Implicit bias in HIV testing based on indicator conditions in primary care: a population-based study in Catalonia, Spain, 2017 to 2021

Abstract

BACKGROUNDHIV testing guided by indicator condition (IC) is recommended by the World Health Organization to facilitate earlier diagnosis. However, it is unclear to what extent these guidelines are followed in routine primary care (PC).AIMTo estimate the prevalence and distribution of ICs in PC in Catalonia, Spain, identify factors associated with, and prevalence of, an HIV test being administered, or not, within 4 months of IC diagnosis and assess trends over time.METHODSA population-based cross-sectional study was conducted using data from the Information System for the Development of Research in Primary Care, covering 5.8 million individuals in Catalonia. We identified IC episodes recorded from 1 January 2017 to 31 August 2021 among patients aged 16-65 years. For each IC episode, we assessed whether an HIV test was performed within 4 months.RESULTSWe identified 372,712 IC episodes; 84,694 (22.7%) led to an HIV test within 4 months. Testing was higher for: men (26.3% vs 19.4% for women); migrants (27.7% vs 21.3% for Spanish citizens); younger patients (29.2% for 16-30-year-olds vs 13.7% for those over 50 years). Testing rates were highest for episodes involving syphilis (68.4%), genital herpes (50.6%), chlamydia (48.2%) and gonorrhoea (43.1%). Factors associated with increased testing included male sex, higher socioeconomic deprivation area, presence of an acute sexually transmitted infection and multiple ICs.CONCLUSIONSubstantial gaps remain in HIV testing based on ICs in PC in Catalonia. Targeted interventions are needed to improve adherence to IC-guided testing, enabling early HIV diagnosis and treatment.

Keywords: HIV testing; implicit bias; indicator conditions; primary care.