“The aim of the study was to compare prospectively indicator-condition (IC)-guided testing versus testing of those with non-indicator conditions (NICs) in four primary care centres (PCCs) in Barcelona, Spain. From October 2009 to February 2011, patients aged from 18 to 65
years old who attended a PCC for a new herpes zoster infection, seborrhoeic eczema, mononucleosis syndrome or leucopenia/thrombopenia were included in the IC group, and one in every 10 randomly selected patients consulting for other reasons were included in the NIC group. A proportion of patients in each group were offered an HIV test; those who agreed to be tested were given a rapid finger-stick HIV test (€6 per test). Epidemiological and clinical
data were collected and analysed. During the study period, 775 patients attended with one of the four selected ICs, while 66 043 patients presented with an NIC. HIV screening was offered to 89 patients with ICs (offer rate Poziotinib supplier 11.5%), of whom 85 agreed to and completed testing (94.4 and 100% acceptance and completion rates, respectively). In the NIC Selleckchem R788 group, an HIV test was offered to 344 persons (offer rate 5.2%), of whom 313 accepted (90.9%) and 304 completed (97.1%) testing. HIV tests were positive in four persons [prevalence 4.7%; 95% confidence interval (CI) 1.3–11.6%] in the IC group and in one person in the NIC group (prevalence 0.3%; 95% CI 0.01–1.82%; P < 0.009). If every eligible person had taken an HIV test, we would have spent €4650 in the IC group and €396 258 in the NIC group, and an estimated 36 (95% CI 25–49) and 198 persons (95% CI 171–227), respectively, would have been diagnosed with HIV infection. The estimated cost per new HIV diagnosis would Montelukast Sodium have
been €129 (95% CI €107–153) in the IC group and €2001 (95% CI €1913–2088) in the NIC group. Although the number of patients included in the study was small and the results should be treated with caution, IC-guided HIV testing, based on four selected ICs, in PCCs seems to be a more feasible and less expensive strategy to improve diagnosis of HIV infection in Spain than a nontargeted HIV testing strategy. The large majority of sexually transmitted infection (STI) prevention, diagnosis, and treatment occurs in primary care centres (PCCs) [1, 2]. In Spain, access to the health service is universal and free, and PCCs are the settings most frequently visited in order to take an HIV test (approximately 30% of all HIV tests are carried out in PCCs) [3, 4], and where 72% of people receive health care at least once a year . As such, they appear to be suitable settings for HIV screening strategies . Moreover, as a consequence of the reduction in morbidity and mortality in HIV-infected patients associated with highly active antiretroviral therapy, an increased number of patients have stable, chronic HIV infection, and this health care challenge may require new approaches.
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