Improving indicator-condition guided testing for HIV in the hospital setting (PROTEST 2·0): A multicenter, interrupted time-series analysis

Saskia J Bogers; Maarten F Schim van der Loeff; Anders Boyd; Udi Davidovich; Marc van der Valk; Kees Brinkman; Kim Sigaloff; Judith Branger; Nejma Bokhizzou; Godelieve J de Bree; Peter Reiss; Jan E A M van Bergen; Suzanne E Geerlings; HIV Transmission Elimination AMsterdam (H-TEAM) Initiative

doi:10.1016/j.lanepe.2022.100515

Improving indicator-condition guided testing for HIV in the hospital setting (PROTEST 2·0): A multicenter, interrupted time-series analysis

Lancet Reg Health Eur. 2022 Oct 7:23:100515. doi: 10.1016/j.lanepe.2022.100515. eCollection 2022 Dec.

Authors

Saskia J Bogers^{1

2

3}, Maarten F Schim van der Loeff^{1

2

4}, Anders Boyd^{2

4

5}, Udi Davidovich⁴, Marc van der Valk^{1

2

5}, Kees Brinkman⁶, Kim Sigaloff^{2

7}, Judith Branger⁸, Nejma Bokhizzou⁹, Godelieve J de Bree¹, Peter Reiss^{1

10

11}, Jan E A M van Bergen^{12

13}, Suzanne E Geerlings^{1

2

3}; HIV Transmission Elimination AMsterdam (H-TEAM) Initiative

Collaborators

HIV Transmission Elimination AMsterdam (H-TEAM) Initiative:
T van Benthem, D Bons, G J de Bree, P Brokx, U Davidovich, F Deug, S E Geerlings, M Heidenrijk, E Hoornenborg, M Prins, P Reiss, A van Sighem, M van der Valk, J de Wit, W Zuilhof, N Schat, D Smith, M van Agtmael, J Ananworanich, D van de Beek, G E L van den Berk, D Bezemer, A van Bijnen, J P Bil, W L Blok, S J Bogers, M Bomers, A Boyd, W Brokking, D Burger, K Brinkman, N Brinkman, M de Bruin, S Bruisten, L Coyer, R van Crevel, M Dijkstra, Y T van Duijnhoven, A van Eeden, L Elsenburg, M A M van den Elshout, E Ersan, P E V Felipa, T B H Geijtenbeek, J van Gool, A Goorhuis, M Groot, C A Hankins, A Heijnen, M M J Hillebregt, M Hommenga, J W Hovius, Y Janssen, K de Jong, V Jongen, N A Kootstra, R A Koup, F P Kroon, T J W van de Laar, F Lauw, M M van Leeuwen, K Lettinga, I Linde, D S E Loomans, I M van der Lubben, J T van der Meer, T Mouhebati, B J Mulder, J Mulder, F J Nellen, A Nijsters, H Nobel, E L M Op de Coul, E Peters, I S Peters, T van der Poll, O Ratmann, C Rokx, M F Schim van der Loeff, W E M Schouten, J Schouten, J Veenstra, A Verbon, F Verdult, J de Vocht, H J de Vries, S Vrouenraets, M van Vugt, W J Wiersinga, F W Wit, L R Woittiez, S Zaheri, P Zantkuijl, A Żakowicz, M C van Zelm, H M L Zimmermann

Affiliations

¹ Amsterdam UMC location University of Amsterdam, Internal Medicine, Meibergdreef 9, Amsterdam, the Netherlands.
² Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands.
³ Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
⁴ Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands.
⁵ Stichting hiv monitoring, Amsterdam, the Netherlands.
⁶ Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
⁷ Amsterdam UMC location Vrije Universiteit Amsterdam, Internal Medicine, De Boelelaan 1117, Amsterdam, the Netherlands.
⁸ Department of Internal Medicine, Flevoziekenhuis, Almere, the Netherlands.
⁹ Department of Internal Medicine, BovenIJ ziekenhuis, Amsterdam, the Netherlands.
¹⁰ Amsterdam institute for Global Health and Development, Amsterdam, the Netherlands.
¹¹ Amsterdam UMC location University of Amsterdam, Global Health, Meibergdreef 9, Amsterdam, the Netherlands.
¹² Amsterdam UMC location University of Amsterdam, General Practice, Meibergdreef 9, Amsterdam, the Netherlands.
¹³ STI AIDS Netherlands, Amsterdam, the Netherlands.

Abstract

Background: Indicator-condition (IC) guided HIV testing is a feasible and cost-effective strategy to identify undiagnosed people living with HIV (PLHIV), but remains insufficiently implemented. We aimed to promote IC-guided HIV testing in seven ICs.

Methods: Relevant departments in five hospitals of the Amsterdam region participated. HIV testing among adult patients without known HIV infection but with an IC was assessed using electronic health records during pre-intervention (January 2015-June 2020) and intervention (July 2020-June 2021) periods. The multifaceted intervention included audit and feedback. The primary endpoint was HIV testing ≤3 months before or after IC diagnosis and the effect of the intervention was evaluated using segmented Poisson regression.

Findings: Data from 7986 patients were included, of whom 6730 (84·3%) were diagnosed with an IC in the pre-intervention period and 1256 (15·7%) in the intervention period. The proportion HIV tested ≤3 months before or after IC diagnosis increased from 36.8% to 47.0% (adjusted risk ratio [RR]= 1.16, 95% CI=1.03-1.30, p=0.02). For individual ICs, we observed significant increases in HIV testing among patients with cervical cancer or intraepithelial neoplasia grade 3 (adjusted RR=3.62, 95% CI=1.93-6.79) and peripheral neuropathy (adjusted RR=2.27 95% CI=1.48-3.49), but not the other ICs. Eighteen of 3068 tested patients were HIV positive (0.6%).

Interpretation: Overall IC-guided testing improved after the intervention, but not for all ICs. Variations in effect by IC may have been due to variations in implemented developments, but the effect of separate elements could not be assessed.

Funding: HIV Transmission Elimination Amsterdam (H-TEAM) initiative, Aidsfonds (grant number: P-42702).

Keywords: Cervical carcinoma; Cervical dysplasia; Diagnostics; HIV; HIV testing; Hepatitis B; Hepatitis C; Indicator condition; Intervention; Lymphoma; Medical education; Neuropathy; Tuberculosis; Vulvar carcinoma; Vulvar dysplasia.