Implementing HIV teams sustainably improves HIV indicator condition testing rates in hospitals in the Netherlands:...

Develop and validate a strategy to improve HIV testing rates using HIV teams.

A prospective clinical trial was conducted from January 2020 to July 2023 in two Dutch university hospitals.

The intervention involved implementing HIV teams to provide peer awareness, education, and feedback to physicians treating patients ≥18 years newly diagnosed with HIV indicator conditions. The primary outcome was the HIV testing rate. Secondary outcomes included testing rates by specialty, HIV prevalence, and reasons for withholding testing.

Of the 313 666 newly registered diagnoses, 2395 involved indicator conditions. The overall HIV testing rate of newly diagnosed HIV indicator conditions increased from 50.1% (222/443) preimplementation to 80.7% (1575/1952) postimplementation of HIV teams ( P  < 0.001) with sustained improvement during the observation period (range 72.4-90.4%). The intervention was effective across physicians from all medical specialties. HIV prevalence among those tested was 0.6% [95% confidence interval (CI) 0.3-1.1]. Peer feedback for 411 untested indicator conditions, resulted in 69 (16.3%) additional HIV tests. Failure to test frequently remained without reason (50.6%) or due to patient loss of follow-up (18.4%). Multivariate analysis indicated that women with indicator conditions were tested less often [adjusted odds ratio (aOR) 0.59, 95% CI 0.45-0.79, P  < 0.01], and indicator conditions without HIV testing recommendations in national guidelines were also less likely to be tested for HIV (aOR 0.36, 95% CI 0.27-0.48, P  < 0.01). For external validation, we implemented this intervention in a second hospital, where it also significantly increased the testing rate postimplementation of HIV teams.

Implementing HIV teams in hospitals is feasible, effective and leads to a sustained increase in HIV indicator condition-guided testing, supporting its broader adoption.