Promoting HIV indicator condition-guided testing in hospital settings (PROTEST 2.0): study protocol for a multicentre interventional study

BMC Infectious Diseases, vol. 21, pp. 519

Abstract

BACKGROUND: Late presentation remains a key barrier towards controlling the HIV epidemic. Indicator conditions (ICs) are those that are AIDS-defining, associated with a prevalence of undiagnosed HIV > 0.1%, or whose clinical management would be impeded if an HIV infection were undiagnosed. IC-guided HIV testing is an effective strategy in identifying undiagnosed HIV, but opportunities for earlier HIV diagnosis through IC-guided testing are being missed. We present a protocol for an interventional study to improve awareness of IC-guided testing and increase HIV testing in patients presenting with ICs in a hospital setting. METHODS: We designed a multicentre interventional study to be implemented at five hospitals in the region of Amsterdam, the Netherlands. Seven ICs were selected for which HIV test ratios (proportion of patients with an IC tested for HIV) will be measured: tuberculosis, cervical/vulvar cancer or high-grade cervical/vulvar dysplasia, malignant lymphoma, hepatitis B and C, and peripheral neuropathy. Prior to the intervention, a baseline assessment of HIV test ratios across ICs will be performed in eligible patients (IC diagnosed January 2015 through May 2020, ≥18 years, not known HIV positive) and an assessment of barriers and facilitators for HIV testing amongst relevant specialties will be conducted using qualitative (interviews) and quantitative methods (questionnaires). The intervention phase will consist of an educational intervention, including presentation of baseline results as competitive graphical audit and feedback combined with discussion on implementation and opportunities for improvement. The effect of the intervention will be assessed by comparing HIV test ratios of the pre-intervention and post-intervention periods. The primary endpoint is the HIV test ratio within ±3 months of IC diagnosis. Secondary endpoints are the HIV test ratio within ±6 months of diagnosis, ratio ever tested for HIV, HIV positivity percentage, proportion of late presenters and proportion with known HIV status prior to initiating treatment for their IC. DISCUSSION: This protocol presents a strategy aimed at increasing awareness of the benefits of IC-guided testing and increasing HIV testing in patients presenting with ICs in hospital settings to identify undiagnosed HIV in Amsterdam, the Netherlands. TRIAL REGISTRATION: Dutch trial registry: NL7521 . Registered 14 February 2019.

Authors 84

1. S Bogers corresponding

   Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, room D3-226, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands. s.j.bogers@amsterdamumc.nl

   Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, room D3-226, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands

2. Maarten F. Schim van der Loeff

   GGD Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands

   Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, room D3-226, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands

3. Udi Davidovich

   GGD Amsterdam

   Affiliation as printed

   Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands

4. Anders C. Boyd

   Stichting HIV Monitoring · GGD Amsterdam

   Affiliation as printed

   Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands

   HIV Monitoring Foundation, Amsterdam, the Netherlands

5. Marc van der Valk

   Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, room D3-226, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands

6. Kees Brinkman

   OLVG

   Affiliation as printed

   Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands

7. Godelieve J. de Bree

   Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, room D3-226, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands

8. PETER C. REISS

   Stichting HIV Monitoring · Amsterdam Institute for Global Health and Development · Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands

   Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands

   Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, room D3-226, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands

   HIV Monitoring Foundation, Amsterdam, the Netherlands

9. Jan E A M van Bergen

   Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

   Affiliation as printed

   Department of General Practice, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

   STI AIDS Netherlands, Amsterdam, the Netherlands

10. Suzanne E. Geerlings

    Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, room D3-226, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands

11. Pieter A. R. Brokx

    Stichting HIV Monitoring

    Affiliation as printed

    HIV Monitoring Foundation, Amsterdam, the Netherlands

12. Febe Deug

    GGD Amsterdam

    Affiliation as printed

    Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands

13. Michiel Heidenrijk

    Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Department of General Practice, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

14. Jan M. Prins

    Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Department of General Practice, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

15. Godelieve J. de Bree

    Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, room D3-226, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands

16. Elske Hoornenborg
    Affiliation as printed

    STI AIDS Netherlands, Amsterdam, the Netherlands

17. Ard van Sighem
18. Wim Zuilhof

    GGD Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands

    Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands

19. Nina Schat
    Affiliation as printed

    STI AIDS Netherlands, Amsterdam, the Netherlands

20. Roel Achterbergh

    Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, room D3-226, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands

