HIDES 1&2 / Guidance: HIV Indicator Conditions / Testing Audit Tool

The HIV in Europe HIV Testing Audit Tool

This tool is a service to hospital departments and clinics to monitor the HIV screening of patients presenting with HIV indicator conditions in their clinics/departments. All indicator conditions listed in the audit tool have a confirmed HIV prevalence of > 0.1%. To use the tool, patient journals are reviewed retrospectively. How many patients presenting with one of the below indicator conditions and who were not yet known to be HIV positive, were offered and accepted an HIV test. Within a period of one year retrospectively, i.e. from 01-01-2016 to 01-01-2015, or >100 consecutive patients.

Click here to access the audit tool.

Data is submitted to the HIV in Europe secretariat and is not publically accessible, the person responsible for the audit allows for the data to be used in meta-analysis of the situation across the continent. Study proposals using this data can be submitted to hie.rigshospitalet@regionh.dk.

 

 

Introduction
The concept of indicator disease guided testing is an approach by which health care practitioners can be encouraged to test more patients based on suspicion of HIV. Little evidence on HIV prevalence exists for various conditions and diseases where HIV prevalence is thought to be higher than in the general population

HIDES 1 
Final results from HIDES phase 1
Presentation from EACS, Belgrade, October 2011

Other presentations from HIDES phase 1
Presentation from the HIV in the European Region Conference, Tallinn, May 2011

Presentation from the 10th International Congress on Drug Therapy in HIV Infection, Glasgow, November 2010, by Anders Sönnerborg

Enrollment by 15 June 2010


Presentation from the HIV in Europe 2009 Stockholm Conference, by Antonella D'Arminio Monforte


Introduction

The concept of indicator disease guided testing is an approach by which health care practitioners can be encouraged to test more patients based on suspicion of HIV. Little evidence on HIV prevalence exists for various conditions and diseases where HIV prevalence is thought to be higher than in the general population.

Objectives
The HIV in Europe pilot study assessed HIV prevalence in 8 indicator diseases in specific populations. The study included 17 centres in 14 countries and enrolled 7000 people presenting with an indicator disease.

Potential indicator diseases surveyed in the pilot phase:
Sexually Transmitted Diseases
Malignant Lymphoma
Cervical or anal dysplasia or cancer
Herpes Zoster
Hepatitis B or C virus infection
Ongoing mononucleosis-like illness
Leukocytopenia or thrombocytopenia
Seborrheic dermatitis / exanthema

Study Documents
Protocol
Analysis plan, May 2010

Newsletters
December 2009

HIDES 2 (HIV Indicator Diseases Across Europe Study) 
2011-2015

The HIDES study aims at developing focused HIV testing in patients presenting with certain clinical conditions and/or diseases.

Study aims:

1. Implement surveys to assess HIV prevalence for one or more diseases and/or conditions within a specific segment of the population not yet diagnosed with HIV and that present for care with the specific disease/condition.

  1. Presenting for care of malignant lymphoma, irrespective of type - patient information leaflet template
  2. Presenting for care of cervical or anal dysplasia or cancer, (Cervical CIN II and above) - patient information leaflet template CC - patient information leaflet template AC
  3. Presenting for care of Hepatitis B or C virus infection (acute or chronic – and irrespective of time of diagnosis relative to time of survey),
  4. Presenting with ongoing mononucleosis-like illness -patient information leaflet template
  5. Presenting with unexplained leukocytopenia or thrombocytopenia lasting at least 4 weeks -patient information leaflet template 
    Procedures for capturing data for ongoing mononucleosis-like illness from the laboratory
  6. Presenting with seborrheic dermatitis / exanthema -patient information leaflet template
  7. Presenting with pneumonia,  admitted to hospital for at least 24h  - patient information leaflet template
  8. Presenting with unexplained lymphadenopathy - patient information leaflet template
  9. Presenting with peripheral neuropathy of unknown cause (diagnosed by neurologist) - patient information leaflet template
  10. Presenting with primary lung cancer - patient information leaflet template
  11. Presenting with severe or recalcitrant psoriasis (newly diagnosed) - patient information leaflet template

2. Launch, implement and evaluate an audit system of the performance of HIV testing of persons presenting with a condition which has already been established as an indicator for HIV testing.

