Missed opportunities for HIV testing in people diagnosed with HIV, Estonia, 2014 to 2015.

ABSTRACT

Background: Studies of missed opportunities for earlier diagnosis of HIV have shown that patients with undiagnosed HIV often present to healthcare settings numerous times before eventually receiving their diagnosis. Aim: The aim of the study was to assess missed opportunities for HIV testing among people newly diagnosed with HIV. Methods: In this observational retrospective study, we collected data from the Estonian Health Board on new HIV cases in people aged 16­49 years diagnosed in 2014­15 and from the Estonian Health Insurance Fund database for treatment invoices on their contacts with healthcare services in the 2 years preceding diagnosis. Diagnoses on treatment invoices were categorised as HIV indicator conditions using ICD-10 codes. Results: Of 538 newly diagnosed HIV cases (62.5%; 336 men), 82% had visited healthcare services at least once during the 2 years before HIV diagnosis; the mean number of visits was 9.1. Of these, 16% had been tested for HIV and 31% had at least one ICD-10 code for an HIV indicator condition on at least one of their treatment invoices. In 390 cases of HIV indicator conditions, only 5% were tested for HIV. Of all new HIV cases aged 20­49 years from high-incidence regions (defined as priority groups in national testing guidance), 18% had been tested. Conclusions: The HIV testing rate in the 2 years before an HIV diagnosis was very low, even in the presence of an HIV indicator condition. This emphasises the importance of implementing the Estonian HIV testing guidelines.