Joore I K, Reukers D F M, Donker G A, van Sighem A I, Op de Coul E L M, Prins J M, Geerlings S E, Barth R E, van Bergen J E A M, van den Broek I V
Department of General Practice, Division Clinical Methods and Public Health, Academic Medical Center, Amsterdam, The Netherlands.
Epidemiology & Surveillance Unit, Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
BMJ Open. 2016 Jan 21;6(1):e009194. doi: 10.1136/bmjopen-2015-009194.
Prior research has shown that Dutch general practitioners (GPs) do not always offer HIV testing and the number of undiagnosed HIV patients remains high. We aimed to further investigate the frequency and reasons for (not) testing for HIV and the contribution of GPs to the diagnosis of HIV infections in the Netherlands.
Observational study.
(1) Dutch primary care network of 42-45 sentinel practices where report forms during sexually transmitted infection (STI)-related consultations were routinely collected, 2008-2013. (2) Dutch observational cohort with medical data of HIV-positive patients in HIV care, 2008-2013.
The proportion of STI-related consultations in patients from high-risk groups tested for HIV, with additional information requested from GPs on HIV testing preconsultation or postconsultation for whom HIV testing was indicated, but not performed. Next, information was collected on the profile of HIV-positive patients entering specialised HIV care following diagnosis by GPs.
Initially, an HIV test was reported (360/907) in 40% of STI-related consultations in high-risk groups. Additionally, in 26% of consultations an HIV test had been performed in previous or follow-up consultations or at different STI-care facilities. The main reasons for not testing were perceived insignificant risk; 'too' recent risk according to GPs or the reluctance of patients. The initiative of the patient was a strong determinant for HIV testing. GPs diagnosed about one third of all newly found cases of HIV. Compared with STI clinics, HIV-positive patients diagnosed in general practice were more likely to be older, female, heterosexual male or sub-Saharan African.
In one-third of the STI-related consultations of persons from high-risk groups, no HIV test was performed in primary care, which is lower than previously reported. Risk-based testing has intrinsic limitations and implementation of new additional strategies in primary care is warranted.
先前的研究表明，荷兰全科医生（GP）并非总是提供HIV检测，未确诊的HIV患者数量仍然很高。我们旨在进一步调查（未）进行HIV检测的频率和原因，以及荷兰全科医生对HIV感染诊断的贡献。
观察性研究。
（1）2008 - 2013年，荷兰42 - 45个哨点诊所的初级保健网络，在与性传播感染（STI）相关的会诊期间常规收集报告表。（2）2008 - 2013年，荷兰HIV护理中HIV阳性患者的观察性队列及医疗数据。
对高危人群患者进行HIV检测的性传播感染相关会诊比例，以及向全科医生额外索要HIV检测前会诊或后会诊的信息，这些会诊表明应进行HIV检测但未进行。接下来，收集关于经全科医生诊断后进入专门HIV护理的HIV阳性患者的资料。
最初，在高危人群40%的性传播感染相关会诊中报告了HIV检测（360/907）。此外，在26%的会诊中，之前或后续会诊或在不同的性传播感染护理机构进行了HIV检测。未检测的主要原因是认为风险不大；全科医生认为“太”近期有风险或患者不情愿。患者的主动性是HIV检测的一个重要决定因素。全科医生诊断出所有新发现HIV病例的约三分之一。与性传播感染诊所相比，在全科医疗中诊断出的HIV阳性患者更可能年龄较大、为女性、异性恋男性或撒哈拉以南非洲人。
在高危人群三分之一的性传播感染相关会诊中，初级保健中未进行HIV检测，这一比例低于先前报道。基于风险的检测有内在局限性，有必要在初级保健中实施新的附加策略。
