HIV Screening in Acute Medical Patients Presenting with an Indicator Condition

Abstract

Aim
In Ireland up to 50% of newly diagnosed HIV positive patients tested are and enter care late (CD4 count <350cells/ul). Late diagnosis is associated with increased HIV related morbidity and mortality, poorer treatment response, increased health care costs and increased transmission rates. International guidelines recommend HIV testing for individuals presenting to healthcare with specific indicator conditions including pneumonia, thrombocytopenia, weight loss. The aim of our study was to evaluate adherence to international HIV screening recommendations in clinical practice.

Methods
A retrospective audit was undertaken evaluating adherence to HIV screening recommendations in acute medical patients assessed in a tertiary referral centre in Ireland during the month of November in 2017 and 2021. Basic demographic data including age, gender, and criteria for HIV testing as per NICE guidelines was recorded. The study was approved by CREC ECM 4 (ss) 22/02/2022.

Results
Of 722 patient episodes included in the study, 150 (21%) presented with a condition indicating that HIV screening should be offered. 19 (13%) patients underwent HIV testing and all tested negative for HIV. In 2017, 28 of 206 patients aged 16 and above seen in an acute medical assessment unit had indicator conditions for HIV testing. 9 of 28 (32%) patients underwent HIV testing. All patients tested negative for HIV. In 2021, 122 of 566 patients aged 16 and above admitted under acute medical services had indicator conditions for HIV testing. 10 of 122 (8%) patients underwent HIV testing and all tested negative for HIV. Patients 60 years of age and under were significantly more likely to be tested for HIV 7/24 (29%) versus 3/98 (3%), p<0.05.

Discussion
Adherence to HIV testing recommendations for patients presenting with indicator conditions is low. Further research is needed to identify barriers to testing which may include a lack of awareness of the indicator conditions, misunderstandings surrounding consent for testing and the accessibility of HIV testing for staff. Strategies to increase routine screening of patients presenting with indicator conditions are needed.