Early signs, late action: missed HIV testing opportunities in routine clinical practice

Late presentation remains a major public health issue in Türkiye, where up to 50% of newly diagnosed patients present with advanced immunosuppression.

To determine the prevalence and correlates of missed opportunities for HIV testing among newly diagnosed adults in Türkiye, where delayed diagnosis remains a major public health concern.

This cross-sectional study was conducted between September 2023 and September 2024 at a tertiary HIV centre in İstanbul, Türkiye. Eligible participants were adults (≥18 years) newly diagnosed with HIV within the past 6 months. Demographic characteristics, healthcare encounters and indicator conditions in the preceding 3 years were collected through interviews and medical-record review. The primary outcome was missed opportunities for HIV testing, defined as healthcare encounters in which a behavioural or clinical indicator was disclosed but no test was offered. Univariable and multivariable logistic regression analyses were performed.

Among 142 participants (median age 34 years, 94% male), 32 (22.5%; 32/142) experienced at least one missed opportunity for HIV testing. Among the 55 individuals who disclosed a behavioural or clinical HIV-related indicator during a healthcare encounter, 32 (58.2%; 32/55) were not offered testing. In the univariable analysis, patients with missed opportunities had higher HIV RNA levels and lower CD4 counts at diagnosis, and those with CD4 <200 cells/mm³ had significantly higher odds of being in the missed-opportunity group (OR 13.4, 95% CI 4.76 to 41.4). In the multivariable analysis, employment status remained independently protective, with employed individuals significantly less likely to experience missed opportunities (adjusted OR 0.17, 95% CI 0.05 to 0.55). Notably, testing was offered in only 60% of encounters involving sexually transmitted infections.

Missed opportunities remain a substantial barrier to early HIV diagnosis in Türkiye. Expanding provider-initiated testing, implementing indicator-condition-guided protocols and strengthening provider-patient communication are essential to improve timely detection.