Early signs, late action: missed HIV testing opportunities in routine clinical practice

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