary care
Primary Care Medicine
Prospective Studies
Questionnaires
Services
Sexually transmitted diseases
STD
Teams
Young Adult
Netherlands
HIV
General practitioner
Family care
Indicator condition
HIV testing
AIDS
Primary care
ISSN:2731-4553, 2731-4553, 1471-2296
Online Access:Get full text
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Summary:Background HIV indicator condition-guided testing is recommended by guidelines to identify undiagnosed HIV infections. However, general practitioners (GPs) frequently see patients for indicator conditions without testing them for HIV. The aim of this study was to evaluate whether implementing HIV teams, using trained GP ambassadors, promoted local HIV indicator condition-guided testing practices in urban GP centers in the Netherlands. Methods We conducted a prospective implementation study between May 2021 and March 2023. Patients ≥ 18 years newly diagnosed with HIV indicator conditions in three GP centers were included. The intervention consisted of HIV expert led education for GPs with a stepwise implementation of point-of-care testing (phase 1), followed by adding peer-to-peer case feedback by trained GP ambassadors (phase 2). Questionnaires were used to assess the experiences and beliefs of HIV indicator condition-driven testing in patients and GPs. The primary outcome was the overall HIV testing rate in patients diagnosed with indicator conditions compared to pre-implementation. Secondary outcomes were HIV testing rate per phase and per indicator condition, HIV positivity rate, and patients’ and GPs’ experiences with this testing strategy. Results In 132,338 patient visits, 846 (0.6%, 95%CI 0.6–0.7%) HIV indicator conditions were diagnosed, including 485 sexually transmitted infections (57.3%). Overall, 215 (25.4%) indicator conditions were tested for HIV after the implementation of HIV teams. The testing rate was comparable between the two phases (25.2% versus 25.9%, p  = 0.83). The testing rates pre- and post-implementation were comparable (21.3% versus 25.4%, p  = 0.33). The most frequently tested HIV indicator conditions were unexplained weight loss ( n  = 13, 41.9%), unexplained lymphadenopathy ( n  = 8, 38.1%), and sexually transmitted infections ( n  = 161, 33.2%). Three patients (1.4%, 95%CI 0.3–4.0%) tested positive for HIV. Test acceptance in patients was high as was the self-perceived knowledge of GPs on HIV indicator conditions. Conclusions Implementing HIV teams did not enhance HIV indicator condition-guided testing in urban GP centers from a low HIV prevalence setting. The high patients acceptance rate and self-perceived knowledge among GPs regarding HIV indicator conditions did not manifest in high HIV testing rates. Patients accepted testing, but a gap was found between the self-perceived knowledge of GPs regarding HIV indicator conditions and testing, and the actual HIV testing rate. Trial registration ClinicalTrials.gov NCT05225493 (registration date: 17-01-2022).
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ISSN:2731-4553
2731-4553
1471-2296
DOI:10.1186/s12875-024-02666-0