Factors associated with presenting late or with advanced HIV disease in the Netherlands, 1996 2014: Results from a national observational cohort

Eline L.M. Op De Coul, Ard Van Sighem, Kees Brinkman, Birgit H. Van Benthem, Marchina E. Van Der Ende, Suzanne Geerlings, Peter Reiss, J. M. Prins, T. W. Kuijpers, H. J. Scherpbier, J. T.M. Van Der Meer, F.W.N.M. Wit, M. H. Godfried, P. Reiss, T. Van Der Poll, F. J.B. Nellen, S. E. Geerlings, M. Van Vugt, D. Pajkrt, J. C. Bos & 214 others W. J. Wiersinga, M. Van Der Valk, A. Goorhuis, J. W. Hovius, J. Van Eden, A. Henderiks, A. M.H. Van Hes, M. Mutschelknauss, H. E. Nobel, F. J.J. Pijnappel, A. M. Westerman, S. Jurriaans, N. K.T. Back, H. L. Zaaijer, B. Berkhout, M. T.E. Cornelissen, C. J. Schinkel, X. V. Thomas, Admiraal De Ruyter Ziekenhuis, M. Van Den Berge, A. Stegeman, S. Baas, L. Hage De Looff, D. Versteeg, M. J.H. Pronk, H. S.M. Ammerlaan, E. M.H.M. Korsten-Vorstermans, E. S. De Munnik, J. Tjhie, M. C.A. Wegdam, A. M. Weijsenfeld, M. E. Van Der Ende, T. E.M.S. De Vries-Sluijs, E. C.M. Van Gorp, C. A.M. Schurink, J. L. Nouwen, A. Verbon, B. J.A. Rijnders, H. I. Bax, R. J. Hassing, M. Van Der Feltz, N. Bassant, J. E.A. Van Beek, M. Vriesde, L. M. Van Zonneveld, A. De Oude-Lubbers, H. J. Van Den Berg-Cameron, F. B. Bruinsma-Broekman, J. De Groot, M. De Zeeuw-De Man, M. J. Broekhoven-Kruijne, M. Schutten, A. D.M.E. Osterhaus, C. A.B. Boucher, G. J.A. Driessen, A. M.C. Van Rossum, L. C. Van Der Knaap, E. Visser, J. Branger, C. J.H.M. Duijf-Van De Ven, E. F. Schippers, C. Van Nieuwkoop, R. W. Brimicombe, J. M. VanJperen, G. Van Der Hut, P. F.H. Franck, A. Van Eeden, M. Groot, I. S. Kwa, J. W. Bouwhuis, A. G.W. Van Hulzen, P. C.J. Bor, P. Bloembergen, M. J.H.M. Wolfhagen, G. J.H.M. Ruijs, R. Soetekouw, L. M.M. Van Der Prijt, M. Schoemaker, W. A. Van Der Reijden, R. Jansen, B. L. Herpers, F. P. Kroon, S. M. Arend, M. G.J. De Boer, M. P. Bauer, H. Jolink, A. M. Vollaard, C. Moons, A. C.M. Kroes, K. Pogany, J. V. Smit, E. Smit, T. Van Niekerk, O. Pontesilli, A. Oude Lashof, D. Posthouwer, J. Schippers, R. Vergoossen, I. H. Loo, R. El Moussaoui, G. Van Twillert, J. W.T.Cohen Stuart, B. M.W. Diederen, F. A. Van Truijen-Oud, R. Jansen, L. B.S. Gelinck, C. Meerkerk, G. S. Wildenbeest, C. L. Jansen, D. P.F. Van Houte, S. Faber, C. E. Delsing, H. Heins, P. H.J. Frissen, W. L. Blok, W. E.M. Schouten, G. E.L. Van Den Berk, C. J. Brouwer, G. F. Geerders, K. Hoeksema, M. J. Kleene, I. B. Van Der Meché, A. J.M. Toonen, S. Wijnands, M. Keuter, A. J.A.M. Van Der Ven, Hjm Ter Hofstede, A. S.M. Dofferhoff, R. Van Crevel, M. E.W. Bosch, K. J.T. Grintjes-Huisman, B. J. Zomer, J. P. Van Der Berg, E. H. Gisolf, P. H.M. Van Bentum, N. Langebeek, C. M.A. Swanink, K. D. Lettinga, H. Sulman, E. Witte, S. M.E. Vrouenraets, F. N. Lauw, H. Paap, D. J. Vlasblom, A. W. Rosingh, A. E. Brouwer, M. Kuipers, R. M.W.J. Santegoets, B. Van Der Ven, A. G.M. Buiting, P. J. Kabel, H. G. Sprenger, E. H. Scholvinck, S. Van Assen, K. R. Wilting, Y. Stienstra, P. A. Van Der Meulen, D. A. De Weerd, A. Riezebos-Brilman, C. C. Van Leer-Buter, M. M.E. Schneider, T. Mudrikova, P. M. Ellerbroek, J. J. Oosterheert, J. E. Arends, R. E. Barth, M. W.M. Wassenberg, L. M. Laan, E. E.B. Van Oers-Hazelzet, J. Patist, S. Vervoort, R. Frauenfelder, F. Verduyn-Lunel, A. M.J. Wensing, M. A. Van Agtmael, R. M. Perenboom, M. Bomers, J. De Vocht, C. M.J.E. Vandenbroucke-Grauls, C. W. Ang, T. F.W. Wolfs, L. J. Bont, L. Gras, A. I. Van Sighem, C. Smit, M. Hillebregt, V. Kimmel, Y. Tong, R. Van Den Boogaard, P. Hoekstra, A. De Lang, M. Berkhout, S. Grivell, A. Jansen, M. Van Den Akker, D. Bergsma, C. Lodewijk, R. Meijering, B. Peeck, M. Raethke, C. Ree, R. Regtop, Y. Ruijs, M. Schoorl, E. Tuijn, L. Veenenberg, T. Woudstra, Y. Bakker, A. De Jong, M. Broekhoven, E. Claessen, M. J. Rademaker, L. Munjishvili, E. Kruijne

