FC30-01 - Severe mental illness is an HIV indicator disease

2011 ◽  
Vol 26 (S2) ◽  
pp. 1983-1983
Author(s):  
M. Ferrara ◽  
G. Solignani ◽  
S. Ferrari ◽  
M. Rigatelli ◽  
G. Guaraldi
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Hiv Testing ◽  
Psychiatric Symptoms ◽  
Case Histories ◽  
Hiv Diagnosis ◽  
Hiv Test ◽  
Mental Health Settings ◽  
Undiagnosed Hiv ◽  
Routine Hiv Testing

IntroductionHIV testing is not yet a routine procedure in most mental health settings although adults with severe mental illness (SMI) are disproportionately affected by HIV/AIDS.ObjectivesWe focused our attention to explore if the appropriate care of patients with SMI may include a routine HIV testing offering and thus contribute to diagnose HIV-infected persons earlier in the course of their infection.MethodsWe present three case histories related to primary HIV diagnosis in patients presenting with different psychiatric disorders, admitted to Modena teaching Hospital in the passed two years.ResultsPsychiatric symptoms delayed HIV diagnosis in all of the three reported cases.ConclusionsThe case histories here presented suggest that HIV testing is appropriate in the care of people with SMI, avoiding delay in HIV diagnosis with an obvious clinical benefit for the patient. Further studies are needed to assess the prevalence of HIV in those patients. These will be able to validate psychiatric diseases within a specific HIV indicator diseases list and help identifying a segment of the population in which HIV test must be routinely offered as a public health strategy, to face the burden of undiagnosed HIV infection.

scholarly journals Promoting HIV indicator condition-guided testing in hospital settings (PROTEST 2.0): study protocol for a multicentre interventional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Saskia J. Bogers ◽  
Maarten F. Schim van der Loeff ◽  
Udi Davidovich ◽  
Anders Boyd ◽  
Marc van der Valk ◽  
...  
Keyword(s):  
The Netherlands ◽  
Hiv Testing ◽  
Quantitative Methods ◽  
Hospital Setting ◽  
Audit And Feedback ◽  
Interventional Study ◽  
Hiv Diagnosis ◽  
Post Intervention ◽  
Hiv Test ◽  
Undiagnosed Hiv

Abstract Background Late presentation remains a key barrier towards controlling the HIV epidemic. Indicator conditions (ICs) are those that are AIDS-defining, associated with a prevalence of undiagnosed HIV > 0.1%, or whose clinical management would be impeded if an HIV infection were undiagnosed. IC-guided HIV testing is an effective strategy in identifying undiagnosed HIV, but opportunities for earlier HIV diagnosis through IC-guided testing are being missed. We present a protocol for an interventional study to improve awareness of IC-guided testing and increase HIV testing in patients presenting with ICs in a hospital setting. Methods We designed a multicentre interventional study to be implemented at five hospitals in the region of Amsterdam, the Netherlands. Seven ICs were selected for which HIV test ratios (proportion of patients with an IC tested for HIV) will be measured: tuberculosis, cervical/vulvar cancer or high-grade cervical/vulvar dysplasia, malignant lymphoma, hepatitis B and C, and peripheral neuropathy. Prior to the intervention, a baseline assessment of HIV test ratios across ICs will be performed in eligible patients (IC diagnosed January 2015 through May 2020, ≥18 years, not known HIV positive) and an assessment of barriers and facilitators for HIV testing amongst relevant specialties will be conducted using qualitative (interviews) and quantitative methods (questionnaires). The intervention phase will consist of an educational intervention, including presentation of baseline results as competitive graphical audit and feedback combined with discussion on implementation and opportunities for improvement. The effect of the intervention will be assessed by comparing HIV test ratios of the pre-intervention and post-intervention periods. The primary endpoint is the HIV test ratio within ±3 months of IC diagnosis. Secondary endpoints are the HIV test ratio within ±6 months of diagnosis, ratio ever tested for HIV, HIV positivity percentage, proportion of late presenters and proportion with known HIV status prior to initiating treatment for their IC. Discussion This protocol presents a strategy aimed at increasing awareness of the benefits of IC-guided testing and increasing HIV testing in patients presenting with ICs in hospital settings to identify undiagnosed HIV in Amsterdam, the Netherlands. Trial registration Dutch trial registry: NL7521. Registered 14 February 2019.

scholarly journals HIV testing among individuals with a severe mental illness: review, suggestions for research, and clinical implications

2008 ◽  
Vol 39 (3) ◽  
pp. 355-363 ◽  
Author(s):  
T. E. Senn ◽  
M. P. Carey
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Hiv Testing ◽  
Clinical Implications ◽  
Ethical Challenges ◽  
The Past ◽  
Drug Risk ◽  
Literature Searches ◽  
Immunodeficiency Virus ◽  
Mental Health Settings

