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. 2023 Jan 3;18(1):e0279958.
doi: 10.1371/journal.pone.0279958. eCollection 2023.

Mapping hematologists' HIV testing behavior among lymphoma patients-A mixed-methods study

Saskia Bogers  1   2   3 , Hanne Zimmermann  4   5 , Amie Ndong  1 , Udi Davidovich  5   6 , Marie José Kersten  7 , Peter Reiss  1   8   9   10 , Maarten Schim van der Loeff  1   2   5 , Suzanne Geerlings  1   2   3 ; HIV Transmission Elimination AMsterdam (H-TEAM) Consortium
Affiliations

Mapping hematologists' HIV testing behavior among lymphoma patients-A mixed-methods study

Saskia Bogers et al. PLoS One. .

Abstract

Background: HIV testing among patients with malignant lymphoma (PWML) is variably implemented. We evaluated HIV testing among PWML, and mapped factors influencing hematologists' testing behavior.

Materials: We conducted a mixed-methods study assessing HIV testing among PWML, factors influencing HIV testing and opportunities for improvement in five hospitals in the region of Amsterdam, the Netherlands. The proportion of PWML tested for HIV within 3 months before or after lymphoma diagnosis and percentage positive were assessed from January 2015 through June 2020. Questionnaires on intention, behavior and psychosocial determinants for HIV testing were conducted among hematologists. Through twelve semi-structured interviews among hematologists and authors of hematology guidelines, we further explored influencing factors and opportunities for improvement.

Findings: Overall, 1,612 PWML were included for analysis, including 976 patients newly diagnosed and 636 patients who were referred or with progressive/relapsed lymphoma. Seventy percent (678/976) of patients newly diagnosed and 54% (343/636) of patients with known lymphoma were tested for HIV. Overall, 7/1,021 (0.7%) PWML tested HIV positive, exceeding the 0.1% cost-effectiveness threshold. Questionnaires were completed by 40/77 invited hematologists, and 85% reported intention to test PWML for HIV. In the interviews, hematologists reported varying HIV testing strategies, including testing all PWML or only when lymphoma treatment is required. Recommendations for improved HIV testing included guideline adaptations, providing electronic reminders and monitoring and increasing awareness.

Conclusions: Missed opportunities for HIV testing among PWML occurred and HIV test strategies varied among hematologists. Efforts to improve HIV testing among PWML should include a combination of approaches.

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Conflict of interest statement

Dr. Bogers has nothing to disclose. Dr. Zimmermann has nothing to disclose. Dr. Ndong has nothing to disclose. Dr. Davidovich has nothing to disclose. Dr. Kersten reports consulting fees: Kite/Gilead; BMS/Celgene; Novartis; Miltenyi Biotec; Adicet Bio: to institution and payment for honoraria: Kite/Gilead; Roche; BMS/Celgene: to institution and participation on a Data Safety Monitoring Board or Advisory Board: SUBITO study (high dose chemotherapy in breast cancer): No financial compensation. Dr. Reiss reports grants or contracts: Gilead Sciences; ViiV Healthcare; Merck: Investigator-initiated study grants to institution; not related to current work and Participation on a Data Safety Monitoring Board or Advisory Board: Gilead Sciences; ViiV Healthcare; Merck: Honoraria for scientific advisory board participation paid to institution. Dr. Schim van der Loeff has nothing to disclose. Dr. Geerlings has nothing to disclose. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Flowchart of identification, screening and inclusion of data of patients diagnosed with malignant lymphoma in five hospitals in the region of Amsterdam, 2015–2020.
*Reasons for exclusion were: no definitive lymphoma diagnosis (20%), lymphoma diagnosis and treatment prior completely took place before the study period (57%), diagnosed and treated for lymphoma all took place at another hospital (20%), and known HIV infection prior to lymphoma work-up and diagnosis (3%). NTH: Non-teaching hospital. TH: Teaching hospital. UH: University hospital.
Fig 2
Fig 2. Questionnaire responses on barriers and facilitators for HIV testing among patients with malignant lymphoma by 40 hematology physicians from 5 hospitals in the region of Amsterdam, 2020, ranked by statement score.
PWML: patients with malignant lymphoma.
See this image and copyright information in PMC

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