HIV testing practices as reported by HIV-infected patients in four European countries

Abstract

HIV testing constitutes an important strategy to control the HIV epidemic, which therefore merits an observation of HIV testing practices to help improve testing effectiveness. In 2008, a cross-sectional survey among recently diagnosed (≤ 3 years) HIV-infected patients was conducted in Belgium, Estonia, Finland and Portugal. Participants were questioned about reasons for HIV testing, testing place and testing conditions. Univariate and multivariate analyses were performed. Out of 1460 eligible participants, 629 (43%) were included. Forty-one per cent were diagnosed late and 55% had never undergone a previous HIV test with perceived low risk being the primary reason for not having been tested earlier. Heterogeneity in HIV testing practices was observed across countries. Overall, tests were most frequently conducted in primary care (38%) and specialised clinics (21%), primarily on the initiative of the health care provider (65%). Sixty-one per cent were tested with informed consent, 31% received pretest counselling, 78% received post-test counselling, 71% were involved in partner notification and 92% were in care three months after diagnosis. The results showed that HIV testing is done in a variety of settings suggesting that multiple pathways to HIV testing are provided. HIV testing practice is being normalised, with less focus on pretest counselling, yet with emphasis on post-test follow-up. Major barriers to testing are centred on the denial of risk. Efforts are needed to concurrently promote public awareness about HIV risk and benefits of HIV testing and train clinicians to be more proactive in offering HIV testing.

Keywords:

• HIV infection
• testing
• Europe
• late diagnosis
• barriers
• prevention

Acknowledgements

The study on HIV testing practices in Europe was funded by the European Centre for Disease Prevention and Control (ECDC)–contract EDC.636: Assessment of HIV testing in Europe: from policies to effectiveness. Opinions expressed are those of the authors only and do not represent the ECDC's official position. We acknowledge the contribution of Minna Nikula, Hannamaria Kuusio and Tomasz Niemiec in the questionnaire development and data collection. We sincerely thank the direction and staff from the different recruitment sites for their willingness to participate in this study: AIDS Reference Centre, University Hospital Ghent, Ghent, Belgium; AIDS Reference Centre, University Hospital Saint Pierre, Brussels, Belgium; AIDS Reference Centre, University Hospital Liège, Liège, Belgium; Merimetsa Infectious Diseases Centre of the West Tallinn Central Hospital, Tallinn, Estonia; Infectious Diseases Centre of the North-Eastern Central Hospital, Puru, Estonia; Estonian Network of People Living with HIV, Tallinn, Estonia; Infectious Disease Department of the Helsinki University Hospital, Helsinki, Finland; Infectious Diseases Department of the São João Hospital, Porto, Portugal; Infectious Diseases Department of the Joaquim Urbano Hospital, Porto, Portugal; Infectious Diseases Department of the Santa Maria Hospital, Lisbon, Portugal; Finally, we thank all study participants for their invaluable contribution.