{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T15:47:17Z","timestamp":1766159237604,"version":"3.48.0"},"reference-count":28,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2023,9,17]],"date-time":"2023-09-17T00:00:00Z","timestamp":1694908800000},"content-version":"unspecified","delay-in-days":16,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,8,15]]},"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Targeted testing policy for HIV\/syphilis at Dutch sexual health centres (SHCs) was evaluated for its efficiency in younger heterosexuals but not for heterosexuals \u226525 years. Currently, all older heterosexuals are tested for HIV\/syphilis at SHCs. To explore possibilities for increased efficiency of testing in heterosexuals aged &gt;25 years, this study aimed to identify determinants of HIV and syphilis diagnoses that could be used in targeted testing strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>An observational study using surveillance data from all Dutch SHC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Women and heterosexual men aged &gt;25 years visiting SHC between 2015 and 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was HIV\/syphilis diagnosis, determinants of a diagnosis were analysed. Based on these determinants and their applicability in SHC practice, different targeted testing scenarios were evaluated. For each scenario, the percentage of consultations involving HIV and syphilis testing and the total amount of missed HIV and syphilis diagnoses were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>109\u2009122 consultations were included among 75\u2009718 individuals. The strongest determinants of HIV\/syphilis diagnosis were HIV\/syphilis-specific symptoms (adjusted OR (aOR) 34.9 (24.1\u201350.2)) and receiving partner notification (aOR 18.3 (13.2\u201325.2)), followed by low\/middle education level (aOR 2.8 (2.0\u20134.0)), male sex (aOR 2.2 (1.6\u20133.0)) and age \u226530 years (aOR 1.8 (1.3\u20132.5)). When applying feasible determinants to targeted testing scenarios, HIV\/syphilis testing would have been conducted in 54.5% of all consultations, missing 2 HIV and 3 syphilis diagnoses annually (13.4% and 11.4% of all diagnoses, respectively). In the scenario with the lowest number of missed HIV\/syphilis diagnoses (0.3 HIV and 2 syphilis diagnoses annually), HIV\/syphilis testing would have been conducted in 74.2% of all consultations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In any targeted testing scenario studied, HIV and\/or syphilis diagnoses would have been missed. This raises the question whether it is acceptable to put any of these scenarios into practice. This study contributes to a discussion about the impact of targeted testing policy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-072862","type":"journal-article","created":{"date-parts":[[2023,9,18]],"date-time":"2023-09-18T23:02:12Z","timestamp":1695078132000},"page":"e072862","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["HIV and syphilis testing for women and heterosexual men aged above 25 years in the Netherlands: possibilities for targeted testing at sexual health centres"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5338-8796","authenticated-orcid":false,"given":"Inge J M","family":"Willemstein","sequence":"first","affiliation":[{"name":"Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1236-6224","authenticated-orcid":false,"given":"Hannelore M","family":"G\u00f6tz","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands"},{"name":"Department of Public Health, GGD Rotterdam-Rijnmond, Rotterdam, The Netherlands"},{"name":"Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2607-7677","authenticated-orcid":false,"given":"Maartje","family":"Visser","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janneke C M","family":"Heijne","sequence":"additional","affiliation":[{"name":"Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands"},{"name":"Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,9,18]]},"reference":[{"key":"2025121512052984000_13.9.e072862.1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.rr7005a1"},{"key":"2025121512052984000_13.9.e072862.2","doi-asserted-by":"crossref","unstructured":"Lanjouw E , Ouburg S , de Vries HJ , et al . \u201cBackground review for the '2015 European guideline on the management of Chlamydia Trachomatis infections'\u201d Int J STD AIDS 2015:0956462415618838. doi:10.1177\/0956462415618838","DOI":"10.1177\/0956462415618838"},{"key":"2025121512052984000_13.9.e072862.3","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1177\/0956462420948739","article-title":"European guideline for the diagnosis and treatment of Gonorrhoea in adults","volume":"32","author":"Unemo","year":"2021","journal-title":"Int J STD AIDS"},{"key":"2025121512052984000_13.9.e072862.4","doi-asserted-by":"publisher","DOI":"10.1111\/jdv.16946"},{"key":"2025121512052984000_13.9.e072862.5","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1111\/jdv.17139","article-title":"European guideline on HIV testing in Genito-urinary medicine settings","volume":"35","author":"G\u00f6kengin","year":"2021","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2025121512052984000_13.9.e072862.6","unstructured":"National Institute for Public Health and the Environment (RIVM) . Draaiboek voor Centra Seksuele Gezondheid in de Publieke Gezondheidszorg. 