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

Objectives: Early testing for HIV and entry into care are crucial to optimise treatment outcomes of HIV-infected patients and to prevent spread of HIV. We examined risk factors for presentation with late or advanced disease in HIV-infected patients in the Netherlands. Methods: HIV-infected patients registered in care between January 1996 and June 2014 were selected from the ATHENA national observational HIV cohort. Risk factors for late presentation and advanced disease were analysed by multivariable logistic regression. Furthermore, geographical differences and time trends were examined. Results: Of 20 965 patients, 53% presented with latestage HIV infection, and 35% had advanced disease. Late presentation decreased from 62% (1996) to 42% (2013), while advanced disease decreased from 46% to 26%. Late presentation only declined significantly among men having sex with men (MSM; p <0.001), but not among heterosexual males (p=0.08) and females (p=0.73). Factors associated with late presentation were: heterosexual male (adjusted OR (aOR), 1.59; 95% CI 1.44 to 1.75 vs MSM), injecting drug use (2.00; CI 1.69 to 2.38), age .50 years (1.46; CI 1.33 to 1.60 vs 30.49 years), region of origin (South-East Asia 2.14; 1.80 to 2.54, sub-Saharan Africa 2.11; 1.88 to 2.36, Surinam 1.59; 1.37 to 1.84, Caribbean 1.31; 1.13 to 1.53, Latin America 1.23; 1.04 to 1.46 vs the Netherlands), and location of HIV diagnosis (hospital 3.27; 2.94 to 3.63, general practitioner 1.66; 1.50 to 1.83, antenatal screening 1.76; 1.38 to 2.34 vs sexually transmitted infection clinic). No association was found for socioeconomic status or level of urbanisation. Compared with Amsterdam, 2 regions had higher adjusted odds and 2 regions had lower odds of late presentation. Results were highly similar for advanced disease. Conclusions: Although the overall rate of late presentation is declining in the Netherlands, targeted programmes to reduce late HIV diagnoses remain needed for all risk groups, but should be prioritised for heterosexual males, migrant populations, people aged ≥50 years and certain regions in the Netherlands.

Original languageEnglish
Article numbere009688
JournalBMJ Open
Volume6
Issue number1
DOIs
Publication statusPublished - 2016

