Patient acceptance of rapid HIV testing practices in an urban emergency department: Assessment of the 2006 CDC recommendations for HIV screening in health care settings
Patient acceptance of rapid HIV testing practices in an urban emergency department: Assessment of the 2006 CDC recommendations for HIV screening in health care settings
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DOI：
10.1016/j.annemergmed.2007.10.028
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发表时间：
2008-03-01
影响因子：
6.2
通讯作者：
Byyny, Richard L.
中科院分区：
文献类型：
--
作者：
Haukoos, Jason S.;Hopkins, Emily;Byyny, Richard L.
研究目的：美国疾病控制和预防中心（CDC）最近发布了修订后的建议，在卫生保健环境中进行艾滋病毒检测，呼吁执行非针对性的选择退出艾滋病毒筛查，将艾滋病毒检测的知情同意纳入医疗保健的一般同意，以及预防咨询和检测的脱钩。然而，目前尚不清楚患者是否会理解选择退出筛查，或对将艾滋病毒检测同意书纳入一般医疗同意书或将咨询与检测脱钩感到满意。本研究的目的是评估患者接受疾病预防控制中心的修订后的建议，在城市急诊科（艾德）。方法：这是一个横断面调查研究，在艾德的城市，公共安全网医院。大约每年的艾德普查是55，000例患者，大约未诊断的HIV血清阳性率范围为0.7%至2.2%。开发并试用了一个标准化调查工具，然后由训练有素的研究助理加以实施。成年患者谁是清醒的，警觉，并同意参加研究included.Results：在3个月的研究期间，529例患者入组。中位年龄为38岁（四分位数范围27 - 49岁;范围18 - 87岁），57%为男性，48%为白色，28%为西班牙裔，18%为黑人，6%代表其他种族或民族。当患者被问及如果使用选择退出方法是否会接受检测时，81%（95%置信区间[CI] 77%至84%）的患者同意接受检测。当被问及如果使用选择加入方法是否会对其进行检测时，没有差异（绝对差异0%; 95% CI-5%至4%）。然而，11%（95% CI 8%-14%）的患者需要解释选择退出筛选，而仅2%（95% CI 1%-4%）的患者需要解释选择加入筛选（绝对差异9%; 95% CI 5%-11%）。当被问及患者的医生是否建议在艾德访视期间进行HIV检测时，93%（95% CI 91%至95%）的患者同意接受检测。当被问及是否同意艾滋病毒检测应分开同意一般紧急医疗护理，50%（95% CI 46%至54%）同意。当被问及在进行艾滋病毒检测之前是否有必要咨询时，34%的人表示，（95% CI 30%至38%）同意，当被问及在收到阴性HIV检测结果后是否需要咨询时，35%（95% CI 31%至40%）同意。结论：很大一部分艾德患者似乎愿意按照CDC修订的卫生保健中HIV检测建议进行HIV感染筛查设置.当使用选择退出或选择加入筛选策略时，愿意接受检测的比例相似;然而，需要解释选择退出筛选的比例显著更高。
Study objective: The Centers for Disease Control and Prevention (CDC) recently released revised recommendations for HIV testing in health care settings, calling for the performance of nontargeted opt-out HIV screening, the integration of informed consent for HIV testing into the general consent for medical care, and the uncoupling of prevention counseling and testing. It is unclear, however, whether patients will understand opt-out screening or be satisfied with integration of the consent for HIV testing into the general medical consent or the uncoupling of counseling from testing. The objective of this study is to evaluate patients' acceptance of the CDC's revised recommendations in an urban emergency department (ED).Methods: This was a cross-sectional survey study performed in the ED of an urban, public safety net hospital. The approximate annual ED census is 55,000 patients, and an approximate undiagnosed HIV seroprevalence ranges from 0.7% to 2.2%. A standardized survey instrument was developed and piloted and was then implemented with trained research assistants. Adult patients who were awake, alert, and agreed to participate in the study were included.Results: During the 3-month study period, 529 patients were enrolled. The median age was 38 years (interquartile range 27 to 49 years; range 18 to 87 years), 57% were men, 48% were white, 28% were Hispanic, 18% were black, and 6% represented another race or ethnicity. When patients were asked whether they would have been tested had opt-out methodology been used, 81% (95% confidence interval [CI] 77% to 84%) would have agreed to be tested. When asked whether they would have been tested had opt-in methodology been used, there was no difference (absolute difference 0%; 95% Cl -5% to 4%). However, explanation of opt-out screening was required for 11% (95% Cl 8% to 14%), whereas explanation of opt-in screening was required for only 2% (95% Cl 1% to 4%) (absolute difference 9%; 95% Cl 5% to 11%). When asked whether the patient's physician recommended an HIV test during the ED visit, 93% (95% Cl 91% to 95%) would have agreed to be tested. When asked whether consent for HIV testing should be separate from consent for general emergency medical care, 50% (95% Cl 46% to 54%) agreed. When asked whether counseling was necessary before performing an HIV test, 34% (95% Cl 30% to 38%) agreed, and when asked whether counseling was necessary after receiving a negative HIV test result, 35% (95% Cl 31% to 40%) agreed.Conclusion: A large proportion of ED patients appear willing to be screened for HIV infection in accordance with the CDC's revised recommendations for HIV testing in health care settings. Similar proportions were willing to be tested when opt-out or opt-in screening strategies were used; however, a significantly greater proportion required explanation of opt-out screening.