Testing and Linkage to Care Outcomes for a Clinician-Initiated Rapid HIV Testing Program in an Urban Emergency Department
Testing and Linkage to Care Outcomes for a Clinician-Initiated Rapid HIV Testing Program in an Urban Emergency Department
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DOI：
10.1089/apc.2011.0041
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发表时间：
2011-07-01
影响因子：
4.9
通讯作者：
Hare, C. Bradley
中科院分区：
文献类型：
--
作者：
Christopoulos, Katerina A.;Kaplan, Beth;Hare, C. Bradley
城市急诊科是检测HIV感染的重要场所。目前的研究集中在急诊部门增加艾滋病毒检测的策略上。随着越来越多的急诊科艾滋病毒病例被发现，需要有明确的系统来联系护理。我们对2008年6月1日至2010年3月31日在城市公共急诊科和一级创伤中心进行的HIV快速检测进行了回顾性研究。本研究的目的是评估在临床医生发起的诊断检测中增加针对性检测所导致的检测数量的增加和新的艾滋病毒诊断，描述新诊断的艾滋病毒感染患者的人口统计学和临床特征，并评估基于艾滋病毒诊所与护理团队联系的有效性。在96,711次急诊就诊中，进行了5340次（5.5%）快速艾滋病毒检测，代表4827名（91.3%）独特的检测人员，其中62.4%为男性，60.8%来自种族/少数民族群体。改变检测策略后，每月检测的中位数从114次增加到273次（p = 0.004），每月新诊断的中位数从1.5例增加到4例（p = 0.01）。在进行的所有检测中，有65例新诊断为HIV感染（1.2%，95%可信区间[CI] 0.9%, 1.5%）。联络小组使90%以上的新诊断和失去护理的艾滋病毒感染者获得护理。总之，在诊断检测的基础上增加针对性检测增加了新的艾滋病毒病例的识别，以艾滋病毒诊所为基础的团队在与护理联系方面是有效的。
The urban emergency department is an important site for the detection of HIV infection. Current research has focused on strategies to increase HIV testing in the emergency department. As more emergency department HIV cases are identified, there need to be well-defined systems for linkage to care. We conducted a retrospective study of rapid HIV testing in an urban public emergency department and level I trauma center from June 1, 2008, to March 31, 2010. The objectives of this study were to evaluate the increase in the number of tests and new HIV diagnoses resulting from the addition of targeted testing to clinician-initiated diagnostic testing, describe the demographic and clinical characteristics of patients with newly diagnosed HIV infection, and assess the effectiveness of an HIV clinic based linkage to care team. Of 96,711 emergency department visits, there were 5340 (5.5%) rapid HIV tests performed, representing 4827 (91.3%) unique testers, of whom 62.4% were male and 60.8% were from racial/ethnic minority groups. After the change in testing strategy, the median number of tests per month increased from 114 to 273 (p = 0.004), and the median number of new diagnoses per month increased from 1.5 to 4 (p = 0.01). From all tests conducted, there were 65 new diagnoses of HIV infection (1.2%, 95% confidence interval [CI] 0.9%, 1.5%). The linkage team connected over 90% of newly diagnosed and out-of-care HIV-infected patients to care. In summary, the addition of targeted testing to diagnostic testing increased new HIV case identification, and an HIV clinic-based team was effective at linkage to care.