TY - JOUR
T1 - Missed opportunities for earlier diagnosis of HIV in patients who presented with advanced HIV disease
T2 - A retrospective cohort study
AU - Levy, Itzchak
AU - Maor, Yasmin
AU - Mahroum, Naim
AU - Olmer, Liraz
AU - Wieder, Anat
AU - Litchevski, Vladislav
AU - Mor, Orna
AU - Rahav, Galia
N1 - Publisher Copyright:
© 2016 BMJ Publishing Group Limited.
PY - 2016/11/1
Y1 - 2016/11/1
N2 - Objective: To quantify and characterise missed opportunities for earlier HIV diagnosis in patients diagnosed with advanced HIV. Design: A retrospective observational cohort study. Setting: A central tertiary medical centre in Israel. Measures: The proportion of patients with advanced HIV, the proportion of missed opportunities to diagnose them earlier, and the rate of clinical indicator diseases (CIDs) in those patients. Results: Between 2010 and 2015, 356 patients were diagnosed with HIV, 118 (33.4%) were diagnosed late, 57 (16%) with advanced HIV disease. Old age (OR=1.45 (95% CI 1.16 to 1.74)) and being heterosexual (OR=2.65 (95% CI 1.21 to 5.78)) were significant risk factors for being diagnosed late. All patients with advanced disease had at least one CID that did not lead to an HIV test in the 5 years prior to AIDS diagnosis. The median time between CID and AIDS diagnosis was 24 months (IQR 10-30). 60% of CIDs were missed by a general practitioner and 40% by a specialist. Conclusions: Missed opportunities to early diagnosis of HIV occur in primary and secondary care. Lack of national guidelines, lack of knowledge regarding CIDs and communication barriers with patients may contribute to a late diagnosis of HIV.
AB - Objective: To quantify and characterise missed opportunities for earlier HIV diagnosis in patients diagnosed with advanced HIV. Design: A retrospective observational cohort study. Setting: A central tertiary medical centre in Israel. Measures: The proportion of patients with advanced HIV, the proportion of missed opportunities to diagnose them earlier, and the rate of clinical indicator diseases (CIDs) in those patients. Results: Between 2010 and 2015, 356 patients were diagnosed with HIV, 118 (33.4%) were diagnosed late, 57 (16%) with advanced HIV disease. Old age (OR=1.45 (95% CI 1.16 to 1.74)) and being heterosexual (OR=2.65 (95% CI 1.21 to 5.78)) were significant risk factors for being diagnosed late. All patients with advanced disease had at least one CID that did not lead to an HIV test in the 5 years prior to AIDS diagnosis. The median time between CID and AIDS diagnosis was 24 months (IQR 10-30). 60% of CIDs were missed by a general practitioner and 40% by a specialist. Conclusions: Missed opportunities to early diagnosis of HIV occur in primary and secondary care. Lack of national guidelines, lack of knowledge regarding CIDs and communication barriers with patients may contribute to a late diagnosis of HIV.
UR - http://www.scopus.com/inward/record.url?scp=84995477420&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2016-012721
DO - 10.1136/bmjopen-2016-012721
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C2 - 28186940
AN - SCOPUS:84995477420
SN - 2044-6055
VL - 6
JO - BMJ Open
JF - BMJ Open
IS - 11
M1 - e012721
ER -
