Work

Use of healthcare services preceding HIV diagnosis – missed opportunities for earlier diagnosis, Finland, 1996 to 2019

Year: 2025

Type: article

Abstract: BackgroundHIV testing based on indicator conditions is recommended to diagnose HIV earlier.AimOur aim was to assess opportunities for earlier diagnosis of HIV.MethodThis is a retrospective study on people living with HIV (PLWH) included in the national HIV register. We collected data on public primary outpatient healthcare (PHC) (2011-2019), secondary and tertiary outpatient healthcare (STHC), and all inpatient care (1996-2019) from the Care Register for Health Care from the presumed acquisition, estimated by CD4+ T-cell count at diagnosis, until the diagnosis of HIV.ResultsOf 907 PLWH diagnosed between 2011 and 2019, 522 (58%) had ≥ 1 healthcare contact at any level between HIV acquisition and > 30 days before diagnosis. At least one European Centre for Disease Prevention and Control (ECDC) indicator condition was recorded for 119 (23% of 522), and 112 (21%) were born in a high-prevalence country. In total, 384 of 907 (42%) had visited a PHC physician, and 58% of those with CD4+ T-cell count < 200 cells/μL at diagnosis. Of 2,082 PLWH diagnosed between 1996 and 2019, 869 (42%) had STHC outpatient contacts > 30 days before diagnosis, 18% with ≥ 1 ECDC indicator condition, and 367 (18%) had been hospitalised, 20% with ≥ 1 ECDC indicator condition. The most common ECDC indicator conditions > 30 days before diagnosis at all levels of healthcare were pneumonia, sexually transmitted infections, unexplained fever, herpes zoster, pregnancy and lymphadenopathy.ConclusionWe recommend enhancing indicator condition-based HIV testing by all healthcare providers, particularly for gonorrhoea, syphilis and, for persons younger than 50 years, also herpes zoster and lymphadenopathy.

Source: Eurosurveillance

DOI: 10.2807/1560-7917.es.2025.30.18.2400610