Implementing HIV teams sustainably improves HIV indicator condition testing rates in hospitals in the Netherlands: the #aware.hiv clinical trial

Objective: Develop and validate a strategy to improve HIV testing rates using HIV teams. Design: A prospective clinical trial was conducted from January 2020 to July 2023 in two Dutch university hospitals. Methods: The intervention involved implementing HIV teams to provide peer awareness, education, and feedback to physicians treating patients ≥18 years newly diagnosed with HIV indicator conditions. The primary outcome was the HIV testing rate. Secondary outcomes included testing rates by specialty, HIV prevalence, and reasons for withholding testing. Results: Of the 313,666 newly registered diagnoses, 2,395 involved indicator conditions. The overall HIV testing rate of newly diagnosed HIV indicator conditions increased from 50.1% (222/443) pre-implementation to 80.7% (1,575/1,952) post-implementation of HIV teams (p<0.001) with sustained improvement during the observation period (range 72.4-90.4%). The intervention was effective across physicians from all medical specialties. HIV prevalence among those tested was 0.6% (95%CI 0.3-1.1%). Peer feedback for 411 untested indicator conditions, resulted in 69 (16.3%) additional HIV tests. Failure to test frequently remained without reason (50.6%) or due to patient loss of follow-up (18.4%). Multivariate analysis indicated that women with indicator conditions were tested less often (aOR 0.59, 95%CI 0.45-0.79, p<0.01), and indicator conditions without HIV testing recommendations in national guidelines were also less likely to be tested for HIV (aOR 0.36, 95%CI 0.27-0.48, p<0.01). For external validation, we implemented this intervention in a second hospital, where it also significantly increased the testing rate post-implementation of HIV teams. Conclusion: Implementing HIV teams in hospitals is feasible, effective and leads to a sustained increase in HIV indicator condition-guided testing, supporting its broader adoption.