2022. Available: https:\/\/lci.rivm.nl\/draaiboeken\/consult-seksuele-gezondheid"},{"key":"2025121512052984000_13.9.e072862.7","article-title":"More efficient testing policy at STI clinics","volume":"158","author":"Suijkerbuijk","year":"2014","journal-title":"Ned Tijdschr Geneeskd"},{"key":"2025121512052984000_13.9.e072862.8","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.healthpol.2017.12.001","article-title":"Consequences of restricted STI testing for young Heterosexuals in the Netherlands on test costs and QALY losses","volume":"122","author":"Suijkerbuijk","year":"2018","journal-title":"Health Policy"},{"key":"2025121512052984000_13.9.e072862.9","unstructured":"van DA , Visser M , van F , et al . Sexually transmitted infections in the Netherlands in 2021. Bilthoven: National Institute for Public Health and the Environment (RIVM), 2022."},{"key":"2025121512052984000_13.9.e072862.10","unstructured":"Statistics Netherlands (CBS) . Migratieachtergrond. 2022. Available: https:\/\/www.cbs.nl\/nl-nl\/onze-diensten\/methoden\/begrippen\/migratieachtergrond"},{"key":"2025121512052984000_13.9.e072862.11","doi-asserted-by":"crossref","DOI":"10.1111\/aji.13263","article-title":"Receptive Anal sex contributes substantially to Heterosexually acquired HIV infections among at-risk women in twenty US cities: results from a Modelling analysis","volume":"84","author":"Elmes","year":"2020","journal-title":"Am J Reprod Immunol"},{"key":"2025121512052984000_13.9.e072862.12","doi-asserted-by":"crossref","first-page":"2895","DOI":"10.1007\/s10461-016-1635-z","article-title":"Contribution of Anal sex to HIV prevalence among Heterosexuals: A modeling analysis","volume":"21","author":"O\u2019Leary","year":"2017","journal-title":"AIDS Behav"},{"key":"2025121512052984000_13.9.e072862.13","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2020-054561"},{"key":"2025121512052984000_13.9.e072862.14","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix243"},{"key":"2025121512052984000_13.9.e072862.15","unstructured":"National Institute for Public Health and the Environment (RIVM) . Richtlijnen & Draaiboeken. 2022. Available: https:\/\/lci.rivm.nl\/richtlijnen"},{"key":"2025121512052984000_13.9.e072862.16","first-page":"308","article-title":"Epidemiological trends in patients living with human immunodeficiency virus: a 13-year experience from a tertiary care center in India","volume":"27","author":"Gupta","year":"2019","journal-title":"Infez Med"},{"key":"2025121512052984000_13.9.e072862.17","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.1177\/0956462420945928","article-title":"Syphilis in Heterosexual women: case characteristics and risk factors for recent Syphilis infection in Tokyo, Japan, 2017-2018","volume":"31","author":"Nishiki","year":"2020","journal-title":"Int J STD AIDS"},{"key":"2025121512052984000_13.9.e072862.18","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1016\/j.gaceta.2010.04.007","article-title":"Increased Syphilis trend among patients in an AIDS information and prevention center","volume":"25","author":"Hurtado","year":"2011","journal-title":"Gac Sanit"},{"key":"2025121512052984000_13.9.e072862.19","doi-asserted-by":"crossref","DOI":"10.1017\/S0950268819000281","article-title":"The resurgence of Syphilis in high-income countries in the 2000S: a focus on Europe","volume":"147","author":"Spiteri","year":"2019","journal-title":"Epidemiol Infect"},{"key":"2025121512052984000_13.9.e072862.20","doi-asserted-by":"crossref","first-page":"258","DOI":"10.2174\/1570162X18666200427223823","article-title":"Temporal trends in the epidemiology of HIV in Turkey","volume":"18","author":"Erdinc","year":"2020","journal-title":"Curr HIV Res"},{"key":"2025121512052984000_13.9.e072862.21","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2021-055186"},{"key":"2025121512052984000_13.9.e072862.22","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1089\/apc.2019.0259","article-title":"Factors associated with HIV seroconversion among women attending an urban health clinic in the south: A matched case\u2013control study","volume":"34","author":"Harrington","year":"2020","journal-title":"AIDS Patient Care and STDS"},{"key":"2025121512052984000_13.9.e072862.23","doi-asserted-by":"crossref","unstructured":"Chen M , Ma Y , Chen H , et al . Demographic characteristics and spatial clusters of recent HIV-1 infections among newly diagnosed HIV-1 cases in Yunnan. BMC Public Health 2019;19. doi:10.1186\/s12889-019-7557-8","DOI":"10.1186\/s12889-019-7557-8"},{"key":"2025121512052984000_13.9.e072862.24","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1177\/09564624211013670","article-title":"Educational level and risk of sexually transmitted infections among clients of Dutch sexual health centres","volume":"32","author":"Slurink","year":"2021","journal-title":"Int J STD AIDS"},{"key":"2025121512052984000_13.9.e072862.25","unstructured":"UNAIDS Joint United Nations Programme on HIV\/AIDS . Fast-track: ending the AIDS epidemic by 2030. Geneva: UNAIDS, 2014."},{"key":"2025121512052984000_13.9.e072862.26","unstructured":"van Sighem AI , Wit F , Boyd A , et al . Monitoring Report 2021. Human Immunodeficiency Virus (HIV) Infection in the Netherlands (stichting HIV monitoring). Amsterdam, 2021."},{"key":"2025121512052984000_13.9.e072862.27","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2021-055034"},{"key":"2025121512052984000_13.9.e072862.28","unstructured":"World health Organization (WHO) [Syphilis]. 2022. Available: https:\/\/www.who.int\/health-topics\/syphilis#tab=tab_1"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2023-072862","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T20:05:38Z","timestamp":1765829138000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2023-072862"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9]]},"references-count":28,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9,18]]},"published-print":{"date-parts":[[2023,9]]}},"alternative-id":["10.1136\/bmjopen-2023-072862"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2023-072862","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"type":"print","value":"2044-6055"},{"type":"electronic","value":"2044-6055"}],"subject":[],"published":{"date-parts":[[2023,9]]}}}