  1. Tuberculosis
  2. Non-hodgkin’s lymphoma
  3. Anal cancer
  4. Cervical cancer
  5. Hep B and C
  6. Candida esophagitis

HIDES2 presentation: 14th European Aids Conference, Friday 18th October 2013 in Brussels

Questionnaire - all participating centres

How to get involved  

Call for Collaboration

Newsletter - September 2012

Newsletter - March 2013

Newsletter - May 2013

Study documents
Protocol version 1.1, English
Protocol version 1.1, German
Protocol version 1.1, French
Protocol version 1.1, Spanish
Protocol version 1.1, Portuguese
Protocol version 1.1, Dutch
Protocol version 1.1, Russian

Instructions for auditing of HIV testing, English
Instructions for auditing of HIV testing, German
Instructions for auditing of HIV testing, French
Instructions for auditing of HIV testing, Spanish
Instructions for auditing of HIV testing, Portuguese
Instructions for auditing of HIV testing, Dutch
Instructions for auditing of HIV testing, Russian

HepHIV2014 Conference, Barcelona 5-7 October
HIDES Press release, 6 October 2014

English version
Russian version

Guidance: HIV Indicator Conditions
The objectives of the guidance are to:
• Encourage and support the inclusion of indicator condition-guided HIV testing in national HIV testing strategies, taking into account the local HIV prevalence, ongoing testing programmes and the local healthcare setting;
• Recommend approaches and practical tools for education and training of healthcare professionals on overcoming barriers to recommending an HIV test.

HIV indicator conditions can be divided into 3 categories:
1. Conditions which are AIDS defining among PLHIV;
2. Conditions associated with an undiagnosed HIV prevalence of >0.1%;
3. Conditions where not identifying the presence of HIV infection may have significant adverse implications for the individual’s clinical management.

There is a large body of  evidence from randomised controlled trials on the consequences of not treating people living with HIV who have AIDS defining conditions. Not recommending a test in these circumstances would not be considered good clinical practice. Routine testing for conditions with an HIV prevalence of >0.1% has been reported to be cost-effective and has the potential to increase earlier diagnosis of HIV, and thus lead to earlier opportunities for care and treatment.

Recommendations:
• Any person (without an HIV-positive test in the patient’s medical record) presenting with potentially AIDS defining conditions should be strongly recommended HIV testing.
• Any person presenting with a condition with an undiagnosed HIV prevalence of >0.1% should be strongly recommended HIV testing. 
• For indicator conditions where expert opinion considers HIV prevalence likely to be >0.1%, but awaiting further evidence, it is recommended to offer testing.
• For conditions where not identifying the presence of HIV infection may have significant adverse implications for the individual’s clinical management, testing should be offered to avoid further immune suppression with potentially serious adverse outcomes for the individual, and to maximize the potential response to the treatment of the indicator condition (despite that the estimated prevalence of HIV is most likely lower than 0.1%).   

Guidance document: HIV Indicator Conditions: Guidance for Implementing HIV Testing in Adults in Health Care Settings (update coming soon)

Please find below an executive summary/ short version of the Guidance document translated into other languages. If you find any mistakes in the translation for your language, please contact the HIV in Europe Secretariat hie.rigshospitalet@regionh.dk

Guidance in short - English

Guidance in short - Albanian

Guidance in short - Arabic

Guidance in short - Bosnian

Guidance in short - Bulgarian

Guidance in short - Croatian

Guidance in short - Czech

Guidance in short - Danish

Guidance in short - Estonian

Guidance in short - Finnish

Guidance in short - French

Guidance in short - German 

Guidance in short - Greek

Guidance in short - Hebrew

Guidance in short - Hungarian

Guidance in short - Icelandic

Guidance in short - Italian

Guidance in short - Lithuanian

Guidance in short -Macedonian

Guidance in short - Maltese

Guidance in short - Norwegian

Guidance in short - Polish

Guidance in short - Romanian

Guidance in short - Russian

Guidance in short - Serbian

Guidance in short - Spanish

Guidance in short - Slovak

Guidance in short - Slovenian

Guidance in short - Swedish

Guidance in short - Turkish

Pdf-version (coming soon)

Appendix 4: Example of patient information leaflet (coming soon)

Appendix 5: Example of presentation of guidance (coming soon)

Appendix 6: Template letter to the editor (coming soon)

Contact
For more information, please contact Project Coordinator:Dorthe Raben
Rigshospitalet, University of Copenhagen
CHIP, Department of Infectious Diseases
Section 2100, Finsencentret
Blegdamsvej 9
DK-2100 Copenhagen Ø
Denmark
Tel: +45 35 45 57 82
Fax: +45 35 45 57 58
E-mail: dorthe.raben@regionh.dk