Cite this

Op De Coul, E. L. M., Van Sighem, A., Brinkman, K., Van Benthem, B. H., Van Der Ende, M. E., Geerlings, S., ... Kruijne, E. (2016). Factors associated with presenting late or with advanced HIV disease in the Netherlands, 1996 2014: Results from a national observational cohort. BMJ Open, 6(1), [e009688]. https://doi.org/10.1136/bmjopen-2015-009688
Op De Coul, Eline L.M. ; Van Sighem, Ard ; Brinkman, Kees ; Van Benthem, Birgit H. ; Van Der Ende, Marchina E. ; Geerlings, Suzanne ; Reiss, Peter ; Prins, J. M. ; Kuijpers, T. W. ; Scherpbier, H. J. ; Van Der Meer, J. T.M. ; Wit, F.W.N.M. ; Godfried, M. H. ; Reiss, P. ; Van Der Poll, T. ; Nellen, F. J.B. ; Geerlings, S. E. ; Van Vugt, M. ; Pajkrt, D. ; Bos, J. C. ; Wiersinga, W. J. ; Van Der Valk, M. ; Goorhuis, A. ; Hovius, J. W. ; Van Eden, J. ; Henderiks, A. ; Van Hes, A. M.H. ; Mutschelknauss, M. ; Nobel, H. E. ; Pijnappel, F. J.J. ; Westerman, A. M. ; Jurriaans, S. ; Back, N. K.T. ; Zaaijer, H. L. ; Berkhout, B. ; Cornelissen, M. T.E. ; Schinkel, C. J. ; Thomas, X. V. ; De Ruyter Ziekenhuis, Admiraal ; Van Den Berge, M. ; Stegeman, A. ; Baas, S. ; De Looff, L. Hage ; Versteeg, D. ; Pronk, M. J.H. ; Ammerlaan, H. S.M. ; Korsten-Vorstermans, E. M.H.M. ; De Munnik, E. S. ; Tjhie, J. ; Wegdam, M. C.A. ; Weijsenfeld, A. M. ; Van Der Ende, M. E. ; De Vries-Sluijs, T. E.M.S. ; Van Gorp, E. C.M. ; Schurink, C. A.M. ; Nouwen, J. L. ; Verbon, A. ; Rijnders, B. J.A. ; Bax, H. I. ; Hassing, R. J. ; Van Der Feltz, M. ; Bassant, N. ; Van Beek, J. E.A. ; Vriesde, M. ; Van Zonneveld, L. M. ; De Oude-Lubbers, A. ; Van Den Berg-Cameron, H. J. ; Bruinsma-Broekman, F. B. ; De Groot, J. ; De Zeeuw-De Man, M. ; Broekhoven-Kruijne, M. J. ; Schutten, M. ; Osterhaus, A. D.M.E. ; Boucher, C. A.B. ; Driessen, G. J.A. ; Van Rossum, A. M.C. ; Van Der Knaap, L. C. ; Visser, E. ; Branger, J. ; Duijf-Van De Ven, C. J.H.M. ; Schippers, E. F. ; Van Nieuwkoop, C. ; Brimicombe, R. W. ; VanJperen, J. M. ; Van Der Hut, G. ; Franck, P. F.H. ; Van Eeden, A. ; Groot, M. ; Kwa, I. S. ; Bouwhuis, J. W. ; Van Hulzen, A. G.W. ; Bor, P. C.J. ; Bloembergen, P. ; Wolfhagen, M. J.H.M. ; Ruijs, G. J.H.M. ; Soetekouw, R. ; Van Der Prijt, L. M.M. ; Schoemaker, M. ; Van Der Reijden, W. A. ; Jansen, R. ; Herpers, B. L. ; Kroon, F. P. ; Arend, S. M. ; De Boer, M. G.J. ; Bauer, M. P. ; Jolink, H. ; Vollaard, A. M. ; Moons, C. ; Kroes, A. C.M. ; Pogany, K. ; Smit, J. V. ; Smit, E. ; Van Niekerk, T. ; Pontesilli, O. ; Lashof, A. Oude ; Posthouwer, D. ; Schippers, J. ; Vergoossen, R. ; Loo, I. H. ; El Moussaoui, R. ; Van Twillert, G. ; Stuart, J. W.T.Cohen ; Diederen, B. M.W. ; Van Truijen-Oud, F. A. ; Jansen, R. ; Gelinck, L. B.S. ; Meerkerk, C. ; Wildenbeest, G. S. ; Jansen, C. L. ; Van Houte, D. P.F. ; Faber, S. ; Delsing, C. E. ; Heins, H. ; Frissen, P. H.J. ; Blok, W. L. ; Schouten, W. E.M. ; Van Den Berk, G. E.L. ; Brouwer, C. J. ; Geerders, G. F. ; Hoeksema, K. ; Kleene, M. J. ; Van Der Meché, I. B. ; Toonen, A. J.M. ; Wijnands, S. ; Keuter, M. ; Van Der Ven, A. J.A.M. ; Hofstede, Hjm Ter ; Dofferhoff, A. S.M. ; Van Crevel, R. ; Bosch, M. E.W. ; Grintjes-Huisman, K. J.T. ; Zomer, B. J. ; Van Der Berg, J. P. ; Gisolf, E. H. ; Van Bentum, P. H.M. ; Langebeek, N. ; Swanink, C. M.A. ; Lettinga, K. D. ; Sulman, H. ; Witte, E. ; Vrouenraets, S. M.E. ; Lauw, F. N. ; Paap, H. ; Vlasblom, D. J. ; Rosingh, A. W. ; Brouwer, A. E. ; Kuipers, M. ; Santegoets, R. M.W.J. ; Van Der Ven, B. ; Buiting, A. G.M. ; Kabel, P. J. ; Sprenger, H. G. ; Scholvinck, E. H. ; Van Assen, S. ; Wilting, K. R. ; Stienstra, Y. ; Van Der Meulen, P. A. ; De Weerd, D. A. ; Riezebos-Brilman, A. ; Van Leer-Buter, C. C. ; Schneider, M. M.E. ; Mudrikova, T. ; Ellerbroek, P. M. ; Oosterheert, J. J. ; Arends, J. E. ; Barth, R. E. ; Wassenberg, M. W.M. ; Laan, L. M. ; Van Oers-Hazelzet, E. E.B. ; Patist, J. ; Vervoort, S. ; Frauenfelder, R. ; Verduyn-Lunel, F. ; Wensing, A. M.J. ; Van Agtmael, M. A. ; Perenboom, R. M. ; Bomers, M. ; De Vocht, J. ; Vandenbroucke-Grauls, C. M.J.E. ; Ang, C. W. ; Wolfs, T. F.W. ; Bont, L. J. ; Gras, L. ; Van Sighem, A. I. ; Smit, C. ; Hillebregt, M. ; Kimmel, V. ; Tong, Y. ; Van Den Boogaard, R. ; Hoekstra, P. ; De Lang, A. ; Berkhout, M. ; Grivell, S. ; Jansen, A. ; Van Den Akker, M. ; Bergsma, D. ; Lodewijk, C. ; Meijering, R. ; Peeck, B. ; Raethke, M. ; Ree, C. ; Regtop, R. ; Ruijs, Y. ; Schoorl, M. ; Tuijn, E. ; Veenenberg, L. ; Woudstra, T. ; Bakker, Y. ; De Jong, A. ; Broekhoven, M. ; Claessen, E. ; Rademaker, M. J. ; Munjishvili, L. ; Kruijne, E. / Factors associated with presenting late or with advanced HIV disease in the Netherlands, 1996 2014 : Results from a national observational cohort. In: BMJ Open. 2016 ; Vol. 6, No. 1.
@article{bc61ec6edf5d4a00b5f7592f63a2ee04,
title = "Factors associated with presenting late or with advanced HIV disease in the Netherlands, 1996 2014: Results from a national observational cohort",
abstract = "Objectives: Early testing for HIV and entry into care are crucial to optimise treatment outcomes of HIV-infected patients and to prevent spread of HIV. We examined risk factors for presentation with late or advanced disease in HIV-infected patients in the Netherlands. Methods: HIV-infected patients registered in care between January 1996 and June 2014 were selected from the ATHENA national observational HIV cohort. Risk factors for late presentation and advanced disease were analysed by multivariable logistic regression. Furthermore, geographical differences and time trends were examined. Results: Of 20 965 patients, 53{\%} presented with latestage HIV infection, and 35{\%} had advanced disease. Late presentation decreased from 62{\%} (1996) to 42{\%} (2013), while advanced disease decreased from 46{\%} to 26{\%}. Late presentation only declined significantly among men having sex with men (MSM; p <0.001), but not among heterosexual males (p=0.08) and females (p=0.73). Factors associated with late presentation were: heterosexual male (adjusted OR (aOR), 1.59; 95{\%} CI 1.44 to 1.75 vs MSM), injecting drug use (2.00; CI 1.69 to 2.38), age .50 years (1.46; CI 