Missed Opportunities for HIV Testing in Hospitalised Adults in Türkiye: Indicator Conditions and Testing Coverage in a National Multicentre Point-Prevalence Survey (HIV-ICs-TR)

Abstract

Abstract To quantify the prevalence of HIV testing indications among hospitalised adults in Türkiye, assess HIV testing coverage when clinically indicated, and identify missed diagnostic opportunities in a national multicentre point-prevalence survey. We conducted a national multicentre cross-sectional point-prevalence survey across tertiary referral hospitals from all seven geographical regions of Türkiye. Adult inpatients present at 08:00 on a predefined index day were assessed for predefined HIV testing indications, including AIDS-defining conditions, indicator conditions associated with an expected undiagnosed HIV prevalence ≥ 0.1%, and conditions in which unrecognised HIV could substantially affect clinical management. Among 3,425 hospitalised adults without known HIV infection, 699 (20.4%) had at least one documented HIV testing indication. HIV testing was requested by the primary clinical team in 424/699 patients (60.7%). Testing was lowest in patients with indicator conditions associated with an expected undiagnosed HIV prevalence ≥ 0.1%, and these conditions were independently associated with higher odds of non-performance of HIV testing by the primary clinical team than AIDS-defining conditions (corresponding adjusted odds ratio [aOR] 3.05, 95% confidence interval [CI] 1.67–5.81). In centres with a specialised HIV outpatient clinic, the odds of non-performance of HIV testing by the primary clinical team were independently lower among patients with an appropriate testing indication (corresponding aOR 0.64, 95% CI 0.43–0.95). Following study-team facilitation, overall testing coverage increased to 677/699 (96.9%). Three reactive screening results were identified, including two confirmed new HIV diagnoses. HIV testing indications were common among hospitalised adults in Türkiye, but non-performance of HIV testing by the primary clinical team remained frequent, particularly for non-AIDS indicator conditions. Strengthening indicator-condition-guided testing through structured clinical pathways and institutional HIV expertise may reduce non-performance and support earlier HIV diagnosis.