Late presentation to HIV care despite good access to health services: current epidemiological trends and how to do better
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Late presentation to HIV care despite good access to health services : current epidemiological trends and how to do better. / Darling, Katharine Ea; Hachfeld, Anna; Cavassini, Matthias; Kirk, Ole; Furrer, Hansjakob; Wandeler, Gilles.
In: Swiss Medical Weekly, Vol. 146, w14348, 2016.Research output: Contribution to journal › Review › Research › peer-review
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TY - JOUR
T1 - Late presentation to HIV care despite good access to health services
T2 - current epidemiological trends and how to do better
AU - Darling, Katharine Ea
AU - Hachfeld, Anna
AU - Cavassini, Matthias
AU - Kirk, Ole
AU - Furrer, Hansjakob
AU - Wandeler, Gilles
PY - 2016
Y1 - 2016
N2 - In 2014, there were 36.9 million people worldwide living with human immunodeficiency virus (PLWH), of whom 17.1 million did not know they were infected. Whilst the number of new human immunodeficiency virus (HIV) infections has declined globally since 2000, there are still regions where new infection rates are rising, and diagnosing HIV early in the course of infection remains a challenge. Late presentation to care in HIV refers to individuals newly presenting for HIV care with a CD4 count below 350 cells/µl or with an acquired immune deficiency syndrome (AIDS)-defining event. Late presentation is associated with increased patient morbidity and mortality, healthcare costs and risk of onward transmission by individuals unaware of their status. Further, late presentation limits the effectiveness of all subsequent steps in the cascade of HIV care. Recent figures from 34 countries in Europe show that late presentation occurs in 38.3% to 49.8% of patients newly presenting for care, depending on region. In Switzerland, data from patients enrolled in the Swiss HIV Cohort Study put the rate of late presentation at 49.8% and show that patients outside established HIV risk groups are most likely to be late presenters. Provider-initiated testing needs to be improved to reach these groups, which include heterosexual men and women and older patients. The aim of this review is to describe the scale and implications of late presentation using cohort data from Switzerland and elsewhere in Europe, and to highlight initiatives to improve early HIV diagnosis. The importance of recognising indicator conditions and the potential for missed opportunities for HIV testing is illustrated in three clinical case studies.
AB - In 2014, there were 36.9 million people worldwide living with human immunodeficiency virus (PLWH), of whom 17.1 million did not know they were infected. Whilst the number of new human immunodeficiency virus (HIV) infections has declined globally since 2000, there are still regions where new infection rates are rising, and diagnosing HIV early in the course of infection remains a challenge. Late presentation to care in HIV refers to individuals newly presenting for HIV care with a CD4 count below 350 cells/µl or with an acquired immune deficiency syndrome (AIDS)-defining event. Late presentation is associated with increased patient morbidity and mortality, healthcare costs and risk of onward transmission by individuals unaware of their status. Further, late presentation limits the effectiveness of all subsequent steps in the cascade of HIV care. Recent figures from 34 countries in Europe show that late presentation occurs in 38.3% to 49.8% of patients newly presenting for care, depending on region. In Switzerland, data from patients enrolled in the Swiss HIV Cohort Study put the rate of late presentation at 49.8% and show that patients outside established HIV risk groups are most likely to be late presenters. Provider-initiated testing needs to be improved to reach these groups, which include heterosexual men and women and older patients. The aim of this review is to describe the scale and implications of late presentation using cohort data from Switzerland and elsewhere in Europe, and to highlight initiatives to improve early HIV diagnosis. The importance of recognising indicator conditions and the potential for missed opportunities for HIV testing is illustrated in three clinical case studies.
KW - Acquired Immunodeficiency Syndrome
KW - Adult
KW - Aged
KW - CD4 Lymphocyte Count
KW - Cohort Studies
KW - Delayed Diagnosis
KW - Early Diagnosis
KW - Europe
KW - Female
KW - HIV Infections
KW - Health Services Accessibility
KW - Humans
KW - Male
KW - Middle Aged
KW - Patient Acceptance of Health Care
KW - Risk Factors
KW - Journal Article
KW - Review
U2 - 10.4414/smw.2016.14348
DO - 10.4414/smw.2016.14348
M3 - Review
C2 - 27544642
VL - 146
JO - Swiss Medical Weekly
JF - Swiss Medical Weekly
SN - 1424-7860
M1 - w14348
ER -
ID: 177534100