1.33 to 1.60 vs 30.49 years), region of origin (South-East Asia 2.14; 1.80 to 2.54, sub-Saharan Africa 2.11; 1.88 to 2.36, Surinam 1.59; 1.37 to 1.84, Caribbean 1.31; 1.13 to 1.53, Latin America 1.23; 1.04 to 1.46 vs the Netherlands), and location of HIV diagnosis (hospital 3.27; 2.94 to 3.63, general practitioner 1.66; 1.50 to 1.83, antenatal screening 1.76; 1.38 to 2.34 vs sexually transmitted infection clinic). No association was found for socioeconomic status or level of urbanisation. Compared with Amsterdam, 2 regions had higher adjusted odds and 2 regions had lower odds of late presentation. Results were highly similar for advanced disease. Conclusions: Although the overall rate of late presentation is declining in the Netherlands, targeted programmes to reduce late HIV diagnoses remain needed for all risk groups, but should be prioritised for heterosexual males, migrant populations, people aged ≥50 years and certain regions in the Netherlands.",
author = "{Op De Coul}, {Eline L.M.} and {Van Sighem}, Ard and Kees Brinkman and {Van Benthem}, {Birgit H.} and {Van Der Ende}, {Marchina E.} and Suzanne Geerlings and Peter Reiss and Prins, {J. M.} and Kuijpers, {T. W.} and Scherpbier, {H. J.} and {Van Der Meer}, {J. T.M.} and F.W.N.M. Wit and Godfried, {M. H.} and P. Reiss and {Van Der Poll}, T. and Nellen, {F. J.B.} and Geerlings, {S. E.} and {Van Vugt}, M. and D. Pajkrt and Bos, {J. C.} and Wiersinga, {W. J.} and {Van Der Valk}, M. and A. Goorhuis and Hovius, {J. W.} and {Van Eden}, J. and A. Henderiks and {Van Hes}, {A. M.H.} and M. Mutschelknauss and Nobel, {H. E.} and Pijnappel, {F. J.J.} and Westerman, {A. M.} and S. Jurriaans and Back, {N. K.T.} and Zaaijer, {H. L.} and B. Berkhout and Cornelissen, {M. T.E.} and Schinkel, {C. J.} and Thomas, {X. V.} and {De Ruyter Ziekenhuis}, Admiraal and {Van Den Berge}, M. and A. Stegeman and S. Baas and {De Looff}, {L. Hage} and D. Versteeg and Pronk, {M. J.H.} and Ammerlaan, {H. S.M.} and Korsten-Vorstermans, {E. M.H.M.} and {De Munnik}, {E. S.} and J. Tjhie and Wegdam, {M. C.A.} and Weijsenfeld, {A. M.} and {Van Der Ende}, {M. E.} and {De Vries-Sluijs}, {T. E.M.S.} and {Van Gorp}, {E. C.M.} and Schurink, {C. A.M.} and Nouwen, {J. L.} and A. Verbon and Rijnders, {B. J.A.} and Bax, {H. I.} and Hassing, {R. J.} and {Van Der Feltz}, M. and N. Bassant and {Van Beek}, {J. E.A.} and M. Vriesde and {Van Zonneveld}, {L. M.} and {De Oude-Lubbers}, A. and {Van Den Berg-Cameron}, {H. J.} and Bruinsma-Broekman, {F. B.} and {De Groot}, J. and {De Zeeuw-De Man}, M. and Broekhoven-Kruijne, {M. J.} and M. Schutten and Osterhaus, {A. D.M.E.} and Boucher, {C. A.B.} and Driessen, {G. J.A.} and {Van Rossum}, {A. M.C.} and {Van Der Knaap}, {L. C.} and E. Visser and J. Branger and {Duijf-Van De Ven}, {C. J.H.M.} and Schippers, {E. F.} and {Van Nieuwkoop}, C. and Brimicombe, {R. W.} and VanJperen, {J. M.} and {Van Der Hut}, G. and Franck, {P. F.H.} and {Van Eeden}, A. and M. Groot and Kwa, {I. S.} and Bouwhuis, {J. W.} and {Van Hulzen}, {A. G.W.} and Bor, {P. C.J.} and P. Bloembergen and Wolfhagen, {M. J.H.M.} and Ruijs, {G. J.H.M.} and R. Soetekouw and {Van Der Prijt}, {L. M.M.} and M. Schoemaker and {Van Der Reijden}, {W. A.} and R. Jansen and Herpers, {B. L.} and Kroon, {F. P.} and Arend, {S. M.} and {De Boer}, {M. G.J.} and Bauer, {M. P.} and H. Jolink and Vollaard, {A. M.} and C. Moons and Kroes, {A. C.M.} and K. Pogany and Smit, {J. V.} and E. Smit and {Van Niekerk}, T. and O. Pontesilli and Lashof, {A. Oude} and D. Posthouwer and J. Schippers and R. Vergoossen and Loo, {I. H.} and {El Moussaoui}, R. and {Van Twillert}, G. and Stuart, {J. W.T.Cohen} and Diederen, {B. M.W.} and {Van Truijen-Oud}, {F. A.} and R. Jansen and Gelinck, {L. B.S.} and C. Meerkerk and Wildenbeest, {G. S.} and Jansen, {C. L.} and {Van Houte}, {D. P.F.} and S. Faber and Delsing, {C. E.} and H. Heins and Frissen, {P. H.J.} and Blok, {W. L.} and Schouten, {W. E.M.} and {Van Den Berk}, {G. E.L.} and Brouwer, {C. J.} and Geerders, {G. F.} and K. Hoeksema and Kleene, {M. J.} and {Van Der Mech{\'e}}, {I. B.} and Toonen, {A. J.M.} and S. Wijnands and M. Keuter and {Van Der Ven}, {A. J.A.M.} and Hofstede, {Hjm Ter} and Dofferhoff, {A. S.M.} and {Van Crevel}, R. and Bosch, {M. E.W.} and Grintjes-Huisman, {K. J.T.} and Zomer, {B. J.} and {Van Der Berg}, {J. P.} and Gisolf, {E. H.} and {Van Bentum}, {P. H.M.} and N. Langebeek and Swanink, {C. M.A.} and Lettinga, {K. D.} and H. Sulman and E. Witte and Vrouenraets, {S. M.E.} and Lauw, {F. N.} and H. Paap and Vlasblom, {D. J.} and Rosingh, {A. W.} and Brouwer, {A. E.} and M. Kuipers and Santegoets, {R. M.W.J.} and {Van Der Ven}, B. and Buiting, {A. G.M.} and Kabel, {P. J.} and Sprenger, {H. G.} and Scholvinck, {E. H.} and {Van Assen}, S. and Wilting, {K. R.} and Y. Stienstra and {Van Der Meulen}, {P. A.} and {De Weerd}, {D. A.} and A. Riezebos-Brilman and {Van Leer-Buter}, {C. C.} and Schneider, {M. M.E.} and T. Mudrikova and Ellerbroek, {P. M.} and Oosterheert, {J. J.} and Arends, {J. E.} and Barth, {R. E.} and Wassenberg, {M. W.M.} and Laan, {L. M.} and {Van Oers-Hazelzet}, {E. E.B.} and J. Patist and S. Vervoort and R. Frauenfelder and F. Verduyn-Lunel and Wensing, {A. M.J.} and {Van Agtmael}, {M. A.} and Perenboom, {R. M.} and M. Bomers and {De Vocht}, J. and Vandenbroucke-Grauls, {C. M.J.E.} and Ang, {C. W.} and Wolfs, {T. F.W.} and Bont, {L. J.} and L. Gras and {Van Sighem}, {A. I.} and C. Smit and M. Hillebregt and V. Kimmel and Y. Tong and {Van Den Boogaard}, R. and P. Hoekstra and {De Lang}, A. and M. Berkhout and S. Grivell and A. Jansen and {Van Den Akker}, M. and D. Bergsma and C. Lodewijk and R. Meijering and B. Peeck and M. Raethke and C. Ree and R. Regtop and Y. Ruijs and M. Schoorl and E. Tuijn and L. Veenenberg and T. Woudstra and Y. Bakker and {De Jong}, A. and M. Broekhoven and E. Claessen and Rademaker, {M. J.} and L. Munjishvili and E. Kruijne",
year = "2016",
doi = "10.1136/bmjopen-2015-009688",
language = "English",
volume = "6",
journal = "BMJ Open",
issn = "2044-6055",
publisher = "BMJ Publishing Group",
number = "1",

