Missed opportunities for detecting HIV remain unacceptably high when undiagnosed patients seek care, according to a recent study from Boston University School of Medicine (BUSM). Dr. Jeffrey Samet, professor of medicine at BUSM and chief of general internal medicine at Boston Medical Center, and colleagues conducted a 10-year retrospective chart review of patients seen at an HIV intake clinic from January 1994 to June 2001. The subjects had tested positive for HIV during the 12 months before presenting at the intake clinic and had at least one encounter documented in the medical record prior to being diagnosed as HIV-positive.

Of the 221 patients meeting study eligibility requirements, all had at least one trigger indicating an increased risk for HIV in a prior encounter note. Of the 3,424 encounters reviewed, triggers were found in 50 percent of medical visits -- yet HIV testing was addressed in only 27 percent of those visits.

Missed opportunities for addressing these triggers remain high despite improvements in HIV testing in recent years, the authors noted, and variation by care site remained key. "In particular, the emergency department merits consideration for increased resource commitment to facilitate HIV testing," said Samet. In order to detect HIV infection prior to advancement to AIDS, clinicians must become more alert to clinical triggers that suggest increased risk for HIV, and lower the threshold at which HIV testing is recommended, the researchers concluded.

The study, "Assessing Missed Opportunities for HIV Testing in Medical Settings," was published in the Journal of General Internal Medicine (2004;19(4):349-356).

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