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Is HIV screening being requested appropriately? The experience of a Victorian public health laboratory
R Darlington1, S C Thompson, J R Forsyth
1Microbiological Diagnostic Unit, University of Melbourne, Parkville, Vic.
Insights
Early HIV testing revealed lower detection rates in females compared to males. Unsatisfactory testing practices often stemmed from missing epidemiological data, not excessive test ordering.
Area of Science:
- * Clinical microbiology and infectious disease epidemiology.
- * Public health surveillance of human immunodeficiency virus (HIV).
Background:
- * The Microbiological Diagnostic Unit conducted extensive HIV antibody testing from 1985 to 1994.
- * A database was established to track testing patterns and outcomes across diverse clinical settings.
Purpose of the Study:
- * To analyze patterns of HIV testing requests and seropositive case detection.
- * To identify factors associated with high rates of positive HIV tests.
- * To compare HIV detection rates and diagnostic pathways between males and females.
Main Methods:
- * Analysis of 134,346 serum samples from 109,391 individuals tested for HIV antibodies.
- * Extraction of data on testing patterns, seropositivity, and clinical settings from a coded database.
- * Comparison of diagnostic routes for HIV-positive males and females.
Main Results:
- * A total of 672 HIV-positive individuals were identified.
- * HIV detection rates were significantly lower in females compared to males.
- * Most male diagnoses occurred via specialist venereology services, while female diagnoses were predominantly from non-specialist practices.
- * Most HIV test requests were deemed justifiable, with issues arising from incomplete epidemiological data rather than overuse.
Conclusions:
- * HIV testing practices during the study period were generally appropriate.
- * Significant differences exist in the diagnosis pathways for HIV-positive males and females.
- * Incomplete epidemiological information accompanying specimens was a key area for practice improvement.
Abstract:
From the start of clinical testing for human immunodeficiency virus (HIV) antibody in 1985 until the end of June 1994, the Microbiological Diagnostic Unit tested 134 346 serum samples from 109 391 individuals, identifying 672 as infected. A suitable database, using coded identities, was established from the beginning. Because the sera came from a variety of clinical settings, it was possible to extract information about patterns of requests for tests and about the yield of seropositive cases. The data were able to highlight factors associated with high rates of positive tests that can be lost in amalgamated statewide data. The discovery of HIV-positive females was sporadic and there was a much lower detection rate than from testing males. While males were most commonly diagnosed through specialist venereology services, 61 per cent of diagnoses in females were through nonspecialised practices, often those without previous experience in diagnosis and management of HIV infection. Despite some individual exceptions, the requesting of HIV tests appears generally to have been justifiable (particularly in view of the direction of official preventive campaigns) and not profligate. Overall, where practice was unsatisfactory, this lay less in thoughtless ordering of tests than in failing to include with the specimen the elementary, but vital, epidemiological information requested.
