Inghels, M., Niangoran, S., Minga, A., et al. PLOS ONE (October 2017), 12(10), doi:e0185117.
This study examined types of missed opportunities for HIV testing among 273 recently diagnosed individuals who had previously attended clinical appointments in Abidjan. A missed opportunity was defined as a medical consultation for a clinical indicator (symptoms, hospitalization, or pregnancy) or a nonclinical indicator (high-risk sex and an HIV-positive partner). The most common reasons for HIV testing were illness (41.7%) and voluntary testing without illness (31.7%). Among participants, 159 reported a total of 312 indicators, with a median of 17 months between the missed opportunity and HIV diagnosis. Two-thirds of reported indicators (216) were testing opportunities; in 67.6 percent of these were missed opportunities, because testing was not proposed. The most common clinical indicators for missed opportunities were hospitalization, unexplained weight loss, chronic or repeat fever, and herpes zoster. The most common nonclinical indicators were having unprotected sex and having an HIV-positive partner. Patients with missed opportunities had lower CD4 cell counts, were diagnosed at later disease stages, had lower hemoglobin concentrations, and were more likely to be diagnosed with HIV due to illness. The authors concluded that HIV testing should be offered more often in clinical settings and in response to the presence of HIV-related illnesses or symptoms. In-depth assessments of patient’s nonclinical indicators should also be routinely conducted.