Who fails to return within 30 days after being tested positive for HIV/STI in a free testing centre?

BACKGROUND: Some patients who test positive for sexually transmitted infections (STIs) fail to return for results and treatment. To target improvement actions, we need to find out who these patients are. This study aimed to explore factors associated with failure to return within 30 days (FTR30) after testing among patients with positive results in a free STI testing centre in Paris. METHODS: All patients with at least one positive result between October 2016 and May 2017 and who completed a self-administered questionnaire were included in this cross-sectional study (n = 214). The questionnaire included sociodemographic factors, sexual behaviour and history of testing. Factors associated with FTR30 were assessed using logistic regression models. RESULTS: More than two-thirds of patients were men (72%), and the median age of patients was 27 years. Most patients were born in metropolitan France (56%) or in sub-Saharan Africa (22%). Men who had sex with men represented 36% of the study population. The FTR30 rate was 14% (95% CI [10-19%]). In multivariate analysis, previous HIV testing in younger persons (aOR: 3.36, 95% CI [1.27-8.84]), being accompanied by another person at the pretest consultation (aOR: 3.45, 95% CI [1.36-8.91]), and lower self-perceived risk of HIV infection (aOR: 2.79, 95% CI [1.07-7.30]) were associated with a higher FTR30. Testing for chlamydia/gonorrhoea without presumptive treatment was associated with a lower FTR30 (aOR: 0.21, 95% CI [0.07-0.59]). CONCLUSIONS: These factors that affect failure to return are related to the patient's representations and involvement in the STI screening process. Increasing health literacy and patient empowerment could help to decrease failure to return after being tested positive for HIV/STI. TRIAL REGISTRATION: Not applicable.

Text Messaging After HIV and Sexually Transmitted Infection Screening: Do Patients' Profiles Matter?

BACKGROUND: Text messaging after sexually transmitted infection (STI)/HIV screening may be a cost-effective means of improving patient care, but it may not be appropriate for all patients. This study aimed to explore the profiles of patients who did not participate in a short message service (SMS) program after STI/HIV testing. METHODS: In October 2016, 396 patients in Paris were screened for STI/HIV and were invited to complete an anonymous self-administered questionnaire. Patients were offered the possibility of being notified by SMS after testing, 68% accepted (SMS group) and 32% did not (no-SMS group). Each of the 100 patients from the no-SMS group who had completed the questionnaire was matched with the next patient from the SMS group. Factors associated with nonparticipation in the SMS program were studied using conditional logistic regression models. RESULTS: Participation in the SMS program was not related to STI screening characteristics (screening results and seriousness of the diseases screened) but seemed to be related to patient characteristics. In multivariate analysis, compared with patients in the SMS group, those in the no-SMS group were more often older, socially less favored (born in Africa or Asia, no university diploma, living outside Paris). They also more often declined to answer sexual questions, which could reflect a need for privacy and discretion. CONCLUSIONS: Although SMS after STI/HIV screening is well accepted, it does not suit all patients. Several contact options should be proposed to comply with patients' preferences and to reduce the risk of nondelivery of STI screening results.

[Management and follow-up of patients treated with antiretroviral prophylaxis: an evaluation of professional practices]. / Prise en charge et suivi des patients traités par prophylaxie antirétrovirale : évaluation des pratiques professionnelles.

The care management of patients treated for cases of sexual or blood exposure requires stringent clinical and biological follow-up procedures. Despite the provision of information about the importance of regular follow-up, the number of patients dropping out of screening consultations at the Hospital Lariboisière-Fernand Widal (Assistance Publique-Hôpitaux de Paris) has increased. The main purpose of this study is to improve follow-up for patients treated with anti-retroviral prophylaxis following a known sexual or blood exposure. An investigation based on 5 markers of a targeted clinical audit form ("drop-outs" or lost to follow-up, conduct of HIV serology tests, traceability of clinical, biological and compliance monitoring) was carried out. A review of practices was conducted on the basis of an analysis of patient cases over a six-month period, followed by the implementation and evaluation of corrective measures over a two-year period. A significant decline in the number of patients lost to follow-up was observed. The study shows a significant improvement in other markers: serological follow-up, compliance traceability, and clinical and biological monitoring. These results were observed between 2005 and 2007. Two distinctive effects were identified: improvement in patient care management and the quality of care, and the empowerment of actors, thereby ensuring a certain continuity of action. The decline in the rate of lost to follow-up patients and improved monitoring of compliance and iatrogenic risks confirm these effects. The overall approach is incorporated into an evaluation of professional practices.

[Anonymous and free screenings: population comparison between those conducted on-site in a testing centre and those done off-site]. / Dépistages anonymes et gratuits: comparaison de la population rencontrée en centre et en dehors des locaux.

The free and anonymous HIV testing centre of Fernand Widal Hospital (CDAG) regularly organises off-site visits to distribute information and provide screening for people at high risk in the community. To demonstrate the benefits of this action, this at-risk targeted population in the community was compared with that which comes to the centre. The individuals screened during the community off-site visits in 2005 were recorded. An equivalent number of patients coming spontaneously to the centre for screening were used as a reference point for comparison. The socio-demographic characteristics, the delay in time between the screening and return to the CDAG for the results and the screening results of the number of people infected were analysed. In total, 427 persons out of 443 were screened in 14 visits: 7,7% of persons tested off-site were infected versus 5,4% of those screened at the centre. Those who were tested off-site were in most cases infected with Hepatitis C, whereas HIV was more prevalent in those who had come to the CDAG centre. The African population (53,6%) was more significantly affected. Even when their results were positive (83,3%), 34,2% of patients tested off-site did not come to get their results versus only 8,2% of those who had come to the hospital centre for testing. The off-site community visits strengthen the role and the capacity of the CDAG to fulfil its mission because high-risk individuals are much less likely to come to the centre for screening. However measures must be taken and procedures established to improve the process and opportunity for results to be returned to the individuals, as well as follow-up and management of those who test positive for infection.