Psychosocial determinants of HIV testing across stages of change in Spanish population: a cross-sectional national survey.

BACKGROUND: The goal of this research is to study the psychosocial determinants of HIV-testing as a function of the decision or change stage concerning this health behavior. The determinants considered in the major ongoing health models and the stages contemplated in the Precaution Adoption Process Model are analysed. METHODS: A cross-sectional survey was administered to 1,554 people over 16 years of age living in Spain by a computer-assisted telephone interview (CATI). The sample design was randomised, with quotas of sex and age. The survey measured various psychosocial determinants of health behaviors considered in the main cognitive theories, the interviewees' stage of change concerning HIV-testing (lack of awareness, decision not to act, decision to act, action, maintenance, and abandonment), and the signal for the action of getting tested or the perceived barriers to being tested. RESULTS: Approximately two thirds of the population had not ever had the HIV test. The predominant stage was lack of awareness. The most frequently perceived barriers to testing were related to the health system and to the stigma. We also found that the psychosocial determinants studied differed depending on the respondents' stage of change. Perception of risk, perceived self-efficacy, proximity to people who had been tested, perceived benefits of knowing the diagnosis, and a positive instrumental and emotional attitude were positively associated with the decision and maintenance of testing behavior. However, unrealistic underestimation of the risk of HIV infection, stereotypes about the infection, and the perceived severity of HIV were associated with the decision not to be tested. CONCLUSIONS: There are various sociocognitive and motivational profiles depending on people's decision stage concerning HIV-testing. Knowing this profile may allow us to design interventions to influence the psychosocial determinants that characterise each stage of change.

[Delayed diagnosis of HIV infection in Spain]. / Retraso diagnóstico de la infección por el virus de la inmunodeficiencia humana en España.

OBJECTIVES: To analyse the prevalence of delayed diagnosis (DD) of human immunodeficiency virus (HIV) infection, the trends over time and its determining factors from the Newly Diagnosed HIV-infected individuals Information System (SINIVIH) data, in process of being implemented in Spain. METHODS: Cross-sectional study of newly diagnosed HIV-infected individuals between 2003 and 2007 in the 8 currently participating Spanish autonomous regions (AR). DD was defined as a CD4 count <200cells/µL at diagnosis. Adjusted odds ratios with 95% confidence interval were calculated using logistic regression (OR; 95%CI). RESULTS: Among the 5785 newly diagnosed HIV cases reported, 4798 had a CD4 cell count at diagnosis. Of these, 37.3% met the DD definition. An additional 19% had between 200 and 350cells/µL. The proportion of DD was lower for women than for men (32.9% versus 38.6%). According to exposure category, it was higher in heterosexuals (42.4%) and injecting drug users (IDUs) (40.1%) than in men who have sex with men (MSM) (26.7%). In the Spanish patient group, in multivariate logistic regression analyses, adjusting for AR and year of diagnosis, men were more likely to have a DD (OR=1.49; 95%CI:1.21-1.85). Compared to younger patients (20-29 years), LD was more frequent in older: 30-39 years (OR=2.08; 95% CI:1.63-2.67), 40-49 years (OR=3.98; 95% CI:3.07-5.16) and >49 years (OR=6.77; 95% CI:5.10-9.00); and compared to MSM, was more frequent in heterosexuals (OR=1.75; 95% CI:1.43-2.15) and IDUs (OR=1.75; 95% CI:1.38-2.22). DD decreased from 2003 to 2007 (OR=1.38; 95% CI:1.08-1.76). The same associated factors were found in immigrants, but with different magnitude: stronger association with men, heterosexuals and IDUs, and weaker association with older age. CONCLUSIONS: DD affects almost four in every ten newly diagnosed HIV-infected individuals, and is significantly more common among men, age group over 30 years, IDUs and heterosexuals. These are associated factors both in Spanish and immigrants, but in the last group the association is stronger. Strategies to increase the perception of risk among these groups are needed, as well as the implementation of the SINIVIH in the whole country to improve and to extend the information on DD.

Widening the Access to HIV Testing: The Contribution of Three In-Pharmacy Testing Programmes in Spain.

BACKGROUND AND OBJECTIVE: Spain has implemented several in-pharmacy HIV testing programmes performed by pharmacists as part of their everyday routine. We aim to assess the feasibility and the main outcomes of three programmes implemented in three Spanish regions with different sociological profiles and also different epidemiology for HIV. METHODS: The characteristics of the 24151 people tested between 2009 and 2013 at 74 urban pharmacies are studied. We compare the main outcomes of the programmes with those of each Regional HIV Surveillance System (RHSS) assessing the contribution to the total new diagnosis in each region and if priority groups are being reached. RESULTS: 45.7% were heterosexual men (MSW), 14.4% men who have sex with men (MSM), and 27% women. The 35% were younger than 30 and 9.6% foreigners. The 52% were previously untested, and women were the most likely to be untested. The three programmes altogether diagnosed 226 people, resulting in a global prevalence of 0.9% (95%CI: 0.8-1.1); 3.4% in MSM (95%CI: 2.8-4.0). The prevalence among Spaniards was 0.8% (0.7-1.0) vs. 2.2 (1.6-2.9) among foreigners. The percentages of MSM diagnosed by all three programmes were higher than the one reported by their respective RHSS. Thirty four percent of the reactive MSM and the 71.4% of the reactive MSW did not have a previous HIV test although big testing history differences were observed across the programmes. Altogether, these services contributed with the 10.6% of all HIV diagnoses in these regions. CONCLUSIONS: In-pharmacy HIV testing programmes are a valuable testing option, having been able to uncover 1 out of 10 the new diagnoses reported in each region. They showed a good capacity of reaching and diagnosing previously untested populations, not only a priority population such as MSM but also heterosexual population who are more affected by delayed diagnosis. They seem to be particularly suitable for regions without large cities and specific HIV diagnostic services.

Predictors of advanced disease and late presentation in new HIV diagnoses reported to the surveillance system in Spain.

OBJECTIVE: To present surveillance data on advanced disease (AD) and late presentation (LP) of HIV in Spain and their determinants. METHODS: We included all new HIV diagnoses notified by the autonomous regions that consistently reported such cases throughout the period 2007-2011. Coverage was 54% of the total Spanish population. Data sources consisted of clinicians, laboratories and medical records. AD was defined as the presence of a CD4 cell count <200cells/µL in the first test after HIV diagnosis, while LP was defined as the presence of a CD4 cell count <350cells/µL after HIV diagnosis. Odds ratios and their 95% confidence intervals (OR, 95% CI) were used as the measure of association. Logistic regressions were fit to identify predictors of AD and LP. RESULTS: A total of 13,021 new HIV diagnoses were included. Among these, data on the outcome variable were available in 87.7%. The median CD4 count at presentation was 363 (interquartile range, 161-565). Overall, 3356 (29.4%) patients met the definition of AD and 5494 (48.1%) were classified as LP. Both AD and LP increased with age and were associated with male sex and infection through drug use or heterosexual contact. All immigrants except western Europeans were more prone to AD and LP. Multivariate models disaggregated by sex showed that the effect of age and region of origin was weaker in women than in men. CONCLUSIONS: Despite universal health care coverage in Spain, men, immigrants and people infected through drug use or heterosexual contact seem to be experiencing difficulties in gaining timely access to HIV care.