Using Nonrapid HIV Technology for Routine, Opt-out HIV Screening in a High-Volume Urban Emergency Department
Using Nonrapid HIV Technology for Routine, Opt-out HIV Screening in a High-Volume Urban Emergency Department
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DOI：
10.1016/j.annemergmed.2011.03.030
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发表时间：
2011-07-01
影响因子：
6.2
通讯作者：
Giordano, Thomas P.
中科院分区：
文献类型：
--
作者：
Hoxhaj, Shkelzen;Davila, Jessica A.;Giordano, Thomas P.
目的：我们实施了一个选择退出常规筛查计划，在高容量，城市急诊科（艾德），使用常规（非快速）技术作为替代快速HIV tests.Methods：我们进行了一项回顾性队列研究。自2008年10月以来，所有到本陶布总医院艾德就诊并抽血的患者都被认为有资格接受常规选择退出艾滋病毒筛查。该医院是德克萨斯州休斯顿的一家大型公立城市学术医院。艾德每月治疗约8，000名患者。用标准化学发光技术进行筛选，每小时分批。筛查结果呈阳性的患者被告知其可能的状况，由服务联系工作人员提供咨询，并在艾滋病毒初级保健诊所提供后续护理。结果：2008年10月1日至2009年4月30日期间，进行了14,093次HIV检测，39例患者（0.3%）选择退出。262例（1.9%）艾滋病毒检测结果呈阳性，80例新诊断，新诊断发生率为0.6%。化学发光假阳性22例，Western blot不确定7例。近一半的患者谁收到了新的诊断没有成功地联系到HIV护理在我们的system.Conclusion：选择退出筛选使用标准的非快速技术，而不是快速检测，是可行的，在一个忙碌繁忙的城市ED。这种方法的HIV筛查具有成本效益和低假阳性率，但积极的后续行动和转诊的患者与新的诊断联系到护理是必需的。[Ann 2011;58：S79-S84.]
Objective: We implement an opt-out routine screening program in a high-volume, urban emergency department (ED), using conventional (nonrapid) technology as an alternative to rapid HIV tests.Methods: We performed a retrospective cohort study. Since October 2008, all patients who visited Ben Taub General Hospital ED and had blood drawn were considered eligible for routine opt-out HIV screening. The hospital is a large, publicly funded, urban, academic hospital in Houston, TX. The ED treats approximately 8,000 patients monthly. Screening was performed with standard chemiluminescence technology, batched hourly. Patients with positive screening test results were informed of their likely status, counseled by a service linkage worker, and offered follow-up care at an HIV primary care clinic. Confirmatory Western blot assays were automatically performed on all new HIV-positive samples.Results: Between October 1, 2008, and April 30, 2009, 14,093 HIV tests were performed and 39 patients (0.3%) opted out. Two hundred sixty-two (1.9%) HIV test results were positive and 80 new diagnoses were made, for an incidence of new diagnoses of 0.6%. There were 22 false-positive chemiluminescence results and 7 indeterminate Western blot results. Nearly half the patients who received a new diagnosis were not successfully linked to HIV care in our system.Conclusion: Opt-out screening using standard nonrapid technology, rather than rapid testing, is feasible in a busy urban ED. This method of HIV screening has cost benefits and a low false-positivity rate, but aggressive follow-up and referral of patients with new diagnoses for linkage to care is required. [Ann Emerg Med. 2011;58:S79-S84.]