Study highlights opportunities to strengthen early HIV diagnosis in primary care in Catalonia

The scientific journal EuroSurveillance has recently published the article "Implicit bias in HIV testing based on indicator conditions in primary care: a population-based study in Catalonia, Spain, 2017 to 2021", led by researchers from the IGTP's research group Centre for Epidemiological Studies on HIV/AIDS and STI of Catalonia (CEEISCAT) and IDIAPJGol. The study analyses the extent to which HIV tests are conducted following the diagnosis of an HIV indicator condition (IC) in primary care, as recommended by the World Health Organization and the European Centre for Disease Prevention and Control.

The study, based on data from over 5.8 million people attended in primary care in Catalonia, analysed more than 370,000 clinical episodes recorded between 2017 and 2021 in ICS primary care centres. It shows that 22.7% of patients diagnosed with an HIV indicator condition received an HIV test within four months, a percentage that highlights significant room for improvement and the opportunity to strengthen early detection and timely treatment initiation.

The study found that HIV testing rates were higher among men (26.3% vs 19.4% in women), younger individuals (29.2% in those under 30 vs 13.7% in those over 50), and migrants (27.7% vs 21.3% in Spanish nationals). Conditions most likely to be followed by an HIV test included syphilis (68.4%), genital herpes (50.6%), chlamydia (48.2%) and gonorrhoea (43.1%).

The results reveal significant differences by sex, age, migrant status, socioeconomic level and geographical area. Men, young people and migrants were more likely to be tested, whereas women, individuals over 50, and those living in rural areas were underdiagnosed. Sexually transmitted infections were the conditions most often associated with testing, while others, such as herpes zoster or seborrhoeic dermatitis, often went unnoticed despite being linked to HIV.

Notable territorial differences were also observed: in the Barcelona region, 28.6% of cases with indicator conditions were followed by an HIV test, compared with less than 15% in areas such as Terres de l'Ebre or Alt Pirineu i Aran. This variability may reflect inequalities in resources, training or access to diagnostic services, particularly in rural settings.

According to Dr Cristina Agustí, "the study highlights how implicit biases can influence clinical practice and perpetuate health inequalities. Specific training initiatives and clear protocols are needed to ensure that all individuals with HIV indicator conditions have equitable access to testing".

The study concludes that targeted interventions are necessary to improve adherence to international recommendations and ensure the systematic offering of HIV tests in response to indicator conditions, particularly in underdiagnosed populations such as women, older adults, and those living in rural areas. It also recommends training healthcare professionals to better recognise ICs and follow protocols correctly, as well as providing tools to reduce implicit bias in clinical practice, including the implementation of electronic alert systems to help avoid missed opportunities for HIV diagnosis.

These actions are essential to advance towards the UNAIDS 95-95-95 targets for 2030: 95% of people living with HIV diagnosed, 95% of those diagnosed receiving treatment, and 95% of those treated achieving viral suppression.