Abstract
Objectives: Despite the availability of HIV testing guidelines to facilitate prompt diagnosis, late HIV diagnosis remains high across Europe. The study synthesizes recent evidence on HIV testing strategies adopted in health care settings in the European Union/European Economic Area (EU/EEA).
Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and systematic searches were run in five databases (2010–2017) to identify studies describing HIV testing interventions in health care settings in the EU/EEA. The grey literature was searched for unpublished studies (2014–2017). Two reviewers independently performed study selection, data extraction and critical appraisal.
Results: One hundred and thirty intervention and/or feasibility studies on HIV testing in health care settings were identified. Interventions included testing provision (n = 94), campaigns (n = 14) and education and training for staff and patients (n = 20). HIV test coverage achieved through testing provision varied: 2.9–94% in primary care compared to 3.9–66% in emergency departments. HIV test positivity was lower in emergency departments (0–1.3%) and antenatal services (0–0.05%) than in other hospital departments (e.g. inpatients: 0–5.3%). Indicator condition testing programmes increased HIV test coverage from 3.9–72% before to 12–85% after their implementation, with most studies reporting a 10–20% increase. There were 51 feasibility and/or acceptability studies that demonstrated that HIV testing interventions were generally acceptable to patients and providers in health care settings (e.g. general practitioner testing acceptable: 77–93%).
Conclusions: This review has identified several strategies that could be adopted to achieve high HIV testing coverage across a variety of health care settings and populations in the EU/EEA. Very few studies compared the intervention under investigation to a baseline, but, where this was assessed, data suggested increases in testing.
| Original language | English |
|---|---|
| Pages (from-to) | 163-179 |
| Number of pages | 17 |
| Journal | HIV Medicine |
| Volume | 21 |
| Issue number | 3 |
| Early online date | 14 Nov 2019 |
| DOIs | |
| Publication status | Published - 1 Mar 2020 |
Bibliographical note
Funding Information: This paper was funded by the European Centre for Disease Prevention and Control (ECDC) as part of a project to update the European HIV testing guidelines (Framework Contract Reference Number: ECDC/2016/035). We would like to thank the wider evidence synthesis working group: from Public Health England (PHE): Peter Kirwan, Cuong Chau, Matthew Hibbert, Meaghan Kall, Alison Brown, Zheng Yin, Nicola Pearce-Smith and Anh Tran; and from the Centre of Excellence for Health, Immunity and Infections (CHIP): Anne Louise Grevsen, Anne Raahauge, Jeff Lazarus, Maiken Mansfeld and Ida Sperle. We would like to thank Carole Kelly (PHE) not only for her involvement in screening studies, but for her input into developing the initial review protocol. We would also like to acknowledge Csaba Kodmon and other colleagues from ECDC involved in reviewing non-English articles.Open Access: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Publisher Copyright: © 2019 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.
Citation: Desai, S., Tavoschi, L., Sullivan, A., Combs, L., Raben, D., Delpech, V., Jakobsen, S., Amato-Gauci, A. and Croxford, S. (2020), HIV testing strategies employed in health care settings in the European Union/European Economic Area (EU/EEA): evidence from a systematic review. HIV Med, 21: 163-179.
DOI: https://doi.org/10.1111/hiv.12809
Keywords
- Europe
- HIV diagnosis and adults
- HIV testing
- adults
- health care
