Comparison of HIV Screening Strategies in the Emergency Department: A Randomized Clinical Trial.
Comparison of HIV Screening Strategies in the Emergency Department: A Randomized Clinical Trial.
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DOI：
10.1001/jamanetworkopen.2021.17763
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发表时间：
2021-07-01
影响因子：
13.8
通讯作者：
HIV TESTED Trial Investigators
中科院分区：
文献类型：
--
作者：
Haukoos JS;Lyons MS;Rothman RE;White DAE;Hopkins E;Bucossi M;Ruffner AH;Ancona RM;Hsieh YH;Peterson SC;Signer D;Toerper MF;Saheed M;Pfeil SK;Todorovic T;Al-Tayyib AA;Bradley-Springer L;Campbell JD;Gardner EM;Rowan SE;Sabel AL;Thrun MW;HIV TESTED Trial Investigators
急诊科最有效的艾滋病毒筛查策略是什么？这项随机临床试验纳入了76561例艾德患者，这些患者被分配接受非靶向HIV筛查或2种靶向HIV筛查形式之一。共完成了14 405次艾滋病毒检测，其中24人（0.17%）被确定为新诊断的艾滋病毒感染者，3种策略之间的诊断率没有差异。有针对性和非有针对性的艾滋病毒筛查产生了相当数量的新的艾滋病毒诊断在ED。这项随机临床试验检查了76561急诊科患者就诊，以比较有针对性和非有针对性的艾滋病毒筛查策略的有效性，以发现新的诊断。美国国家艾滋病毒战略计划建议在急诊室进行艾滋病毒筛查。基于ED的HIV筛查的最有效方法仍然未知。比较HIV筛查策略与常规艾德实践的整合。这项随机临床试验纳入了2014年4月至2016年1月期间在4家美国城市医院急诊室就诊的患者。纳入的患者年龄在16岁或以上，没有危重病或精神改变，不知道有HIV阳性状态，预期住院时间为30分钟或更长。数据分析截至2021年3月。对比性患者接受隐藏随机分组，接受非靶向筛查、使用定量HIV风险预测工具的增强靶向筛查或根据疾病控制和预防中心改编的传统靶向筛查。筛查被整合到临床实践中，使用选择退出同意和第四代抗原抗体检测。使用意向治疗分析、绝对差异和风险比（RR）进行新的HIV诊断。共有76561例患者接受随机化访视;中位（四分位距）年龄为40（28-54）岁，34807例患者（51.2%）为女性，26776例（39.4%）为黑人，22131例（32.6%）为非西班牙裔白色患者，14542例（21.4%）为西班牙裔患者。共有25469人随机接受非靶向筛查; 25453人接受增强靶向筛查; 25639人接受传统靶向筛查。在非目标组中，6744名参与者（26.5%）完成测试，（0.15%）为新诊断;在增强目标组中，13883名参与者（54.5%）符合风险标准，4488（32.3%）完成测试，7新诊断占0.16%;在传统目标人群中，7099名参与者（27.7%）符合风险标准，3173名（44.7%）完成了检测，7名（0.22%）为新诊断。与非靶向筛查相比，靶向策略与更高的新诊断率无关（增强靶向和传统靶向组合：差异，-0.01%; 95%CI，-0.04%至0.02%; RR，0.7; 95%CI，0.30至1.56; P = 0.38;仅增强靶向：差异，-0.01%; 95% CI，-0.04%至0.02%; RR，0.70; 95% CI，0.27至1.84; P = 0.47）。有针对性的艾滋病毒筛查并不上级非有针对性的艾滋病毒筛查在ED。非有针对性的筛查导致显着更多的测试进行，虽然所有的策略确定了相对较低的新的艾滋病毒诊断。ClinicalTrials.gov标识符：NCT 01781949
What is the most effective HIV screening strategy for emergency departments (EDs)? This randomized clinical trial included 76 561 ED patient visits allocated to either nontargeted HIV screening or 1 of 2 forms of targeted HIV screening. A total of 14 405 HIV tests were completed resulting in 24 (0.17%) individuals identified with newly diagnosed HIV, with no difference in rates of diagnosis among the 3 strategies. Targeted and nontargeted HIV screening yielded comparable numbers of new HIV diagnoses in the ED. This randomized clinical trial examines 76 561 emergency department patient visits to compare effectiveness of targeted and nontargeted HIV screening strategies for finding new diagnoses. The National HIV Strategic Plan for the US recommends HIV screening in emergency departments (EDs). The most effective approach to ED-based HIV screening remains unknown. To compare strategies for HIV screening when integrated into usual ED practice. This randomized clinical trial included patients visiting EDs at 4 US urban hospitals between April 2014 and January 2016. Patients included were ages 16 years or older, not critically ill or mentally altered, not known to have an HIV positive status, and with an anticipated length of stay 30 minutes or longer. Data were analyzed through March 2021. Consecutive patients underwent concealed randomization to either nontargeted screening, enhanced targeted screening using a quantitative HIV risk prediction tool, or traditional targeted screening as adapted from the Centers for Disease Control and Prevention. Screening was integrated into clinical practice using opt-out consent and fourth-generation antigen-antibody assays. New HIV diagnoses using intention-to-treat analysis, absolute differences, and risk ratios (RRs). A total of 76 561 patient visits were randomized; median (interquartile range) age was 40 (28-54) years, 34 807 patients (51.2%) were women, and 26 776 (39.4%) were Black, 22 131 (32.6%) non-Hispanic White, and 14 542 (21.4%) Hispanic. A total of 25 469 were randomized to nontargeted screening; 25 453, enhanced targeted screening; and 25 639, traditional targeted screening. Of the nontargeted group, 6744 participants (26.5%) completed testing and 10 (0.15%) were newly diagnosed; of the enhanced targeted group, 13 883 participants (54.5%) met risk criteria, 4488 (32.3%) completed testing, and 7 (0.16%) were newly diagnosed; and of the traditional targeted group, 7099 participants (27.7%) met risk criteria, 3173 (44.7%) completed testing, and 7 (0.22%) were newly diagnosed. When compared with nontargeted screening, targeted strategies were not associated with a higher rate of new diagnoses (enhanced targeted and traditional targeted combined: difference, −0.01%; 95% CI, −0.04% to 0.02%; RR, 0.7; 95% CI, 0.30 to 1.56; P = .38; and enhanced targeted only: difference, −0.01%; 95% CI, −0.04% to 0.02%; RR, 0.70; 95% CI, 0.27 to 1.84; P = .47). Targeted HIV screening was not superior to nontargeted HIV screening in the ED. Nontargeted screening resulted in significantly more tests performed, although all strategies identified relatively low numbers of new HIV diagnoses. ClinicalTrials.gov Identifier: NCT01781949
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影响因子：
6.2
作者：
Hoxhaj, Shkelzen;Davila, Jessica A.;Giordano, Thomas P.
通讯作者：
Giordano, Thomas P.
影响因子：
4.4
作者：
Haukoos, Jason S.;Hopkins, Emily;Bakes, Katherine
通讯作者：
Bakes, Katherine
影响因子：
4.7
作者：
Rothman, Richard E.;Gauvey-Kern, Megan;Hsieh, Yu-Hsiang
通讯作者：
Hsieh, Yu-Hsiang
DOI：
10.1097/qai.0000000000000518
发表时间：
2015-04-15
影响因子：
3.6
作者：
Haukoos, Jason S.;Hopkins, Emily;Thrun, Mark W.
通讯作者：
Thrun, Mark W.
影响因子：
158.5
作者：
Paltiel, AD;Weinstein, MC;Walensky, RP
通讯作者：
Walensky, RP