{
  "abstract": "Background Late presentation remains a major public health issue in Türkiye, where up to 50% of newly diagnosed patients present with advanced immunosuppression.Aims To determine the prevalence and correlates of missed opportunities for HIV testing among newly diagnosed adults in Türkiye, where delayed diagnosis remains a major public health concern.Methods This cross-sectional study was conducted between September 2023 and September 2024 at a tertiary HIV centre in İstanbul, Türkiye. Eligible participants were adults (≥18 years) newly diagnosed with HIV within the past 6 months. Demographic characteristics, healthcare encounters and indicator conditions in the preceding 3 years were collected through interviews and medical-record review. The primary outcome was missed opportunities for HIV testing, defined as healthcare encounters in which a behavioural or clinical indicator was disclosed but no test was offered. Univariable and multivariable logistic regression analyses were performed.Results Among 142 participants (median age 34 years, 94% male), 32 (22.5%; 32/142) experienced at least one missed opportunity for HIV testing. Among the 55 individuals who disclosed a behavioural or clinical HIV-related indicator during a healthcare encounter, 32 (58.2%; 32/55) were not offered testing. In the univariable analysis, patients with missed opportunities had higher HIV RNA levels and lower CD4 counts at diagnosis, and those with CD4 <200 cells/mm³ had significantly higher odds of being in the missed-opportunity group (OR 13.4, 95% CI 4.76 to 41.4). In the multivariable analysis, employment status remained independently protective, with employed individuals significantly less likely to experience missed opportunities (adjusted OR 0.17, 95% CI 0.05 to 0.55). Notably, testing was offered in only 60% of encounters involving sexually transmitted infections.Conclusions Missed opportunities remain a substantial barrier to early HIV diagnosis in Türkiye. Expanding provider-initiated testing, implementing indicator-condition-guided protocols and strengthening provider–patient communication are essential to improve timely detection.",
  "authors": [
    {
      "affiliations": [
        "Infectious Diseases and Clinical Microbiology Department, Sisli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye"
      ],
      "name": "Nazife Duygu Demirbas"
    },
    {
      "affiliations": [
        "Infectious Diseases and Clinical Microbiology Department, Sisli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye"
      ],
      "name": "Ozlem Gul"
    },
    {
      "affiliations": [
        "Infectious Diseases and Clinical Microbiology Department, Sisli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye"
      ],
      "name": "Ceren Atasoy Tahtasakal"
    },
    {
      "affiliations": [
        "Infectious Diseases and Clinical Microbiology Department, Sisli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye"
      ],
      "name": "Umut Ozgur"
    },
    {
      "affiliations": [
        "Infectious Diseases and Clinical Microbiology Department, Sisli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye",
        "Epidemiology PhD Program, Graduate School of Health Sciences, Istanbul Medipol University, İstanbul, Türkiye"
      ],
      "name": "Okan Derin"
    },
    {
      "affiliations": [
        "Infectious Diseases and Clinical Microbiology Department, Sisli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye"
      ],
      "name": "Ahsen Oncul"
    },
    {
      "affiliations": [
        "Infectious Diseases and Clinical Microbiology Department, Sisli Hamidiye Etfal Training and Research Hospital, İstanbul, Türkiye"
      ],
      "name": "Dilek Yildiz Sevgi"
    }
  ],
  "title": "Early signs, late action: missed HIV testing opportunities in routine clinical practice",
  "uid": "c6f40125-7a2e-59a1-938b-b0b724447e30"
}