Proactive HIV testing strategies in primary care

After the introduction of therapy, HIV changed from a deadly disease to a chronic treatable infection, with those infected – if treated in time – having almost the same life expectancy as those not infected. Also, other studies have reported that early initiation of therapy greatly reduces the risk of transmission of HIV to sexual partners. Thus early detection is essential, but to date HIV testing of high-risk groups has not halted the progress of the epidemic in the Netherlands. The studies in this thesis were initiated with the goal of increasing our understanding of additional proactive HIV testing strategies in primary care and other healthcare settings. The results of this thesis contribute in particular to improve HIV testing programmes and assist in the implementation of these strategies in daily practice. General practitioners are key players in a proactive HIV testing policy. One of the main findings of this thesis is that HIV-infected patients frequently visit their general practitioner and a large group of these individuals present with HIV indicator conditions in the period prior to HIV diagnosis. HIV indicator condition-guided testing by general practitioners could be the starting point for more proactive provider-initiated HIV testing.