Increasing Viral Testing in the Emergency Department (InVITED)

描述（由申请人提供）：急诊科（ED）可能为那些滥用药物的人提供HIV、B型肝炎和丙型肝炎的联合快速筛查，并作为所需初级和专业医疗护理的渠道。艾滋病毒的即时快速筛查是可用的，但尚未用于B/C型肝炎。然而，Miriam医院临床实验室可以在工作日正常工作时间内使用自动化系统以“快速”方式（不到一小时）进行传统的B/C型肝炎检测。在这项创新的R21研究中，增加艾德的病毒检测（INVITE艾德），我们将抓住这一独特的机会进行模拟床旁快速B/C肝炎筛查。此外，我们将进行真正的快速艾滋病毒筛查，以期待未来在滥用药物的艾德患者中对所有三种感染进行真正的快速筛查。 在Invited中测量的主要结果是筛查的摄取（即，愿意接受测试）的所有这三种感染的艾德患者谁滥用药物。我们还将调查一些与早期研究相称的过程措施。这些措施将有助于确定是否联合筛查艾滋病毒和B/C型肝炎的所有艾德患者谁滥用药物是一个值得追求的，即使在艾德患者谁不是注射毒品使用者。 作为Invited的一部分，我们将进行一项随机对照试验，以调查与单独进行风险评估相比，简短干预（BI）沿着HIV和B/C肝炎风险行为的风险评估是否会增加HIV和B/C肝炎联合筛查的接受率。如果BI和风险评估比单独的风险评估更有效地增加了Invited中筛选的吸收，那么我们可以在未来更大的研究工作中进一步开发和完善BI方法。 在这项R21早期研究的次要目的中，我们将考虑几个过程和支持性措施，以评价筛选经验、艾德联合筛选的产量以及提供给受试者的BI。我们将：（1）调查影响接受HIV和B/C型肝炎筛查的因素;（2）检查BI对自我识别和准备接受筛查的影响;（3）了解该人群中未被识别的HIV和B/C型肝炎感染的患病率;（4）了解该人群对B型肝炎疫苗接种的需求和接受情况;（5）量化HIV和B/C型肝炎患者的病毒载量和疾病严重程度;（6）评估艾德对这些感染的筛查;（7）了解BI的主观体验。我们还将展示一个将这些感染患者直接与医疗保健联系起来的系统。 公共卫生相关性：急诊科可以作为一个重要的场所，确定未识别的艾滋病毒，B型肝炎和丙型肝炎感染的药物滥用者，通过联合快速筛查。一个简短的干预措施，以增加联合筛查的吸收可能会进一步促进识别未被识别的感染，并加强与护理的联系。

DESCRIPTION (provided by applicant): Emergency departments (EDs) could potentially provide combined rapid screening for HIV, hepatitis B, and hepatitis C to those who misuse drugs and serve as a conduit to needed primary and specialty medical care. Point-of-care rapid screening is available for HIV, but not yet for hepatitis B/C. However, The Miriam Hospital clinical laboratory can perform conventional hepatitis B/C testing in a "rapid" manner (less than one hour) using automated systems during weekday regular working hours. In this innovative R21 study, Increasing Viral Testing in the ED (InVITED), we will seize upon this unique chance to perform simulated point-of- care rapid hepatitis B/C screening. In addition, we will perform true rapid HIV screening in anticipation of the future availability of true rapid screening for all three infections among ED patients who misuse drugs. The primary outcome measured in InVITED is uptake of screening (i.e., willingness to be tested) for all three of these infections by ED patients who misuse drugs. We also will investigate a number of process measures commensurate with this early stage research. These measures will help determine if combined screening for HIV and hepatitis B/C among all ED patients who misuse drugs is a worthwhile pursuit, even among ED patients who are not injection-drug users. As part of InVITED, we will conduct a randomized, controlled trial to investigate if a brief intervention (BI) along with a risk assessment about HIV and hepatitis B/C risk behaviors increases uptake of combined screening for HIV and hepatitis B/C, compared to a risk assessment alone. If BI and a risk assessment are more effective than a risk assessment alone in increasing uptake of screening in InVITED, then we can further develop and refine the BI methods in future larger research endeavors. In the secondary aims of this R21 early-stage research, we will consider several process and supportive measures to evaluate the screening experience, yield of combined screening in the ED, and the BI provided to participants. We will: (1) investigate factors influencing uptake of HIV and hepatitis B/C screening; (2) examine the impact of a BI on self-recognition for and readiness to be screened; (3) learn the prevalence of unrecognized HIV and hepatitis B/C infections in this population; (4) understand the need for and uptake of hepatitis B vaccination in this population; (5) quantify the viral load and disease severity among those with HIV and hepatitis B/C; (6) evaluate the provision of screening for these infections in the ED; and (7) understand the subjective experience of the BI. We also will demonstrate a system of linking patients with these infections directly into medical care. PUBLIC HEALTH RELEVANCE: The emergency department could serve as an important venue for identifying unrecognized HIV, hepatitis B, and hepatitis C infections among drug misusers through combined rapid screening. A brief intervention to increase uptake of combined screening might further boost identification of unrecognized infections and enhance linkage to care.