}

Op De Coul, ELM, Van Sighem, A, Brinkman, K, Van Benthem, BH, Van Der Ende, ME, Geerlings, S, Reiss, P, Prins, JM, Kuijpers, TW, Scherpbier, HJ, Van Der Meer, JTM, Wit, FWNM, Godfried, MH, Reiss, P, Van Der Poll, T, Nellen, FJB, Geerlings, SE, Van Vugt, M, Pajkrt, D, Bos, JC, Wiersinga, WJ, Van Der Valk, M, Goorhuis, A, Hovius, JW, Van Eden, J, Henderiks, A, Van Hes, AMH, Mutschelknauss, M, Nobel, HE, Pijnappel, FJJ, Westerman, AM, Jurriaans, S, Back, NKT, Zaaijer, HL, Berkhout, B, Cornelissen, MTE, Schinkel, CJ, Thomas, XV, De Ruyter Ziekenhuis, A, Van Den Berge, M, Stegeman, A, Baas, S, De Looff, LH, Versteeg, D, Pronk, MJH, Ammerlaan, HSM, Korsten-Vorstermans, EMHM, De Munnik, ES, Tjhie, J, Wegdam, MCA, Weijsenfeld, AM, Van Der Ende, ME, De Vries-Sluijs, TEMS, Van Gorp, ECM, Schurink, CAM, Nouwen, JL, Verbon, A, Rijnders, BJA, Bax, HI, Hassing, RJ, Van Der Feltz, M, Bassant, N, Van Beek, JEA, Vriesde, M, Van Zonneveld, LM, De Oude-Lubbers, A, Van Den Berg-Cameron, HJ, Bruinsma-Broekman, FB, De Groot, J, De Zeeuw-De Man, M, Broekhoven-Kruijne, MJ, Schutten, M, Osterhaus, ADME, Boucher, CAB, Driessen, GJA, Van Rossum, AMC, Van Der Knaap, LC, Visser, E, Branger, J, Duijf-Van De Ven, CJHM, Schippers, EF, Van Nieuwkoop, C, Brimicombe, RW, VanJperen, JM, Van Der Hut, G, Franck, PFH, Van Eeden, A, Groot, M, Kwa, IS, Bouwhuis, JW, Van Hulzen, AGW, Bor, PCJ, Bloembergen, P, Wolfhagen, MJHM, Ruijs, GJHM, Soetekouw, R, Van Der Prijt, LMM, Schoemaker, M, Van Der Reijden, WA, Jansen, R, Herpers, BL, Kroon, FP, Arend, SM, De Boer, MGJ, Bauer, MP, Jolink, H, Vollaard, AM, Moons, C, Kroes, ACM, Pogany, K, Smit, JV, Smit, E, Van Niekerk, T, Pontesilli, O, Lashof, AO, Posthouwer, D, Schippers, J, Vergoossen, R, Loo, IH, El Moussaoui, R, Van Twillert, G, Stuart, JWTC, Diederen, BMW, Van Truijen-Oud, FA, Jansen, R, Gelinck, LBS, Meerkerk, C, Wildenbeest, GS, Jansen, CL, Van Houte, DPF, Faber, S, Delsing, CE, Heins, H, Frissen, PHJ, Blok, WL, Schouten, WEM, Van Den Berk, GEL, Brouwer, CJ, Geerders, GF, Hoeksema, K, Kleene, MJ, Van Der Meché, IB, Toonen, AJM, Wijnands, S, Keuter, M, Van Der Ven, AJAM, Hofstede, HT, Dofferhoff, ASM, Van Crevel, R, Bosch, MEW, Grintjes-Huisman, KJT, Zomer, BJ, Van Der Berg, JP, Gisolf, EH, Van Bentum, PHM, Langebeek, N, Swanink, CMA, Lettinga, KD, Sulman, H, Witte, E, Vrouenraets, SME, Lauw, FN, Paap, H, Vlasblom, DJ, Rosingh, AW, Brouwer, AE, Kuipers, M, Santegoets, RMWJ, Van Der Ven, B, Buiting, AGM, Kabel, PJ, Sprenger, HG, Scholvinck, EH, Van Assen, S, Wilting, KR, Stienstra, Y, Van Der Meulen, PA, De Weerd, DA, Riezebos-Brilman, A, Van Leer-Buter, CC, Schneider, MME, Mudrikova, T, Ellerbroek, PM, Oosterheert, JJ, Arends, JE, Barth, RE, Wassenberg, MWM, Laan, LM, Van Oers-Hazelzet, EEB, Patist, J, Vervoort, S, Frauenfelder, R, Verduyn-Lunel, F, Wensing, AMJ, Van Agtmael, MA, Perenboom, RM, Bomers, M, De Vocht, J, Vandenbroucke-Grauls, CMJE, Ang, CW, Wolfs, TFW, Bont, LJ, Gras, L, Van Sighem, AI, Smit, C, Hillebregt, M, Kimmel, V, Tong, Y, Van Den Boogaard, R, Hoekstra, P, De Lang, A, Berkhout, M, Grivell, S, Jansen, A, Van Den Akker, M, Bergsma, D, Lodewijk, C, Meijering, R, Peeck, B, Raethke, M, Ree, C, Regtop, R, Ruijs, Y, Schoorl, M, Tuijn, E, Veenenberg, L, Woudstra, T, Bakker, Y, De Jong, A, Broekhoven, M, Claessen, E, Rademaker, MJ, Munjishvili, L & Kruijne, E 2016, 'Factors associated with presenting late or with advanced HIV disease in the Netherlands, 1996 2014: Results from a national observational cohort' BMJ Open, vol. 6, no. 1, e009688. https://doi.org/10.1136/bmjopen-2015-009688

