Impact of the <scp>COVID</scp> ‐19 pandemic on missed opportunities for diagnosis of <scp>HIV</scp> infection: <scp>HUCS</scp> ‐ <scp>ODIPER</scp> (missed diagnostic opportunities) study

AIMS: The COVID-19 pandemic caused substantial disruption in healthcare, particularly in the monitoring and diagnosis of chronic diseases such as HIV infection. The reduction in diagnoses during the pandemic raised doubts about whether there was a true decrease in incidence or a higher rate of occult infection. Given guidelines' recommendations on using indicator conditions (ICs) for requesting HIV serology tests, it was proposed to study whether there was a change in missed diagnostic opportunities (MDOs). The main aim was to analyze the frequency of MDO in people living with HIV (PLWHIV) diagnosed in the pre-pandemic, pandemic and post-pandemic periods. Secondary aims included the frequency of late diagnosis (LD) and its relationship with clinical and sociodemographic characteristics. METHODS: This is an observational, retrospective, single-center study that included PLWHIV diagnosed between 2018 and 2023. The 5 years prior to diagnosis were reviewed to identify MDO, segmented by level of care. Clinical, immunovirological and follow-up variables were collected. RESULTS: Of 198 PLWHIV, 32.8% had at least one MDO. No differences were observed between periods, although there was a non-significant downward trend in the post-pandemic period. A total of 49.5% had an LD, which was associated with higher mortality (9.3% vs. 0%; p = 0.006). MDOs were more frequent in primary care and among heterosexuals. LD was more common in non-Spanish born. CONCLUSIONS: MDOs did not increase during the pandemic. High rates of LD and MDOs persist, especially for certain patient profiles. These findings reinforce the need to implement systematic screening strategies based on indicator conditions to improve early diagnosis.