21. Michiel A. van Agtmael
    Affiliation as printed

    STI AIDS Netherlands, Amsterdam, the Netherlands

22. Jintanat Ananworanich
    Affiliation as printed

    STI AIDS Netherlands, Amsterdam, the Netherlands

23. Diederik van de Beek

    Stichting HIV Monitoring

    Affiliation as printed

    HIV Monitoring Foundation, Amsterdam, the Netherlands

24. G.E.L. van den Berk

    GGD Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands

    Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands

25. Daniela Bezemer

    Stichting HIV Monitoring

    Affiliation as printed

    HIV Monitoring Foundation, Amsterdam, the Netherlands

26. Arjan Van Bijnen
27. Willem L. Blok
28. Marije Kristianne Bomers
    Affiliation as printed

    STI AIDS Netherlands, Amsterdam, the Netherlands

29. Charles A. Boucher
30. Wilma Brokking

    GGD Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands

    Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands

31. David Marinus Burger

    Stichting HIV Monitoring

    Affiliation as printed

    HIV Monitoring Foundation, Amsterdam, the Netherlands

32. Marijn de Bruin

    Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands

33. Sylvia Maria Bruisten

    GGD Amsterdam

    Affiliation as printed

    Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands

34. Liza Coyer
    Affiliation as printed

    STI AIDS Netherlands, Amsterdam, the Netherlands

35. Reinout van Crevel

    GGD Amsterdam · Amsterdam University Medical Centers · University of Amsterdam · Amsterdam UMC Location Vrije Universiteit Amsterdam

    Affiliation as printed

    Center of Expertise on Gender Dysphoria, Amsterdam UMC -location VUMC, Amsterdam, the Netherlands

    Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands

    Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands

36. Ceranza G. Daans

    GGD Amsterdam

    Affiliation as printed

    Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands

37. L. Dellemann
    Affiliation as printed

    STI AIDS Netherlands, Amsterdam, the Netherlands

38. Maartje Dijkstra

    GGD Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands

    Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands

39. Y. T. van Duijnhoven
    Affiliation as printed

    DC Klinieken, Amsterdam, the Netherlands

40. Arne van Eeden

    GGD Amsterdam

    Affiliation as printed

    Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands

41. Loek J. M. Elsenburg

    GGD Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands

    Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands

42. Mark A. M. van den Elshout

    GGD Amsterdam

    Affiliation as printed

    Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands

43. Carmen Cristina Ester
    Affiliation as printed

    STI AIDS Netherlands, Amsterdam, the Netherlands

44. P. E. V. Felipa

    OLVG

    Affiliation as printed

    Department of internal medicine, OLVG -location East, Amsterdam, the Netherlands

45. P. H. J. Frissen

    Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers

    Affiliation as printed

    Laboratory of Experimental Immunology, Amsterdam UMC -location AMC Amsterdam, the Netherlands

46. Teunis B. H. Geijtenbeek

    Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Department of General Practice, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

    Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC -location AMC, Amsterdam, the Netherlands

47. M. H. Godfried
    Affiliation as printed

    STI AIDS Netherlands, Amsterdam, the Netherlands

48. Jacobus Van Gool

    Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Department of General Practice, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

    Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC -location AMC, Amsterdam, the Netherlands

49. Abraham Goorhuis
    Affiliation as printed

    STI AIDS Netherlands, Amsterdam, the Netherlands

50. M. de Groot

    GGD Amsterdam

    Affiliation as printed

    Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands

51. Catherine A Hankins
    Affiliation as printed

    GP practice Heijnen & de Meij, Amsterdam, the Netherlands

    Sexology Center Amsterdam, Amsterdam, the Netherlands

52. A. Heijnen

    Stichting HIV Monitoring

    Affiliation as printed

    STI AIDS Netherlands, Amsterdam, the Netherlands

    Stichting HIV Monitoring, Amsterdam, the Netherlands

53. M Hillebregt

    GGD Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands

    Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands

54. A.A. Hogewoning
    Affiliation as printed

    STI AIDS Netherlands, Amsterdam, the Netherlands

55. M. Hommenga

    Amsterdam UMC Location University of Amsterdam · GGD Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Department of General Practice, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

    Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands

    Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands

    Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC -location AMC, Amsterdam, the Netherlands

56. Joppe W. Hovius

    Stichting HIV Monitoring

    Affiliation as printed

    HIV Monitoring Foundation, Amsterdam, the Netherlands

57. Vita Willemijn Jongen
    Affiliation as printed

    STI AIDS Netherlands, Amsterdam, the Netherlands

58. Neeltje A. Kootstra
    Affiliation as printed

    STI AIDS Netherlands, Amsterdam, the Netherlands

59. Richard A. Koup Aachen Department of Infectious Diseases

    Leiden University Medical Center

    Affiliation as printed

    Department of Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands

60. Frank P. Kroon

    Sanquin · OLVG

    Affiliation as printed

    Department of Donor Medicine Research, Laboratory of Blood-borne Infec-tions, Sanquin Research, Amsterdam, the Netherlands

    Department of Medical Microbiology, OLVG, Amsterdam, the Netherlands

61. Thijs J. W. van de Laar

    GGD Amsterdam

    Affiliation as printed

    Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands

62. Fanny N. Lauw

    Henry M. Jackson Foundation · Radboud University Nijmegen · Erasmus MC · Amsterdam UMC Location University of Amsterdam · Radboud University Medical Center · Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Center of Infection and Immunity Amsterdam (CINIMA), Department of Neurology, Amsterdam UMC -location AMC, Amsterdam, the Netherlands

    Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, room D3-226, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands

    Department of Pharmacy, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands

    Department of viro-science, Erasmus Medical Center Rotterdam, Rotter-dam, the Netherlands

    US Military HIV Research Program and the Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, United States

63. Merle M. van Leeuwen

    OLVG

    Affiliation as printed

    Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands

64. Kamilla D. Lettinga

    Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands

65. Ineke Linde

    GGD Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands

    Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands

66. Dominique Loomans

    Amsterdam UMC Location University of Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Department of General Practice, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

    Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC -location AMC, Amsterdam, the Netherlands

67. J. T. van der Meer

    Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands

68. T. Mouhebati

    Slotervaartziekenhuis

    Affiliation as printed

    Department of Internal Medicine, Slotervaart Hospital (former), Amsterdam, the Netherlands

69. Barbara J.M. Mulder
    Affiliation as printed

    STI AIDS Netherlands, Amsterdam, the Netherlands

70. F.J.B. Nellen

    Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, room D3-226, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands

    Soa Aids Nederland, Amsterdam, the Netherlands

71. A. Nijsters

    GGD Amsterdam

    Affiliation as printed

    Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands

72. H. Nobel

    Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands

73. Paul M. Oostvogel

    National Institute for Public Health and the Environment · Stichting HIV Monitoring

    Affiliation as printed

    Epidemiology and Surveillance Unit, Center for Infectious Disease Control, National Institute of Public Health and the Environment, the Netherlands

    HIV Monitoring Foundation, Amsterdam, the Netherlands

74. Eline Op de Coul
    Affiliation as printed

    STI AIDS Netherlands, Amsterdam, the Netherlands

75. Edgar J.G. Peters

    Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands

76. I. S. Peters

    Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands

77. T. van der Poll

    Stichting HIV Monitoring

    Affiliation as printed

    HIV Monitoring Foundation, Amsterdam, the Netherlands

78. Oliver Ratmann

    GGD Amsterdam

    Affiliation as printed

    Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands

79. Casper Rokx

    GGD Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands

    Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands

80. Martijn Sebastiaan van Rooijen

    GGD Amsterdam

    Affiliation as printed

    Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands

81. Wilhelmina E. M. Schouten

    GGD Amsterdam · Amsterdam University Medical Centers · University of Amsterdam

    Affiliation as printed

    Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands

    Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands

82. Gerard J.B. Sonder
    Affiliation as printed

    STI AIDS Netherlands, Amsterdam, the Netherlands

83. Annelies Verbon

    GGD Amsterdam

    Affiliation as printed

    Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands

84. F. Verdult
    Affiliation as printed

    STI AIDS Netherlands, Amsterdam, the Netherlands