Factors associated with offering HIV testing to people aged ≥ 50 years: A qualitative study

Background Individuals aged ≥ 50 years continue to be disproportionately affected by late HIV diagnosis, which is associated with poorer health outcomes and onward transmission. Despite HIV testing guidelines and high acceptability of HIV testing among all patients, clinicians are less likely to offer a test to an older individual. The aim of this study was to identify clinician-related factors associated with offering HIV testing to patients aged ≥ 50 years. Methods Twenty clinicians who had been involved in the care of an older patient diagnosed late with HIV were interviewed. Results Thematic analysis identified seven factors associated with offering HIV testing to older people: knowledge, stigma, stereotyping and perception of risk, symptom attribution, discussing HIV with patients, consent procedures and practical issues. Conclusions Although some factors are not unique to older patients, some are unique to this group. Many clinicians lack up-to-date HIV-related knowledge, feel anxious discussing HIV with older patients and perceive asexuality in older age. In order to increase the offer of HIV testing to this group, we identified clinician-related barriers to test offer that need to be addressed.

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CD4 Cell Counts at HIV Diagnosis among HIV Outpatient Study Participants, 2000–2009

AIDS Research and Treatment ◽

10.1155/2012/869841 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Kate Buchacz ◽

Carl Armon ◽

Frank J. Palella ◽

Rose K. Baker ◽

Ellen Tedaldi ◽

...

Keyword(s):

Hiv Testing ◽

Population Level ◽

Cd4 Count ◽

Hiv Diagnosis ◽

Cell Counts ◽

Late Hiv Diagnosis ◽

Cd4 Cell Counts ◽

The Usa ◽

Study Participants ◽

Cd4 Cell

Background. It is unclear if CD4 cell counts at HIV diagnosis have improved over a 10-year period of expanded HIV testing in the USA.Methods. We studied HOPS participants diagnosed with HIV infection ≤6 months prior to entry into care during 2000–2009. We assessed the correlates of CD4 count <200 cells/mm3at HIV diagnosis (late HIV diagnosis) by logistic regression.Results. Of 1,203 eligible patients, 936 (78%) had a CD4 count within 3 months after HIV diagnosis. Median CD4 count at HIV diagnosis was 299 cells/mm3and did not significantly improve over time (P=0.13). Comparing periods 2000-2001 versus 2008-2009, respectively, 39% and 35% of patients had a late HIV diagnosis (P=0.34). Independent correlates of late HIV diagnosis were having an HIV risk other than being MSM, age ≥35 years at diagnosis, and being of nonwhite race/ethnicity.Conclusions. There is need for routine universal HIV testing to reduce the frequency of late HIV diagnosis and increase opportunity for patient- and potentially population-level benefits associated with early antiretroviral treatment.

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Temporal Trend and Factors Associated with Late HIV Diagnosis in Hong Kong, a Low HIV Prevalence Locality

AIDS Patient Care and STDs ◽

10.1089/108729103322395492 ◽

2003 ◽

Vol 17 (9) ◽

pp. 461-469 ◽

Cited By ~ 22

Author(s):

Ka-Hing Wong ◽

Shui-Shan Lee ◽

Kelvin Hon-Kei Low ◽

Wai-Yee Wan

Keyword(s):

Hong Kong ◽

Temporal Trend ◽

Hiv Prevalence ◽

Hiv Diagnosis ◽

Factors Associated ◽

Late Hiv Diagnosis

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Infrequent HIV Testing and Late HIV Diagnosis Are Common Among a Cohort of Black Men Who Have Sex With Men in 6 US Cities

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0000000000000334 ◽

2014 ◽

Vol 67 (4) ◽

pp. 438-445 ◽

Cited By ~ 47

Author(s):

Sharon B. Mannheimer ◽

Lei Wang ◽

Leo Wilton ◽

Hong Van Tieu ◽

Carlos del Rio ◽

...

Keyword(s):

Hiv Testing ◽

Black Men ◽

Hiv Diagnosis ◽

Late Hiv Diagnosis ◽

Sex With Men ◽

Us Cities

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Tailoring HIV testing in a setting of late HIV diagnosis: is the tide turning?

British Journal of Hospital Medicine ◽

10.12968/hmed.2015.76.10.592 ◽

2015 ◽

Vol 76 (10) ◽

pp. 592-595 ◽

Cited By ~ 4

Author(s):

Monica Lascar ◽

Joseph Freer ◽

Elias Phiri

Keyword(s):

Hiv Testing ◽

Hiv Diagnosis ◽

Late Hiv Diagnosis

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Prevalence and factors associated with late HIV diagnosis

Journal of Medical Virology ◽

10.1002/jmv.24066 ◽

2015 ◽

Vol 87 (6) ◽

pp. 970-977 ◽

Cited By ~ 19

Author(s):

Se-Ying Dai ◽

Jin-Ji Liu ◽

Yin-Guang Fan ◽

Gui-Su Shan ◽

Hong-Bo Zhang ◽

...

Keyword(s):

Hiv Diagnosis ◽

Factors Associated ◽

Late Hiv Diagnosis

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HIV – lessons from a late diagnosis

Acute Medicine Journal ◽

10.52964/amja.0613 ◽

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.

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What Shapes Late HIV Diagnosis in Vietnam? A Qualitative Investigation of Multilevel Factors

AIDS Education and Prevention ◽

10.1521/aeap.2021.33.5.450 ◽

2021 ◽

Vol 33 (5) ◽

pp. 450-463

Author(s):

Thu Trang Nguyen ◽

Anh Ngoc Luong ◽

Thi Dieu Thuy Dao ◽

Nicolas Nagot ◽

Didier Laureillard ◽

...

