Researchers from Boston University School of Medicine (BUSM) have shown that missed opportunities for addressing HIV testing remain unacceptably high when patients seek medical care in the period before their HIV diagnosis.
The researchers, led by Jeffrey Samet, MD, professor of medicine at BUSM and chief of General Internal Medicine at Boston Medical Center (BMC), performed a 10-year retrospective chart review of patients seen at an HIV intake clinic between January 1994 and June 2001 who: 1) tested positive for HIV during the 12 months prior to their presentation at the intake clinic and 2) had one or more encounters recorded in the medical record prior to their HIV positive status.
Among the 221 patients meeting eligibility criteria, all had at least one trigger for HIV testing found in a prior encounter note. Of the 3424 encounters reviewed, triggers were found in 50 percent of these medical visits. HIV was addressed in 27 percent of visits in which triggers were identified.
According to Samet, while missed opportunities for addressing these triggers still remain high, despite improvement in testing in recent years, variation by site of care remained important. “In particular, the emergency department merits consideration for increased resource commitment to facilitate HIV testing,” said Samet. Lastly, in order to detect HIV infection prior to advanced immunosuppression, clinicians must become more aware of clinical triggers that suggest a patient’s increased risk for this infection and lower the threshold at which HIV testing is recommended.