Burden of HIV infection, vulnerable populations and access barriers to healthcare. / Magnitud de la infección por VIH, poblaciones vulnerables y barreras de acceso a la atención sanitaria.

In Spain, HIV incidence has remained stable and higher than the European average since 2000 due to insuf-ficient prevention measures. An estimated 130,000-160,000 people are believed to be living with HIV in Spain, including 18% who do not know they are infected, and half are late diagnoses, with a poorer clinical course, lower quality of life and life expectancy, as well as higher costs. Late diagnosis is more common in heterosexuals, intravenous drug users, people over 50 years of age and immigrants, whereas men who have sex with men are the only group where the rate of new diagnoses is increasing. An estimated 34% of people with HIV have a detectable viral load, mainly due to barriers that hinder diagnosis such as insufficient testing availability and the low risk perception of undiagnosed individuals and healthcare professionals.

A feasibility study for 3 strategies promoting HIV testing in primary health care in Madrid, Spain (ESTVIH project).

RATIONALE AND OBJECTIVES: Late diagnosis of HIV infection is a public health problem. Framed by the international guidelines for improving HIV testing, in 2014, the Spanish Ministry of Health published a guide of recommendations to promote early diagnosis of HIV in health care settings. In the Community of Madrid, in order to implement these recommendations, we defined 3 new HIV testing strategies in primary health care. The objectives of this study were to know the interest of professionals and the acceptability for patients towards these strategies. METHODS: We performed a quasi-experimental study to assess the feasibility of the implementation of new strategies (indicator condition, risk based, and universal offer) to promote early detection of HIV infection in the framework of the ESTVIH project. The centres participating in this project were randomly chosen among centres located in the health areas with the highest incidence of HIV infection. The feasibility was assessed in 6 centres. We considered outcomes by strategy in relation to the participation of professionals (family physician and nursing) and patients. RESULTS: Overall, 56.9% of eligible professionals agreed to take part in the study; however, the percentage of professionals who recruited patients was 25.9%. This percentage was higher in the indicator condition strategy (47.2%, versus 18.5% in the universal offer and 14.3% in the risk-based strategy, P-value < 0.05). The test uptake percentage was greater than 80%, and there were no statistically significant differences between strategies. CONCLUSION: Different strategies promoting HIV testing in primary care had different acceptability among professionals and similar among patients. At the end of the ESTVIH project, these results will be complemented with others related to the contribution of each strategy to improving the early diagnosis of HIV infection.

Targeted rapid HIV testing in public primary care services in Madrid. Are we reaching the vulnerable populations?

OBJECTIVES: To describe the population targeted for the rapid HIV testing program delivered via socio-culturally adapted services in primary care centers and to assess factors associated with uptake of first-time testing. METHODS: This was a descriptive cross-sectional study. We analyzed consultations between April 29, 2010 and May 31, 2012. We assessed the differences in age, origin, education, and sexual history between men who have sex with men (MSM), heterosexual men (HM), and women, using a two-sided independent t-test and Chi-square statistics. Factors associated with first-time testing were analyzed by logistic regression. RESULTS: Of 1940 consultations, 45.1% were HM, 25.4% MSM, and 29.5% women; 35.4% were immigrants, 2.5% were or had been sex workers, and 15.4% had visited one. The test was reactive in 2.1%. Up to 44.2% had never been tested. The probability of being tested for the first time increased in HM, women, populations from the Indian Subcontinent, those with no casual sexual partners, those whose partner's serostatus was unknown, and those with no history of other sexually transmitted infections. CONCLUSIONS: This program managed to reach a high proportion of vulnerable people. First time HIV testing rates were high.

Magnitud de la infección por VIH, poblaciones vulnerables y barreras de acceso a la atención sanitaria / Burden of HIV infection, vulnerable populations and access barriers to healthcare

En España, los esfuerzos realizados en la prevención del VIH han sido insuficientes y, desde el año 2000, su incidencia permanece estable, por encima de la media europea. Se estima que en España viven entre 130.000 y 160.000 personas con VIH; de ellas, el 18% desconoce estar infectado y la mitad recibe el diagnóstico de forma tardía, lo que conlleva peor evolución, menor esperanza y calidad de vida, y mayores costes. El retraso diagnóstico es mayor en heterosexuales, usuarios de drogas inyectadas, mayores de 50 años e inmigrantes, mientras que los hombres que tienen sexo con hombres son el único grupo donde aumentan los nuevos diagnósticos. Se estima que hasta el 34% de las personas con VIH presentan carga viral detecta-ble, principalmente debido a barreras que dificultan su diagnóstico, como el insuficiente acceso a la prueba y la baja percepción del riesgo tanto por personas que desconocen estar infectadas como por los profesionales

In Spain, HIV incidence has remained stable and higher than the European average since 2000 due to insuf-ficient prevention measures. An estimated 130,000-160,000 people are believed to be living with HIV in Spain, including 18% who do not know they are infected, and half are late diagnoses, with a poorer clinical course, lower quality of life and life expectancy, as well as higher costs. Late diagnosis is more common in heterosexuals, intravenous drug users, people over 50 years of age and immigrants, whereas men who have sex with men are the only group where the rate of new diagnoses is increasing. An estimated 34% of people with HIV have a detectable viral load, mainly due to barriers that hinder diagnosis such as insufficient testing availability and the low risk perception of undiagnosed individuals and healthcare professionals