P191 Who is providing HIV testing and diagnosis? Comparing general practitioners and sexual health centres in five regions in the Netherlands

Background General practitioners (GPs) and sexual health centres (SHCs) are the main providers of STI and HIV testing in the Netherlands. We compared HIV testing by GPs versus SHCs to gain insight in strategies to improve HIV testing, stimulating timely HIV diagnosis. Methods Laboratory data (2011–2018) on HIV testing by GPs and SHCs in five Dutch regions with varying levels of urbanisation were used. Mean regional HIV testing rates per 10,000 residents ≥15 years were compared between providers using negative binomial generalised additive models, and additionally stratified by sex and age (15–29y, 30–44y, 45–59y, ≥60y). Chi-squared tests were used to compare percentage positive between providers. Results Analysed data included 507,197 HIV tests (GP 36%, SHC 64%). The highest HIV testing rates and positivity were observed in highly urbanised regions, with large variation between regions. The HIV testing rates ranged from 28–178/10,000 residents by GPs and from 30–379/10,000 residents by SHCs. Testing rates by GPs were lower than by SHCs in two regions, while these rates were comparable in the others. In all regions, men were tested less by GPs than by SHCs; for women this varied per region. Among 15–29 year olds, GPs’ testing rates were lower than SHCs’, while this was reversed in older age categories. The overall mean HIV positivity was 0.5% for GPs and 0.4% for SHCs. In Amsterdam, positivity was higher among individuals tested by GPs, but in the other regions no difference was observed. Conclusion This is the first study comparing HIV testing by GPs versus SHCs using laboratory data in the Netherlands. Our results show that besides SHCs, GPs also play a key role, especially in some subgroups, but large regional variation exists. Regional-specific interventions to improve GPs’ HIV testing practices are needed for populations not attending the SHCs to ensure timely HIV diagnosis.