Primary health care: an opportunity for early identification of people living with undiagnosed HIV infection

R. Martin-Iguacel*, C. Pedersen, J. M. Llibre, J. Søndergaard, J. Jensen, L. H. Omland, I. S. Johansen, N. Obel, L. D. Rasmussen

*Kontaktforfatter for dette arbejde

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Resumé

Objectives: We aimed to determine the fraction of HIV-diagnosed individuals who had primary health care (PHC) contacts 3 years prior to HIV diagnosis and whether the risk of HIV diagnosis and degree of immunodeficiency were associated with the frequency of visits or procedures performed. Methods: We used data from national registries to conduct a population-based nested case–control study. Cases were individuals diagnosed with HIV infection in Denmark from 1998 to 2016. Population controls were extracted from the general population matched 13:1 on gender and age. We used conditional logistic regression. As there was a statistically significant interaction, analyses were further stratified by gender and Danish/non-Danish origin. Results: We identified 2784 cases and 36 192 controls. Ninety-three per cent of cases and 88% of controls attended PHC at least once in the 3 years prior to diagnosis, with a higher median number of visits to PHC (NVPC) for cases. We found a statistically significant positive association between NVPC and risk of subsequent HIV diagnosis in men and non-Danish women. A U-shaped association between NVPC and risk of HIV diagnosis among Danish women. No substantial association between NVPC and degree of immunodeficiency was found. Risk of HIV diagnosis and degree of immunodeficiency were weakly associated with type of procedures performed. Conclusions: For most HIV-infected individuals, there seem to be many opportunities for earlier diagnosis in PHC. In men and non-Danish women, the risk of HIV diagnosis but not the degree of immunodeficiency was related to NVPC. The results suggest that the type of medical procedure performed cannot not be used as a guide by the primary physician to indicate which patients to test.

OriginalsprogEngelsk
TidsskriftHIV Medicine
Vol/bind20
Udgave nummer6
Sider (fra-til)404-417
ISSN1464-2662
DOI
StatusUdgivet - jul. 2019

Fingeraftryk

Primary Health Care
HIV
Population Control
Denmark
Population
Registries
Logistic Models
Physicians

Citer dette

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title = "Primary health care: an opportunity for early identification of people living with undiagnosed HIV infection",
abstract = "Objectives: We aimed to determine the fraction of HIV-diagnosed individuals who had primary health care (PHC) contacts 3 years prior to HIV diagnosis and whether the risk of HIV diagnosis and degree of immunodeficiency were associated with the frequency of visits or procedures performed. Methods: We used data from national registries to conduct a population-based nested case–control study. Cases were individuals diagnosed with HIV infection in Denmark from 1998 to 2016. Population controls were extracted from the general population matched 13:1 on gender and age. We used conditional logistic regression. As there was a statistically significant interaction, analyses were further stratified by gender and Danish/non-Danish origin. Results: We identified 2784 cases and 36 192 controls. Ninety-three per cent of cases and 88{\%} of controls attended PHC at least once in the 3 years prior to diagnosis, with a higher median number of visits to PHC (NVPC) for cases. We found a statistically significant positive association between NVPC and risk of subsequent HIV diagnosis in men and non-Danish women. A U-shaped association between NVPC and risk of HIV diagnosis among Danish women. No substantial association between NVPC and degree of immunodeficiency was found. Risk of HIV diagnosis and degree of immunodeficiency were weakly associated with type of procedures performed. Conclusions: For most HIV-infected individuals, there seem to be many opportunities for earlier diagnosis in PHC. In men and non-Danish women, the risk of HIV diagnosis but not the degree of immunodeficiency was related to NVPC. The results suggest that the type of medical procedure performed cannot not be used as a guide by the primary physician to indicate which patients to test.",
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author = "R. Martin-Iguacel and C. Pedersen and Llibre, {J. M.} and J. S{\o}ndergaard and J. Jensen and Omland, {L. H.} and Johansen, {I. S.} and N. Obel and Rasmussen, {L. D.}",
year = "2019",
month = "7",
doi = "10.1111/hiv.12735",
language = "English",
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pages = "404--417",
journal = "HIV Medicine",
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Primary health care : an opportunity for early identification of people living with undiagnosed HIV infection. / Martin-Iguacel, R.; Pedersen, C.; Llibre, J. M.; Søndergaard, J.; Jensen, J.; Omland, L. H.; Johansen, I. S.; Obel, N.; Rasmussen, L. D.