Factors associated with presenting late or with advanced HIV disease in the Netherlands, 1996 2014 : Results from a national observational cohort. / Op De Coul, Eline L.M.; Van Sighem, Ard; Brinkman, Kees; Van Benthem, Birgit H.; Van Der Ende, Marchina E.; Geerlings, Suzanne; Reiss, Peter; Prins, J. M.; Kuijpers, T. W.; Scherpbier, H. J.; Van Der Meer, J. T.M.; Wit, F.W.N.M.; Godfried, M. H.; Reiss, P.; Van Der Poll, T.; Nellen, F. J.B.; Geerlings, S. E.; Van Vugt, M.; Pajkrt, D.; Bos, J. C.; Wiersinga, W. J.; Van Der Valk, M.; Goorhuis, A.; Hovius, J. W.; Van Eden, J.; Henderiks, A.; Van Hes, A. M.H.; Mutschelknauss, M.; Nobel, H. E.; Pijnappel, F. J.J.; Westerman, A. M.; Jurriaans, S.; Back, N. K.T.; Zaaijer, H. L.; Berkhout, B.; Cornelissen, M. T.E.; Schinkel, C. J.; Thomas, X. V.; De Ruyter Ziekenhuis, Admiraal; Van Den Berge, M.; Stegeman, A.; Baas, S.; De Looff, L. Hage; Versteeg, D.; Pronk, M. J.H.; Ammerlaan, H. S.M.; Korsten-Vorstermans, E. M.H.M.; De Munnik, E. S.; Tjhie, J.; Wegdam, M. C.A.; Weijsenfeld, A. M.; Van Der Ende, M. E.; De Vries-Sluijs, T. E.M.S.; Van Gorp, E. C.M.; Schurink, C. A.M.; Nouwen, J. L.; Verbon, A.; Rijnders, B. J.A.; Bax, H. I.; Hassing, R. J.; Van Der Feltz, M.; Bassant, N.; Van Beek, J. E.A.; Vriesde, M.; Van Zonneveld, L. M.; De Oude-Lubbers, A.; Van Den Berg-Cameron, H. J.; Bruinsma-Broekman, F. B.; De Groot, J.; De Zeeuw-De Man, M.; Broekhoven-Kruijne, M. J.; Schutten, M.; Osterhaus, A. D.M.E.; Boucher, C. A.B.; Driessen, G. J.A.; Van Rossum, A. M.C.; Van Der Knaap, L. C.; Visser, E.; Branger, J.; Duijf-Van De Ven, C. J.H.M.; Schippers, E. F.; Van Nieuwkoop, C.; Brimicombe, R. W.; VanJperen, J. M.; Van Der Hut, G.; Franck, P. F.H.; Van Eeden, A.; Groot, M.; Kwa, I. S.; Bouwhuis, J. W.; Van Hulzen, A. G.W.; Bor, P. C.J.; Bloembergen, P.; Wolfhagen, M. J.H.M.; Ruijs, G. J.H.M.; Soetekouw, R.; Van Der Prijt, L. M.M.; Schoemaker, M.; Van Der Reijden, W. A.; Jansen, R.; Herpers, B. L.; Kroon, F. P.; Arend, S. M.; De Boer, M. G.J.; Bauer, M. P.; Jolink, H.; Vollaard, A. M.; Moons, C.; Kroes, A. C.M.; Pogany, K.; Smit, J. V.; Smit, E.; Van Niekerk, T.; Pontesilli, O.; Lashof, A. Oude; Posthouwer, D.; Schippers, J.; Vergoossen, R.; Loo, I. H.; El Moussaoui, R.; Van Twillert, G.; Stuart, J. W.T.Cohen; Diederen, B. M.W.; Van Truijen-Oud, F. A.; Jansen, R.; Gelinck, L. B.S.; Meerkerk, C.; Wildenbeest, G. S.; Jansen, C. L.; Van Houte, D. P.F.; Faber, S.; Delsing, C. E.; Heins, H.; Frissen, P. H.J.; Blok, W. L.; Schouten, W. E.M.; Van Den Berk, G. E.L.; Brouwer, C. J.; Geerders, G. F.; Hoeksema, K.; Kleene, M. J.; Van Der Meché, I. B.; Toonen, A. J.M.; Wijnands, S.; Keuter, M.; Van Der Ven, A. J.A.M.; Hofstede, Hjm Ter; Dofferhoff, A. S.M.; Van Crevel, R.; Bosch, M. E.W.; Grintjes-Huisman, K. J.T.; Zomer, B. J.; Van Der Berg, J. P.; Gisolf, E. H.; Van Bentum, P. H.M.; Langebeek, N.; Swanink, C. M.A.; Lettinga, K. D.; Sulman, H.; Witte, E.; Vrouenraets, S. M.E.; Lauw, F. N.; Paap, H.; Vlasblom, D. J.; Rosingh, A. W.; Brouwer, A. E.; Kuipers, M.; Santegoets, R. M.W.J.; Van Der Ven, B.; Buiting, A. G.M.; Kabel, P. J.; Sprenger, H. G.; Scholvinck, E. H.; Van Assen, S.; Wilting, K. R.; Stienstra, Y.; Van Der Meulen, P. A.; De Weerd, D. A.; Riezebos-Brilman, A.; Van Leer-Buter, C. C.; Schneider, M. M.E.; Mudrikova, T.; Ellerbroek, P. M.; Oosterheert, J. J.; Arends, J. E.; Barth, R. E.; Wassenberg, M. W.M.; Laan, L. M.; Van Oers-Hazelzet, E. E.B.; Patist, J.; Vervoort, S.; Frauenfelder, R.; Verduyn-Lunel, F.; Wensing, A. M.J.; Van Agtmael, M. A.; Perenboom, R. M.; Bomers, M.; De Vocht, J.; Vandenbroucke-Grauls, C. M.J.E.; Ang, C. W.; Wolfs, T. F.W.; Bont, L. J.; Gras, L.; Van Sighem, A. I.; Smit, C.; Hillebregt, M.; Kimmel, V.; Tong, Y.; Van Den Boogaard, R.; Hoekstra, P.; De Lang, A.; Berkhout, M.; Grivell, S.; Jansen, A.; Van Den Akker, M.; Bergsma, D.; Lodewijk, C.; Meijering, R.; Peeck, B.; Raethke, M.; Ree, C.; Regtop, R.; Ruijs, Y.; Schoorl, M.; Tuijn, E.; Veenenberg, L.; Woudstra, T.; Bakker, Y.; De Jong, A.; Broekhoven, M.; Claessen, E.; Rademaker, M. J.; Munjishvili, L.; Kruijne, E.

In: BMJ Open, Vol. 6, No. 1, e009688, 2016.

