1. Missed opportunities for HIV testing in patients newly diagnosed with HIV in Morocco
- Author
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Kamal Marhoum El Filali, Noura Tassi, Rajaa Bensghir, Victoire Sawras, L. Marih, Karen Champenois, Didier Laureillard, Juliette Pavie, Mourad Malmoussi, Mustapha Sodqi, Laurence Weiss, Ahd Oulad Lahsen, Samira Nani, CHU Ibn Rochd [Casablanca], Infection, Anti-microbiens, Modélisation, Evolution (IAME (UMR_S_1137 / U1137)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, Université Sorbonne Paris Nord, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de recherche sur l'Inflammation (CRI (UMR_S_1149 / ERL_8252 / U1149)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Paris (UP), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Centre Hospitalier Universitaire Hassan II (CHU HII), Centre Hospitalier Universitaire Mohammed VI [Marrakech, Morocco] (CHUMVI), Faculté De Médecine Et De Pharmacie [Casablanca, Morocco] (FMP), Centre Hospitalier Universitaire de Nîmes (CHU Nîmes), Immunologie humaine, physiopathologie & immunothérapie (HIPI (UMR_S_976 / U976)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP), Université Paris Descartes - Paris 5 (UPD5), Université Sorbonne Paris Cité (USPC), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Paris Cité (UPCité), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité), and Malbec, Odile
- Subjects
Adult ,Male ,medicine.medical_specialty ,Sexual Behavior ,[SDV]Life Sciences [q-bio] ,030231 tropical medicine ,HIV indicator conditions ,Hiv testing ,Men who have sex with men ,lcsh:Infectious and parasitic diseases ,Missed opportunities ,03 medical and health sciences ,Sexual and Gender Minorities ,0302 clinical medicine ,Medical microbiology ,Risk-Taking ,Acquired immunodeficiency syndrome (AIDS) ,Late HIV diagnosis ,Surveys and Questionnaires ,medicine ,Prevalence ,Humans ,Mass Screening ,Medical history ,In patient ,lcsh:RC109-216 ,030212 general & internal medicine ,Medical diagnosis ,Homosexuality, Male ,Heterosexuality ,Acquired Immunodeficiency Syndrome ,business.industry ,HIV ,virus diseases ,Key populations ,medicine.disease ,3. Good health ,Test (assessment) ,HIV testing ,[SDV] Life Sciences [q-bio] ,Morocco ,Infectious Diseases ,Cross-Sectional Studies ,Family medicine ,Female ,business ,Research Article - Abstract
Background In Morocco, of the estimated 29,000 people living with HIV in 2011, only 20% were aware of their HIV status. More than half of diagnoses were at the AIDS stage. We assumed that people who were unaware of their infection had contacts with the healthcare system for HIV indicators that might prompt the healthcare provider to offer a test. The aim was to assess missed opportunities for HIV testing in patients newly diagnosed with HIV who accessed care in Morocco. Methods A cross-sectional study was conducted in 2012–2013 in six Moroccan HIV centers. Participants were aged ≥18, and had sought care within 6 months after their HIV diagnosis. A standardized questionnaire administered during a face-to-face interview collected the patient’s characteristics at HIV diagnosis, HIV testing and medical history. Contacts with care and the occurrence of clinical conditions were assessed during the 3 years prior to HIV diagnosis. Over this period, we assessed whether healthcare providers had offered HIV testing to patients with HIV-related clinical or behavioral conditions. Results We enrolled 650 newly HIV-diagnosed patients (median age: 35, women: 55%, heterosexuals: 81%, diagnosed with AIDS or CD4 3: 63%). During the 3 years prior to the HIV diagnosis, 71% (n = 463) of participants had ≥1 contact with the healthcare system. Of 323 people with HIV-related clinical conditions, 22% did not seek care for them and 9% sought care and were offered an HIV test by a healthcare provider. The remaining 69% were not offered a test and were considered as missed opportunities for HIV testing. Of men who have sex with men, 83% did not address their sexual behavior with their healthcare provider, 11% were not offered HIV testing, while 6% were offered HIV testing after reporting their sexual behavior to their provider. Conclusions Among people who actually sought care during the period of probable infection, many opportunities for HIV testing, based on at-risk behaviors or clinical signs, were missed. This highlights the need to improve the recognition of HIV clinical indicators by physicians, further expand community-based HIV testing by lay providers, and implement self-testing to increase accessibility and privacy.
- Published
- 2021
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