I: HIV Medicine, Bind 20, Nr. 6, 07.2019, s. 404-417.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Primary health care

T2 - an opportunity for early identification of people living with undiagnosed HIV infection

AU - Martin-Iguacel, R.

AU - Pedersen, C.

AU - Llibre, J. M.

AU - Søndergaard, J.

AU - Jensen, J.

AU - Omland, L. H.

AU - Johansen, I. S.

AU - Obel, N.

AU - Rasmussen, L. D.

PY - 2019/7

Y1 - 2019/7

N2 - Objectives: We aimed to determine the fraction of HIV-diagnosed individuals who had primary health care (PHC) contacts 3 years prior to HIV diagnosis and whether the risk of HIV diagnosis and degree of immunodeficiency were associated with the frequency of visits or procedures performed. Methods: We used data from national registries to conduct a population-based nested case–control study. Cases were individuals diagnosed with HIV infection in Denmark from 1998 to 2016. Population controls were extracted from the general population matched 13:1 on gender and age. We used conditional logistic regression. As there was a statistically significant interaction, analyses were further stratified by gender and Danish/non-Danish origin. Results: We identified 2784 cases and 36 192 controls. Ninety-three per cent of cases and 88% of controls attended PHC at least once in the 3 years prior to diagnosis, with a higher median number of visits to PHC (NVPC) for cases. We found a statistically significant positive association between NVPC and risk of subsequent HIV diagnosis in men and non-Danish women. A U-shaped association between NVPC and risk of HIV diagnosis among Danish women. No substantial association between NVPC and degree of immunodeficiency was found. Risk of HIV diagnosis and degree of immunodeficiency were weakly associated with type of procedures performed. Conclusions: For most HIV-infected individuals, there seem to be many opportunities for earlier diagnosis in PHC. In men and non-Danish women, the risk of HIV diagnosis but not the degree of immunodeficiency was related to NVPC. The results suggest that the type of medical procedure performed cannot not be used as a guide by the primary physician to indicate which patients to test.

AB - Objectives: We aimed to determine the fraction of HIV-diagnosed individuals who had primary health care (PHC) contacts 3 years prior to HIV diagnosis and whether the risk of HIV diagnosis and degree of immunodeficiency were associated with the frequency of visits or procedures performed. Methods: We used data from national registries to conduct a population-based nested case–control study. Cases were individuals diagnosed with HIV infection in Denmark from 1998 to 2016. Population controls were extracted from the general population matched 13:1 on gender and age. We used conditional logistic regression. As there was a statistically significant interaction, analyses were further stratified by gender and Danish/non-Danish origin. Results: We identified 2784 cases and 36 192 controls. Ninety-three per cent of cases and 88% of controls attended PHC at least once in the 3 years prior to diagnosis, with a higher median number of visits to PHC (NVPC) for cases. We found a statistically significant positive association between NVPC and risk of subsequent HIV diagnosis in men and non-Danish women. A U-shaped association between NVPC and risk of HIV diagnosis among Danish women. No substantial association between NVPC and degree of immunodeficiency was found. Risk of HIV diagnosis and degree of immunodeficiency were weakly associated with type of procedures performed. Conclusions: For most HIV-infected individuals, there seem to be many opportunities for earlier diagnosis in PHC. In men and non-Danish women, the risk of HIV diagnosis but not the degree of immunodeficiency was related to NVPC. The results suggest that the type of medical procedure performed cannot not be used as a guide by the primary physician to indicate which patients to test.

KW - HIV

KW - HIV diagnosis

KW - late HIV presentation

KW - primary health care

U2 - 10.1111/hiv.12735

DO - 10.1111/hiv.12735

M3 - Journal article

C2 - 31016849

AN - SCOPUS:85065054756

VL - 20

SP - 404

EP - 417

JO - HIV Medicine

JF - HIV Medicine

SN - 1464-2662

IS - 6

ER -