Research output: Contribution to journalReview articleAcademicpeer-review

TY - JOUR

T1 - Factors associated with presenting late or with advanced HIV disease in the Netherlands, 1996 2014

T2 - Results from a national observational cohort

AU - Op De Coul, Eline L.M.

AU - Van Sighem, Ard

AU - Brinkman, Kees

AU - Van Benthem, Birgit H.

AU - Van Der Ende, Marchina E.

AU - Geerlings, Suzanne

AU - Reiss, Peter

AU - Prins, J. M.

AU - Kuijpers, T. W.

AU - Scherpbier, H. J.

AU - Van Der Meer, J. T.M.

AU - Wit, F.W.N.M.

AU - Godfried, M. H.

AU - Reiss, P.

AU - Van Der Poll, T.

AU - Nellen, F. J.B.

AU - Geerlings, S. E.

AU - Van Vugt, M.

AU - Pajkrt, D.

AU - Bos, J. C.

AU - Wiersinga, W. J.

AU - Van Der Valk, M.

AU - Goorhuis, A.

AU - Hovius, J. W.

AU - Van Eden, J.

AU - Henderiks, A.

AU - Van Hes, A. M.H.

AU - Mutschelknauss, M.

AU - Nobel, H. E.

AU - Pijnappel, F. J.J.

AU - Westerman, A. M.

AU - Jurriaans, S.

AU - Back, N. K.T.

AU - Zaaijer, H. L.

AU - Berkhout, B.

AU - Cornelissen, M. T.E.

AU - Schinkel, C. J.

AU - Thomas, X. V.

AU - De Ruyter Ziekenhuis, Admiraal

AU - Van Den Berge, M.

AU - Stegeman, A.

AU - Baas, S.

AU - De Looff, L. Hage

AU - Versteeg, D.

AU - Pronk, M. J.H.

AU - Ammerlaan, H. S.M.

AU - Korsten-Vorstermans, E. M.H.M.

AU - De Munnik, E. S.

AU - Tjhie, J.

AU - Wegdam, M. C.A.

AU - Weijsenfeld, A. M.

AU - Van Der Ende, M. E.

AU - De Vries-Sluijs, T. E.M.S.

AU - Van Gorp, E. C.M.

AU - Schurink, C. A.M.

AU - Nouwen, J. L.

AU - Verbon, A.

AU - Rijnders, B. J.A.

AU - Bax, H. I.

AU - Hassing, R. J.

AU - Van Der Feltz, M.

AU - Bassant, N.

AU - Van Beek, J. E.A.

AU - Vriesde, M.

AU - Van Zonneveld, L. M.

AU - De Oude-Lubbers, A.

AU - Van Den Berg-Cameron, H. J.

AU - Bruinsma-Broekman, F. B.

AU - De Groot, J.

AU - De Zeeuw-De Man, M.

AU - Broekhoven-Kruijne, M. J.

AU - Schutten, M.

AU - Osterhaus, A. D.M.E.

AU - Boucher, C. A.B.

AU - Driessen, G. J.A.

AU - Van Rossum, A. M.C.

AU - Van Der Knaap, L. C.

AU - Visser, E.

AU - Branger, J.

AU - Duijf-Van De Ven, C. J.H.M.

AU - Schippers, E. F.

AU - Van Nieuwkoop, C.

AU - Brimicombe, R. W.

AU - VanJperen, J. M.

AU - Van Der Hut, G.

AU - Franck, P. F.H.

AU - Van Eeden, A.

AU - Groot, M.

AU - Kwa, I. S.

AU - Bouwhuis, J. W.

AU - Van Hulzen, A. G.W.

AU - Bor, P. C.J.

AU - Bloembergen, P.

AU - Wolfhagen, M. J.H.M.

AU - Ruijs, G. J.H.M.

AU - Soetekouw, R.

AU - Van Der Prijt, L. M.M.

AU - Schoemaker, M.

AU - Van Der Reijden, W. A.

AU - Jansen, R.

AU - Herpers, B. L.

AU - Kroon, F. P.

AU - Arend, S. M.

AU - De Boer, M. G.J.

AU - Bauer, M. P.

AU - Jolink, H.

AU - Vollaard, A. M.

AU - Moons, C.

AU - Kroes, A. C.M.

AU - Pogany, K.

AU - Smit, J. V.

AU - Smit, E.

AU - Van Niekerk, T.

AU - Pontesilli, O.

AU - Lashof, A. Oude

AU - Posthouwer, D.

AU - Schippers, J.

AU - Vergoossen, R.

AU - Loo, I. H.

AU - El Moussaoui, R.

AU - Van Twillert, G.

AU - Stuart, J. W.T.Cohen

AU - Diederen, B. M.W.

AU - Van Truijen-Oud, F. A.

AU - Jansen, R.

AU - Gelinck, L. B.S.

AU - Meerkerk, C.

AU - Wildenbeest, G. S.

AU - Jansen, C. L.

AU - Van Houte, D. P.F.

AU - Faber, S.

AU - Delsing, C. E.

AU - Heins, H.

AU - Frissen, P. H.J.

AU - Blok, W. L.

AU - Schouten, W. E.M.

AU - Van Den Berk, G. E.L.

AU - Brouwer, C. J.

AU - Geerders, G. F.

AU - Hoeksema, K.

AU - Kleene, M. J.

AU - Van Der Meché, I. B.

AU - Toonen, A. J.M.

AU - Wijnands, S.

AU - Keuter, M.

AU - Van Der Ven, A. J.A.M.

AU - Hofstede, Hjm Ter

AU - Dofferhoff, A. S.M.

AU - Van Crevel, R.

AU - Bosch, M. E.W.

AU - Grintjes-Huisman, K. J.T.

AU - Zomer, B. J.

AU - Van Der Berg, J. P.

AU - Gisolf, E. H.

AU - Van Bentum, P. H.M.

AU - Langebeek, N.

AU - Swanink, C. M.A.

AU - Lettinga, K. D.

AU - Sulman, H.

AU - Witte, E.

AU - Vrouenraets, S. M.E.

AU - Lauw, F. N.

AU - Paap, H.

AU - Vlasblom, D. J.

AU - Rosingh, A. W.

AU - Brouwer, A. E.

AU - Kuipers, M.

AU - Santegoets, R. M.W.J.

AU - Van Der Ven, B.

AU - Buiting, A. G.M.

AU - Kabel, P. J.

AU - Sprenger, H. G.

AU - Scholvinck, E. H.

AU - Van Assen, S.