Keyword(s):

Hiv Testing ◽

Hiv Treatment ◽

Public Health Issue ◽

Structural Level ◽

Key Populations ◽

Global Public Health ◽

Hiv Diagnosis ◽

Cd4 Counts ◽

Late Hiv Diagnosis ◽

Increased Risk

Late HIV treatment remains a global public health issue despite significant efforts. To better understand what shapes this issue, we interviewed 36 Vietnamese ART-naive patients who came to HIV treatment in 2017. Half of them had intake CD4 counts fewer than 100 cells/mm3, the others had intake CD4 counts of 350 cells/mm3 and above. Late diagnosis was the reason of late treatment in our sample. Most late presenters were not members of the key populations at increased risk of HIV (e.g., people who inject drugs, commercial sex workers, and men who have sex with men). Individual-level factors included low risk appraisal, habit of self-medication, and fear of stigma. Network and structural-level factors included challenges to access quality health care, normalization of HIV testing in key populations and inconsistent provider-initiated HIV testing practices. Structural interventions coupled with existing key population-targeted strategies would improve the issue of late HIV diagnosis.

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Patterns of engagement in HIV care during pregnancy and breastfeeding: findings from a cohort study in North-Eastern South Africa

BMC Public Health ◽

10.1186/s12889-021-11742-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

David Etoori ◽

Brian Rice ◽

Georges Reniers ◽

Francesc Xavier Gomez-Olive ◽

Jenny Renju ◽

...

Keyword(s):

Hiv Testing ◽

Cox Regression ◽

Sub Saharan Africa ◽

Hiv Care ◽

Hiv Diagnosis ◽

Factors Associated ◽

Art Initiation ◽

Risk Period ◽

Hiv Care Engagement ◽

Engagement In Hiv Care

Abstract Background Eliminating mother-to-child transmission of HIV (MTCT) in sub-Saharan Africa is hindered by limited understanding of HIV-testing and HIV-care engagement among pregnant and breastfeeding women. Methods We investigated HIV-testing and HIV-care engagement during pregnancy and breastfeeding from 2014 to 2018 in the Agincourt Health and Demographic Surveillance System (HDSS). We linked HIV patient clinic records to HDSS pregnancy data. We modelled time to a first recorded HIV-diagnosis following conception, and time to antiretroviral therapy (ART) initiation following diagnosis using Kaplan-Meier methods. We performed sequence and cluster analyses for all pregnancies linked to HIV-related clinic data to categorise MTCT risk period engagement patterns and identified factors associated with different engagement patterns using logistic regression. We determined factors associated with ART resumption for women who were lost to follow-up (LTFU) using Cox regression. Results Since 2014, 15% of 10,735 pregnancies were recorded as occurring to previously (51%) or newly (49%) HIV-diagnosed women. New diagnoses increased until 2016 and then declined. We identified four MTCT risk period engagement patterns (i) early ART/stable care (51.9%), (ii) early ART/unstable care (34.1%), (iii) late ART initiators (7.6%), and (iv) postnatal seroconversion/early, stable ART (6.4%). Year of delivery, mother’s age, marital status, and baseline CD4 were associated with these patterns. A new pregnancy increased the likelihood of treatment resumption following LTFU. Conclusion Almost half of all pregnant women did not have optimal ART coverage during the MTCT risk period. Programmes need to focus on improving retention, and leveraging new pregnancies to re-engage HIV-positive women on ART.

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Epidemiological factors associated with the absence of previous HIV testing among HIV-positive persons in Singapore, 2012–2017

BMJ Open ◽

10.1136/bmjopen-2021-050133 ◽

2021 ◽

Vol 11 (8) ◽

pp. e050133

Author(s):

Li Wei Ang ◽

Matthias Paul Han Sim Toh ◽

Irving Charles Boudville ◽

Chen Seong Wong ◽

Sophia Archuleta ◽

...

Keyword(s):

Risk Factors ◽

Hiv Infection ◽

Hiv Testing ◽

Heterosexual Transmission ◽

Hiv Positive ◽

Multivariable Logistic Regression Analysis ◽

Targeted Prevention ◽

Hiv Diagnosis ◽

Factors Associated ◽

Epidemiological Factors

ObjectiveTo assess the temporal trend and identify risk factors associated with the absence of previous HIV testing prior to their diagnosis among HIV-positive persons in Singapore.Study designCross-sectional.Setting and participantsWe analysed data of HIV-positive persons infected via sexual transmission, who were notified to the National HIV Registry in 2012–2017.OutcomesEpidemiological factors associated with the absence of HIV testing prior to diagnosis were determined separately for two groups of HIV-positive persons: early and late stages of HIV infection at diagnosis.Results2188 HIV-positive persons with information on HIV testing history and CD4 cell count were included in the study. The median age at HIV diagnosis was 40 years (IQR 30–51). Nearly half (45.1%) had never been tested for HIV prior to their diagnosis. The most common reason cited for no previous HIV testing was ‘not necessary to test’ (73.7%). The proportion diagnosed at late-stage HIV infection was significantly higher among HIV-positive persons who had never been tested for HIV (63.9%) compared with those who had undergone previous HIV tests (29.0%). Common risk factors associated with no previous HIV testing in multivariable logistic regression analysis stratified by stage of HIV infection were: older age at HIV diagnosis, lower educational level, detection via medical care and HIV infection via heterosexual transmission. In the stratified analysis for persons diagnosed at early-stage of HIV infection, in addition to the four risk factors, women and those of Malay ethnicity were also less likely to have previous HIV testing prior to their diagnosis.ConclusionTargeted prevention efforts and strategies are needed to raise the level of awareness of HIV/AIDS and to encourage early and regular screening among the at-risk groups by making HIV testing more accessible.

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