Differences between proof-of-concept studies and effective implementation: routine, opt-out HIV testing in emergency departments.
Differences between proof-of-concept studies and effective implementation: routine, opt-out HIV testing in emergency departments.
复制标题
概念验证研究与有效实施之间的差异：急诊科的常规、选择性退出艾滋病毒检测。
DOI：
10.1097/qai.0b013e3181582da9
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发表时间：
2007
期刊：
影响因子：
--
通讯作者：
Etzel,MarkA
中科院分区：
文献类型：
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作者：
Rotheram-Borus,MaryJane;Klosinski,LeeE;Etzel,MarkA
In 2006, the Centers for Disease Control and Prevention (CDC) announced guidelines recommending routine HIV testing in all health care settings anticipated to have an HIV prevalence rate of> 0.1% among its population. 1 Between 1% and 4% of the patients served in emergency departments (EDs) are anticipated to be HIV seropositive. 2, 3 Given the CDC policy, HIV testing programs have recently been evaluated in 6 EDs, 2-5 including the article by Brown 3 in this journal. Overall, the studies demonstrate that routine, opt-out HIV testing is feasible in EDs, resulting in cost-effective identification of HIV-positive patients and the ability to link HIV-positive patients to care. Together, these studies prove the concept of using ED-based testing to help to identify the 25% of HIV-positive adults unaware of their serostatus and the 40,000 annual incident HIV infections in the United States. 1However, there were substantial variations in each of the EDs in terms of the percentage of patients who were approached for HIV testing (2.1% to 47.5%), those who accepted testing (52% to 98.3%), and the percentage of HIV-positive patients linked to care after testing (50% to 90.8%). 2-5 The desired goal would be for ED staff to routinely approach most patients for HIV testing, for almost all patients approached to agree to be tested, and then for those who are identified as HIV-positive to be linked to care. Yet none of the proof-of-concept studies came close to meeting this goal. Together, these studies suggest that there are significant opportunities to improve the rates of offering, accepting, testing, and linking patients to care when moving from research studies to actual implementation in EDs nationwide. This article outlines the opportunities to improve the rates from those observed in the proof-of-concept research studies. There are both policy and organizational changes that must accompany broad diffusion of the CDC's guidelines for HIV testing. 8