AU - Wilting, K. R.

AU - Stienstra, Y.

AU - Van Der Meulen, P. A.

AU - De Weerd, D. A.

AU - Riezebos-Brilman, A.

AU - Van Leer-Buter, C. C.

AU - Schneider, M. M.E.

AU - Mudrikova, T.

AU - Ellerbroek, P. M.

AU - Oosterheert, J. J.

AU - Arends, J. E.

AU - Barth, R. E.

AU - Wassenberg, M. W.M.

AU - Laan, L. M.

AU - Van Oers-Hazelzet, E. E.B.

AU - Patist, J.

AU - Vervoort, S.

AU - Frauenfelder, R.

AU - Verduyn-Lunel, F.

AU - Wensing, A. M.J.

AU - Van Agtmael, M. A.

AU - Perenboom, R. M.

AU - Bomers, M.

AU - De Vocht, J.

AU - Vandenbroucke-Grauls, C. M.J.E.

AU - Ang, C. W.

AU - Wolfs, T. F.W.

AU - Bont, L. J.

AU - Gras, L.

AU - Van Sighem, A. I.

AU - Smit, C.

AU - Hillebregt, M.

AU - Kimmel, V.

AU - Tong, Y.

AU - Van Den Boogaard, R.

AU - Hoekstra, P.

AU - De Lang, A.

AU - Berkhout, M.

AU - Grivell, S.

AU - Jansen, A.

AU - Van Den Akker, M.

AU - Bergsma, D.

AU - Lodewijk, C.

AU - Meijering, R.

AU - Peeck, B.

AU - Raethke, M.

AU - Ree, C.

AU - Regtop, R.

AU - Ruijs, Y.

AU - Schoorl, M.

AU - Tuijn, E.

AU - Veenenberg, L.

AU - Woudstra, T.

AU - Bakker, Y.

AU - De Jong, A.

AU - Broekhoven, M.

AU - Claessen, E.

AU - Rademaker, M. J.

AU - Munjishvili, L.

AU - Kruijne, E.

PY - 2016

Y1 - 2016

N2 - Objectives: Early testing for HIV and entry into care are crucial to optimise treatment outcomes of HIV-infected patients and to prevent spread of HIV. We examined risk factors for presentation with late or advanced disease in HIV-infected patients in the Netherlands. Methods: HIV-infected patients registered in care between January 1996 and June 2014 were selected from the ATHENA national observational HIV cohort. Risk factors for late presentation and advanced disease were analysed by multivariable logistic regression. Furthermore, geographical differences and time trends were examined. Results: Of 20 965 patients, 53% presented with latestage HIV infection, and 35% had advanced disease. Late presentation decreased from 62% (1996) to 42% (2013), while advanced disease decreased from 46% to 26%. Late presentation only declined significantly among men having sex with men (MSM; p <0.001), but not among heterosexual males (p=0.08) and females (p=0.73). Factors associated with late presentation were: heterosexual male (adjusted OR (aOR), 1.59; 95% CI 1.44 to 1.75 vs MSM), injecting drug use (2.00; CI 1.69 to 2.38), age .50 years (1.46; CI 1.33 to 1.60 vs 30.49 years), region of origin (South-East Asia 2.14; 1.80 to 2.54, sub-Saharan Africa 2.11; 1.88 to 2.36, Surinam 1.59; 1.37 to 1.84, Caribbean 1.31; 1.13 to 1.53, Latin America 1.23; 1.04 to 1.46 vs the Netherlands), and location of HIV diagnosis (hospital 3.27; 2.94 to 3.63, general practitioner 1.66; 1.50 to 1.83, antenatal screening 1.76; 1.38 to 2.34 vs sexually transmitted infection clinic). No association was found for socioeconomic status or level of urbanisation. Compared with Amsterdam, 2 regions had higher adjusted odds and 2 regions had lower odds of late presentation. Results were highly similar for advanced disease. Conclusions: Although the overall rate of late presentation is declining in the Netherlands, targeted programmes to reduce late HIV diagnoses remain needed for all risk groups, but should be prioritised for heterosexual males, migrant populations, people aged ≥50 years and certain regions in the Netherlands.

AB - Objectives: Early testing for HIV and entry into care are crucial to optimise treatment outcomes of HIV-infected patients and to prevent spread of HIV. We examined risk factors for presentation with late or advanced disease in HIV-infected patients in the Netherlands. Methods: HIV-infected patients registered in care between January 1996 and June 2014 were selected from the ATHENA national observational HIV cohort. Risk factors for late presentation and advanced disease were analysed by multivariable logistic regression. Furthermore, geographical differences and time trends were examined. Results: Of 20 965 patients, 53% presented with latestage HIV infection, and 35% had advanced disease. Late presentation decreased from 62% (1996) to 42% (2013), while advanced disease decreased from 46% to 26%. Late presentation only declined significantly among men having sex with men (MSM; p <0.001), but not among heterosexual males (p=0.08) and females (p=0.73). Factors associated with late presentation were: heterosexual male (adjusted OR (aOR), 1.59; 95% CI 1.44 to 1.75 vs MSM), injecting drug use (2.00; CI 1.69 to 2.38), age .50 years (1.46; CI 1.33 to 1.60 vs 30.49 years), region of origin (South-East Asia 2.14; 1.80 to 2.54, sub-Saharan Africa 2.11; 1.88 to 2.36, Surinam 1.59; 1.37 to 1.84, Caribbean 1.31; 1.13 to 1.53, Latin America 1.23; 1.04 to 1.46 vs the Netherlands), and location of HIV diagnosis (hospital 3.27; 2.94 to 3.63, general practitioner 1.66; 1.50 to 1.83, antenatal screening 1.76; 1.38 to 2.34 vs sexually transmitted infection clinic). No association was found for socioeconomic status or level of urbanisation. Compared with Amsterdam, 2 regions had higher adjusted odds and 2 regions had lower odds of late presentation. Results were highly similar for advanced disease. Conclusions: Although the overall rate of late presentation is declining in the Netherlands, targeted programmes to reduce late HIV diagnoses remain needed for all risk groups, but should be prioritised for heterosexual males, migrant populations, people aged ≥50 years and certain regions in the Netherlands.

UR - http://www.scopus.com/inward/record.url?scp=84962289368&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2015-009688

DO - 10.1136/bmjopen-2015-009688

M3 - Review article

VL - 6

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 1

M1 - e009688

ER -