Summary

Missed opportunities for in-hospital diagnosis of HIV infection in patients with delayed diagnoses from 2015 through 2021

Melisa Hernández-Febles¹, Eduardo Lagarejos¹, Miguel Ángel Cárdenes Santana², Rafael Granados Monzón², José Antonio Pavón³, María José Pena López¹

Affiliation of the authors

¹Servicio de Microbiología, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de GC, Spain. ²Unidad de Enfermedades Infecciosas, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de GC, Spain. ³Servicio de Urgencias, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de GC, Spain.

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Hernández-Febles M, Lagarejos E, Cárdenes Santana MA, Granados Monzón R, Pavón JA, Pena López MJ. Missed opportunities for in-hospital diagnosis of HIV infection in patients with delayed diagnoses from 2015 through 2021. Rev Esp Urg Emerg. 2023;2:65–9

Summary

BACKGROUND AND OBJECTIVE. Unrecognized or late-diagnosed HIV infections create problems for the control of the epidemic and for the health of individuals. This study aimed to identify the rate of missed chances for in-hospital diagnosis of HIV infection in patients finally found to have an advanced stage of infection.
MATERIAL AND METHODS. Retrospective descriptive study including all patients diagnosed with HIV infection between 2015 and 2021 in our catchment area. Late-diagnosed cases were reviewed to determine the reasons the patients sought care in the 3 years prior to diagnosis and evaluating whether visits were missed opportunities for detecting HIV infection.
RESULTS. A total of 358 patients were diagnosed late; 145 (40.5%) of them were diagnosed late in the disease. We identified 139 missed chances to detect HIV infection in 62 (42.8%) of the late-diagnosed patients. Missed chances occurred more than once for 37 (59.7%) of these patients. On average, 15.8 months passed between the first chance of detection and the diagnosis. In 51.8% of the visits before diagnosis, the patient had presented a defining, indicator, or associated condition for HIV infection, and the chance to offer routine testing was missed in 48.2%. The emergency department was the location of the majority of missed chances, with 76 of the lost opportunities (54.7%) in 49 (79%) patients.
CONCLUSIONS. In over 40% of patients diagnosed late, the chance for in-hospital detection of HIV infection in-hospital was missed during the 3 years prior to diagnosis. Good medical practice calls for HIV screening in certain clinical scenarios. Our findings reveal a need to implement new tools for improving the situation identified in this study.