BackgroundThe prevalence of human immunodeficiency virus (HIV) is elevated among individuals with a severe mental illness (SMI). Because of the benefits of HIV testing, it is important for individuals with SMI to have routine access to testing. The goals of this review are: to summarize knowledge about HIV testing prevalence, correlates, and interventions among individuals with an SMI; to identify research needs; and to discuss clinical implications of the studies reviewed.MethodLiterature searches were conducted using PsycINFO, PubMed, and Medline. Additional articles were obtained from reference lists of relevant articles.ResultsFewer than one-half of individuals with an SMI have been tested for HIV in the past year. Engaging in sex or drug risk behavior was the only consistent correlate of HIV testing. Interventions for promoting HIV testing among individuals with an SMI have not been well developed or evaluated.ConclusionsResearch on HIV testing among individuals with an SMI is needed. Mental health settings may be opportune venues for HIV testing, even though providers face ethical challenges when implementing testing programs in these settings.

scholarly journals HIV – lessons from a late diagnosis

2016 ◽  
Vol 15 (2) ◽  
pp. 84-87
Author(s):  
Xin Hui S. Chan ◽  
◽  
Barbara L. Onen ◽  
Mansoor M. Raza ◽  
Dushyant Mital ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Hiv Diagnosis ◽  
Septic Complications ◽  
Routine Testing ◽  
Late Hiv Diagnosis ◽  
Hiv Test ◽  
High Prevalence ◽  
Wide Experience ◽  
Routine Hiv Testing ◽  
The Uk

Late HIV diagnosis is the most important predictor of HIV-related morbidity and mortality in the UK and often results from missed testing opportunities during earlier contact with health services. The HPA now recommends routine HIV testing be commissioned as a priority for all general medical admissions in high prevalence areas, such as Milton Keynes. We present the case of a patient admitted to our Medical Admissions Unit (MAU) managed initially for presumed septic complications of metastatic disease who was later found to have terminal HIV disease. In keeping with UK-wide experience which we review, a local audit following this case found MAU HIV test coverage increased after routine testing but not after staff education alone, and resulted in implementation of routine HIV testing in our MAU.

scholarly journals Evaluation of the Utility of Point-of-Care HIV Testing on a Canadian Internal Medicine Inpatient Unit

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
Lawrence Lau ◽  
Beverly Wudel ◽  
Eugene Lee ◽  
Majid Darraj ◽  
Quinlan Richert ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Point Of Care ◽  
Tertiary Hospital ◽  
Cross Sectional Study ◽  
Inpatient Unit ◽  
Cross Sectional ◽  
Hiv Test ◽  
Undiagnosed Hiv ◽  
Acceptable Method ◽  
Routine Hiv Testing

Point-of-care (POC) HIV testing has been shown to be an acceptable method for increasing HIV testing uptake. To date, no studies have examined the use of POC testing for routine HIV screening on the medicine inpatient unit. A prospective cross-sectional study was conducted over a three-month period in July, August, and October 2016 to evaluate the prevalence of undiagnosed HIV and the attitudes towards routine POC HIV testing. Patients admitted directly to medicine inpatient teaching units at a tertiary hospital in Winnipeg, Canada, were approached for participation. The POC HIV test was administered at the bedside. Reactive and indeterminate tests were confirmed with standard serological HIV testing. Participants were given a questionnaire regarding their attitudes towards POC testing on the unit. Although no cases of previously undiagnosed HIV were identified during the study period, only 35% of participants were found to have ever had HIV testing previously. The majority of participants were satisfied with the POC testing experience and would choose to have the POC testing again. Overall, the low rate of outpatient testing highlights the need for routine HIV testing on an inpatient basis.

scholarly journals Low Rates of HIV Testing Among Adults With Severe Mental Illness Receiving Care in Community Mental Health Settings

2017 ◽  
Vol 68 (5) ◽  
pp. 443-448 ◽  
Author(s):  
Christina Mangurian ◽  
Francine Cournos ◽  
Dean Schillinger ◽  
Eric Vittinghoff ◽  
Jennifer M. Creasman ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Community Mental Health ◽  
Severe Mental Illness ◽  
Hiv Testing ◽  
Mental Health Settings ◽  
Community Mental Health Settings

Audit on routine HIV testing in patients attending genitourinary medicine clinics

2005 ◽  
Vol 16 (12) ◽  
pp. 825-826 ◽  
Author(s):  
V Lee ◽  
J M Tobin
Keyword(s):  
Sexual Health ◽  
Hiv Testing ◽  
Antibody Test ◽  
Hiv Infections ◽  
Clinic Visit ◽  
Medicine Clinic ◽  
Health Strategy ◽  
Hiv Test ◽  
Undiagnosed Hiv ◽  
Routine Hiv Testing

The Sexual Health Strategy was published in 2001. One of the recommendations was that all patients attending genitourinary (GU) medicine clinics for a sexual health screen should be offered an HIV test. This audit was undertaken in the GU medicine clinic at Portsmouth, offering a routine HIV antibody test to patients attending the clinic. This audit shows that patients will accept HIV testing when offered, during a routine GU medicine clinic visit. This initiative is important especially in areas with high HIV prevalence to identify undiagnosed HIV infections. Early diagnosis and intervention are important to reduce the morbidity and mortality of HIV infection.

scholarly journals 1120. Impact of Training Residents to Improve HIV Screening in a Teaching Hospital in Mexico City

