Dorthe Raben [7], Anne L Grevsen [1], Joanne Reekie [2], Lars Peters [3], Marie L Jakobsen [4], Anne Raahauge [5], Ann Sullivan [6]

Affiliates

CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Denmark [1,2,3,4,5,7], Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom [6]

Abstract

Background
Late diagnosis continues to be a challenge for the management of HIV in Europe. About half (51%) of those diagnosed with HIV in 2016 in the European Region were diagnosed at a late stage of infection. In Denmark 45,7% of new HIV diagnoses in 2016 were late presenters with CD4 cell counts below 350 cells per mm3, including 25,9% with advanced HIV infection (CD4 <200 cells/mm3). (1)
National recommendations on HIV testing indicate that individuals in special risk of HIV infection should regularly and actively be offered a HIV test when in contact with the Danish Health System and recommend routine testing when people present with indicator conditions. (2) The objective of this review was to examine to which extent national guidelines and non-HIV specialty guidelines also recommend HIV testing in 14 indicator conditions.
Method
The method used in this review builds on work in the OptTEST project (3,4). An online literature search for relevant national and specialty guidelines for 14 indicator conditions were conducted through websites of the Danish health authorities and relevant medical societies.
All identified guidelines were reviewed and classified into 3 categories 1) HIV was not mentioned, 2) The
association with HIV was mentioned but testing was not recommended and 3) HIV was mentioned and testing was recommended.
The association between recommendation to test for HIV and categorical variables (source of guideline and type of condition) and with year of publication were tested using Fischers’ exact test and Mantel-Haenszel linear-by-linear chi square tests respectively.
Results
A total of 77 relevant guidelines were identified; 47 national guidelines, 24 specialty society guidelines and 6 guidelines from pharmaceutical industry. Guidelines were identified for all indicator conditions.
The association with HIV was discussed in 53 guidelines (69%) and HIV testing was recommended in 30 (39%). A higher proportion of guidelines concerning malignant lymphoma and hepatitis C recommended HIV testing. National guidelines were less likely to recommend HIV testing than specialist society guidelines (67% vs 30%, p = 0,03). No association was observed between year of publication and recommendation to test (p =0,578). (See table 1.)
Conclusion
Analyses show that National health authorities were significantly less likely to recommend HIV testing for the 14 indicator conditions compared with specialist society guidelines.
Indicator condition guided testing is an important part of promoting earlier diagnosis of HIV, and thereby reducing health care cost due to reduced morbidity and mortality and reduced onward transmission. By including HIV test recommendations in national guidelines for indicator conditions a wider range of medical disciplines can be reached.

1 HIV/AIDS surveillance in Europe 2017, 2016 data. ECDC & WHO Regional Office for Europe, 2017.
2 Anbefalinger om forebyggelse, diagnose og behandling af seksuelt overførbare infektioner. Danish Health Board, 2015.
3 Evaluation of HIV testing recommendations in specialty guidelines for the management of HIV indicator conditions. Lord E, Stockdale AJ, Maleck R et al. HIV Medicine2016.
4 OptTEST (http://www.opttest.eu/)