Amsterdam UMC Location University of Amsterdam, Internal Medicine, Amsterdam, The Netherlands.
Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, The Netherlands.
PLoS One. 2023 Mar 6;18(3):e0282607. doi: 10.1371/journal.pone.0282607. eCollection 2023.
In the Netherlands, general practitioners (GPs) play a key role in HIV testing. However, the proportion of people diagnosed with late-stage HIV remains high, and opportunities for earlier diagnosis are being missed. We implemented an educational intervention to improve HIV and STI testing in primary care in Amsterdam, the Netherlands.
GPs were invited to participate in an educational program between 2015 and 2020, which included repeat sessions using audit and feedback and quality improvement plans. Data on HIV, chlamydia and gonorrhoea testing by GPs were collected from 2011 through 2020. The primary outcome was HIV testing frequency, which was compared between GPs before and after participation using Poisson regression. Secondary outcomes were chlamydia and gonorrhoea testing frequencies, and positive test proportions. Additional analyses stratified by patient sex and age were done.
GPs after participation performed 7% more HIV tests compared to GPs before participation (adjusted relative ratio [aRR] 1.07, 95%CI 1.04-1.09); there was no change in the proportion HIV positive tests (aRR 0.87, 95%CI 0.63-1.19). HIV testing increased most among patients who were female and ≤19 or 50-64 years old. After participation, HIV testing continued to increase (aRR 1.02 per quarter, 95%CI 1.01-1.02). Chlamydia testing by GPs after participation increased by 6% (aRR 1.06, 95%CI 1.05-1.08), while gonorrhoea testing decreased by 2% (aRR 0.98, 95%CI 0.97-0.99). We observed increases specifically in extragenital chlamydia and gonorrhoea testing.
The intervention was associated with a modest increase in HIV testing among GPs after participation, while the proportion positive HIV tests remained stable. Our results suggest that the intervention yielded a sustained effect.
在荷兰，全科医生（GP）在 HIV 检测中发挥着关键作用。然而，被诊断为晚期 HIV 的人数仍然居高不下，错过了早期诊断的机会。我们在荷兰阿姆斯特丹实施了一项教育干预措施，以改善初级保健中的 HIV 和性传播感染（STI）检测。
邀请全科医生参加 2015 年至 2020 年期间的教育计划，该计划包括使用审计和反馈以及质量改进计划的重复课程。收集了 2011 年至 2020 年期间全科医生的 HIV、衣原体和淋病检测数据。主要结果是 HIV 检测频率，使用泊松回归比较参与前后 GP 的 HIV 检测频率。次要结果是衣原体和淋病检测频率以及阳性检测比例。还按患者性别和年龄进行了分层分析。
与参与前相比，参与后的 GP 进行了 7%的 HIV 检测（调整后的相对比率[aRR]1.07，95%CI1.04-1.09）；HIV 阳性检测比例没有变化[aRR 0.87，95%CI0.63-1.19]。女性和≤19 岁或 50-64 岁的患者中 HIV 检测增加最多。参与后，HIV 检测继续增加[aRR 每季度增加 1.02，95%CI1.01-1.02]。参与后的 GP 进行的衣原体检测增加了 6%（aRR1.06，95%CI1.05-1.08），而淋病检测减少了 2%（aRR0.98，95%CI0.97-0.99）。我们观察到特定于生殖器外的衣原体和淋病检测增加。
该干预措施与参与后的 GP 中 HIV 检测适度增加有关，而 HIV 阳性检测比例保持稳定。我们的结果表明，该干预措施产生了持续的效果。
