Delayed diagnosis of HIV infection in women in the Auckland and Northland regions.

AIMS: We aimed to describe the epidemiology of women with HIV infection in the Auckland and Northland regions, and to assess whether there were missed opportunities for an earlier diagnosis of HIV infection. METHODS: We undertook a retrospective cohort analysis of women diagnosed with HIV infection between July 2011 and June 2021 under the care of the Infectious Disease Unit, Auckland City Hospital. RESULTS: Fifty-six women (54 cis and 2 trans) were diagnosed during the period. Eleven (20%) were diagnosed following a presentation with one or more AIDS-defining illnesses. Three (6%) died within six months of diagnosis. Fifteen of 44 (34%) women residing in New Zealand prior to their diagnosis of HIV infection had identifiable healthcare interactions that could have resulted in an earlier diagnosis of this infection. CONCLUSIONS: Women account for one in eight of the total population of people diagnosed with HIV infection in the Auckland and Northland regions. There are currently inadequate levels of HIV testing for women in the Auckland and Northland regions. There is a need for targeted HIV screening efforts for women. HIV screening needs to be optimised to maximise coverage, normalise testing and reduce the stigmatisation associated with testing.

Uptake, yield and resource requirements of screening for asymptomatic sexually transmissible infections among HIV-positive people attending a hospital outpatient clinic.

UNLABELLED: Background We performed a prospective audit of screening for asymptomatic sexually transmissible infections (STIs), during an intensive effort to screen all patients at our hospital-based HIV clinic. We aimed to measure the effectiveness and resource implications of our screening program. METHODS: All outpatients who attended during an 8-month period were invited to take part in opt-out screening for chlamydia (Chlamydia trachomatis), gonorrhoea (Neisseria gonorrhoeae) and syphilis. Participants completed a brief questionnaire, were asked about current symptoms of STIs and self-collected specimens for laboratory testing. RESULTS: The majority (535 out of 673, 80%) of the patients who were asked to participate provided specimens for screening. No chlamydia, gonorrhoea or syphilis infections were identified in women (n=91) or in heterosexual men (n=76). In contrast, 34 out of 368 (10%) of men who have sex with men tested positive (chlamydia, 25; gonorrhoea, 2; chlamydia and gonorrhoea, 2; syphilis, 5). The laboratory cost of diagnosing each case of rectal chlamydia or gonorrhoea (NZ$664) was substantially lower than the cost of diagnosing each case of urethral infection (NZ$5309). CONCLUSIONS: There was high uptake of screening among our clinic population, who preferred screening to be performed at the hospital clinic. The yield of screening men who have sex with men warrants continued annual screening for rectal gonorrhoea and chlamydia and for syphilis.

Audit of cervical screening in women with HIV infection in the Auckland and Northland regions of New Zealand.

AIM: We aimed to review our current cohort of women with HIV infection to document the number of women who had received a yearly cervical smear since their diagnosis of HIV infection and the number of women who were likely to have had undiagnosed HIV infection at the time of their first abnormal cervical smear. METHOD: This audit was a retrospective review of the cervical smear history of all adult women (> or =16 years) with HIV infection who were under active follow-up by the Infectious Diseases and Sexual Health Services at Auckland City Hospital on 31 December 2007. RESULTS: Sixty-nine of the 123 (56%) women in this audit met the definition for yearly cervical smears. The factor associated with not receiving yearly cervical smears was women who had received cervical smears from their general practitioner (GP). Taking into account the women's CD4 count at the time of the diagnosis of their HIV infection, it is very likely that seven women had undiagnosed HIV infection at the time of their first abnormal cervical smear. CONCLUSION: The proportion of women with HIV infection in the Auckland and Northland regions who received a yearly cervical smear during the audit period was low. We have put a number of interventions in place that we expect will improve this rate. These interventions include informing GPs of the need for yearly cervical smears for women with HIV infection, informing the National Cervical Screening Unit that these women are immunocompromised which will result in a yearly recall comment and informing these women of options for obtaining a cervical smear at little or no cost. Cervical smear takers should consider offering an HIV test to all women with an abnormal cervical smear who have resided in areas with high rates of HIV infection.