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

Saskia Bogers; Hanne Zimmermann; Amie Ndong; Udi Davidovich; Marie José Kersten; Peter Reiss; Maarten Schim van der Loeff; Suzanne Geerlings; HIV Transmission Elimination AMsterdam (H-TEAM) Consortium

doi:10.1371/journal.pone.0279958

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

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

Authors

Saskia Bogers^{1

2

3}, Hanne Zimmermann^{4

5}, Amie Ndong¹, Udi Davidovich^{5

6}, Marie José Kersten⁷, 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

¹ Amsterdam UMC, Location University of Amsterdam, Internal Medicine, Amsterdam, the Netherlands.
² Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands.
³ Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
⁴ Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands.
⁵ Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands.
⁶ Department of Social Psychology, University of Amsterdam, Amsterdam, the Netherlands.
⁷ Amsterdam UMC, Location University of Amsterdam, Hematology, Cancer Center Amsterdam, Amsterdam, the Netherlands.
⁸ Stichting HIV Monitoring, Amsterdam, the Netherlands.
⁹ Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands.
¹⁰ Amsterdam UMC, Location University of Amsterdam, Global Health, Amsterdam, the Netherlands.

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.

Copyright: © 2023 Bogers et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

HIV Infections* / diagnosis
HIV Testing
Hematology*
Humans
Lymphoma* / diagnosis
Netherlands

Grants and funding

This study was funded by Aidsfonds (grant number: P-42702; funding acquired by SEG. www.aidsfonds.nl) and the HIV Transmission Elimination Amsterdam (H-TEAM) initiative (funding acquired by SEG. www.hteam.nl). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.