Jordans Carlijn C E, Vliegenthart-Jongbloed Klaske, Osbak Kara K, Hanssen Jaap L J, van Beek Jan, Vriesde Marion, van Holten Natasja, Dorama Willemien, van der Sluis Dorien, de Steenwinkel Jurriaan, van Kampen Jeroen, Verbon Annelies, Roukens Anna H E, Rokx Casper
Department of Medical Microbiology and Infectious Diseases.
Department of Internal Medicine, Erasmus University Medical Center.
AIDS. 2025 Jul 1;39(8):995-1004. doi: 10.1097/QAD.0000000000004167. Epub 2025 Mar 18.
Develop and validate a strategy to improve HIV testing rates using HIV teams.
A prospective clinical trial was conducted from January 2020 to July 2023 in two Dutch university hospitals.
The intervention involved implementing HIV teams to provide peer awareness, education, and feedback to physicians treating patients ≥18 years newly diagnosed with HIV indicator conditions. The primary outcome was the HIV testing rate. Secondary outcomes included testing rates by specialty, HIV prevalence, and reasons for withholding testing.
Of the 313 666 newly registered diagnoses, 2395 involved indicator conditions. The overall HIV testing rate of newly diagnosed HIV indicator conditions increased from 50.1% (222/443) preimplementation to 80.7% (1575/1952) postimplementation of HIV teams ( P < 0.001) with sustained improvement during the observation period (range 72.4-90.4%). The intervention was effective across physicians from all medical specialties. HIV prevalence among those tested was 0.6% [95% confidence interval (CI) 0.3-1.1]. Peer feedback for 411 untested indicator conditions, resulted in 69 (16.3%) additional HIV tests. Failure to test frequently remained without reason (50.6%) or due to patient loss of follow-up (18.4%). Multivariate analysis indicated that women with indicator conditions were tested less often [adjusted odds ratio (aOR) 0.59, 95% CI 0.45-0.79, P < 0.01], and indicator conditions without HIV testing recommendations in national guidelines were also less likely to be tested for HIV (aOR 0.36, 95% CI 0.27-0.48, P < 0.01). For external validation, we implemented this intervention in a second hospital, where it also significantly increased the testing rate postimplementation of HIV teams.
Implementing HIV teams in hospitals is feasible, effective and leads to a sustained increase in HIV indicator condition-guided testing, supporting its broader adoption.
制定并验证一项利用艾滋病病毒（HIV）团队提高HIV检测率的策略。
2020年1月至2023年7月在两家荷兰大学医院进行了一项前瞻性临床试验。
干预措施包括组建HIV团队，为治疗新诊断出患有HIV指示性疾病的18岁及以上患者的医生提供同伴宣传、教育和反馈。主要结局是HIV检测率。次要结局包括各专科的检测率、HIV流行率以及不进行检测的原因。
在313666例新登记诊断中，2395例涉及指示性疾病。新诊断出HIV指示性疾病的总体HIV检测率从实施干预前的50.1%（222/443）提高到实施HIV团队后的80.7%（1575/1952）（P<0.001），且在观察期内持续改善（范围为72.4%-90.4%）。该干预措施对所有医学专科的医生均有效。检测人群中的HIV流行率为0.6%[95%置信区间（CI）0.3-1.1]。针对411例未检测的指示性疾病的同伴反馈，额外促成了69例（16.3%）HIV检测。不经常进行检测的原因仍然是无故（50.6%）或患者失访（18.4%）。多变量分析表明，患有指示性疾病的女性接受检测的频率较低[调整后的优势比（aOR）0.59，95%CI 0.45-0.79，P<0.01]，并且国家指南中没有HIV检测建议的指示性疾病接受HIV检测的可能性也较小（aOR 0.36，95%CI 0.27-0.48，P<0.01）。为进行外部验证，我们在另一家医院实施了该干预措施，在那里实施HIV团队后检测率也显著提高。
在医院组建HIV团队是可行、有效的，并且能使基于HIV指示性疾病的检测持续增加，支持其更广泛地应用。