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S590-S590
Author(s):  
Lorena Guerrero-Torres ◽  
Isaac Núñez-Saavedra ◽  
Yanink Caro-Vega ◽  
Brenda Crabtree-Ramírez
Keyword(s):  
Emergency Department ◽  
Time Series ◽  
Hiv Testing ◽  
Teaching Hospital ◽  
Educational Intervention ◽  
Temporal Trends ◽  
Hiv Screening ◽  
Hiv Diagnosis ◽  
Post Intervention ◽  
Hiv Test

Abstract Background Among 230,000 people living with HIV in Mexico, 24% are unaware of their diagnosis, and half of newly diagnosed individuals are diagnosed with advanced disease. Early diagnosis is the goal to mitigate HIV epidemic. Missed opportunities may reflect a lack of clinicians’ consideration of HIV screening as part of routine medical care. We assessed whether an educational intervention on residents was effective to 1) improve the knowledge on HIV screening; 2) increase the rate of HIV tests requested in the hospitalization floor (HF) and the emergency department (ED); and 3) increase HIV diagnosis in HF and ED. Methods Internal Medicine and Surgery residents at a teaching hospital were invited to participate. The intervention occurred in August 2018 and consisted in 2 sessions on HIV screening with an expert. A questionnaire was applied before (BQ) and after (AQ) the intervention, which included HIV screening indications and clinical cases. The Institutional Review Board approved this study. Written informed consent was obtained from all participants. BQ and AQ scores were compared with a paired t-test. To evaluate the effect on HIV test rate in the HF and ED, an interrupted time series analysis was performed. Daily rates of tests were obtained from September 2016 to August 2019 and plotted along time. Restricted cubic splines (RCS) were used to model temporal trends. HIV diagnosis in HF and ED pre- and post-intervention were compared with a Fisher’s exact test. A p< 0.05 was considered significant. Results Among 104 residents, 57 participated and completed both questionnaires. BQ score was 79/100 (SD±12) and AQ was 85/100 (SD±8), p< .004. Time series of HIV testing had apparent temporal trends (Fig 1). HIV test rate in the HF increased (7.3 vs 11.1 per 100 episodes) and decreased in the ED (2.6 vs 2.3 per 100 episodes). HIV diagnosis increased in the HF, from 0/1079 (0%) pre-intervention to 5/894 (0.6%) post-intervention (p< .018) (Table 1). Fig 1. HIV test rates. Gray area represents post-intervention period. Table 1. Description of episodes, HIV tests and rates pre- and post-intervention in the Emergency Department and Hospitalization Floor. Conclusion A feasible educational intervention improved residents’ knowledge on HIV screening, achieved maintenance of a constant rate of HIV testing in the HF and increased the number of HIV diagnosis in the HF. However, these results were not observed in the ED, where administrative barriers and work overload could hinder HIV screening. Disclosures All Authors: No reported disclosures

scholarly journals The smoking culture in psychiatry: time for change

2011 ◽  
Vol 198 (1) ◽  
pp. 6-7 ◽  
Author(s):  
Elena Ratschen ◽  
John Britton ◽  
Ann McNeill
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Mental Health Settings ◽  
Detrimental Impact

SummarySmoking is closely linked to severe mental illness and has a major detrimental impact on individuals' lives. Despite this and the recent societal ‘de-normalisation’ of smoking, the historic ‘smoking culture’ still prevails within mental health settings. Change is urgently required to prevent a widening of existing health gaps.

scholarly journals HIV testing in patients presenting with indicator conditions in outpatient settings: offer and uptake rates, and educational and active interventions

2018 ◽  
Vol 29 (13) ◽  
pp. 1289-1294
Author(s):  
Elaney Youssef ◽  
Tanjinder Sanghera ◽  
Andrew Bexley ◽  
Madeleine Hayes ◽  
Nicky Perry ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Individual Case ◽  
Case Note ◽  
Routine Screening ◽  
People Living With Hiv ◽  
Hiv Test ◽  
Uptake Rates ◽  
Undiagnosed Hiv ◽  
The Uk ◽  
Outpatient Settings

Approximately 13% of people living with HIV in the UK are undiagnosed which has significant implications in terms of onward transmission and late diagnosis. HIV testing guidelines recommend routine screening in anyone presenting to healthcare with an HIV indicator condition (IC); however, this does not occur routinely. This study aimed to assess the feasibility and effectiveness of using case note prompts highlighting the presence of an IC to increase HIV testing. Clinicians in three outpatient departments received case note prompts either before or after a period of clinician-led identification. Test offer and uptake rates were assessed. A parallel anonymous seroprevalence study estimated the prevalence of undiagnosed HIV. A total of 4191 patients had an appointment during the study period; 608 (14.5%) had an IC. HIV test offer was significantly higher when a prompt was inserted into notes (34.3% versus 3.2%, p < 0.001). The prevalence of diagnosed HIV in the cohort was 4.1%. No cases of undiagnosed HIV infection were identified. Despite guidelines, offer of HIV testing is low. Strategies to increase routine screening of patients presenting with an IC are needed. Individual case note prompts significantly increase HIV test offer; however, the effect is lost if the strategy is withdrawn.

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