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Effectiveness of Rapid HIV Screening Methods in Urban Emergency Departments

城市急诊科艾滋病毒快速筛查方法的有效性

基本信息

批准号：
9121462
负责人：
JASON HAUKOOS
金额：
$ 59.71万
依托单位：
DENVER HEALTH AND HOSPITAL AUTHORITY
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-09-18 至 2018-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9121462
关键词：
Accident and Emergency department Advisory Committees Area Behavioral Caring Centers for Disease Control and Prevention (U.S.)Characteristics Clinical Clinical Trials Clinical effectiveness Cohort Studies Crowding Data Diagnosis Diagnostic Diagnostic tests Early identification Effectiveness Emergency Care Emergency Department evaluation Emergency department visit Evaluation HIV HIV Infections HIV diagnosis HIV risk Health Human immunodeficiency virus test Individual Infection Interdisciplinary Study Intervention Investigation Left Length of Stay Measures Medical Methods Motion Patients Prevalence Preventive service Process Public Health Public Health Practice Publishing Quasi-experiment Recommendation Research Research Infrastructure Resources Risk Risk Estimate Sampling Site Symptoms Testing Time Underserved Population United States Work base compare effectiveness cost cost effective design disorder prevention high risk improved innovation instrument novel patient population programs prospective public health priorities screening time use tool

项目摘要

DESCRIPTION (provided by applicant): Early identification of undiagnosed HIV infection is a critical public health priority. In the United States, despite several substantial HIV-related publc health initiatives, approximately 250,000 HIV-infected individuals remain undiagnosed and 50,000 new infections occur annually. Although HIV testing is an important intervention, controversy still exists as to how it should be implemented. In 2006, the Centers for Disease Control and Prevention (CDC) recommended nontargeted opt-out HIV screening in clinical settings where the undiagnosed prevalence was �0.1%. Emergency departments (EDs) have been a major focus of these recommendations, prompted by the fact that over 120 million ED visits occur annually in the United States, they serve large proportions of underserved patients, and are the most common site of missed diagnostic opportunities for HIV infection. In contrast, in 2007 the United States Preventive Services Task Force recommended targeted HIV screening (i.e., testing high-risk subpopulations) as the principal approach to HIV testing because insufficient evidence existed to support the CDC recommendations. Led by Jason Haukoos, MD, MSc, our research team has pioneered investigations in this area since 2004, recently publishing the largest clinical trial to date, concluding that nontargeted opt-out rapid HV screening in the ED was associated with a small increase in number of newly-identified HIV-infected patients when compared to diagnostic testing (i.e., testing based on clinical signs or symptoms) by clinicians. Our team also recently developed the Denver HIV Risk Score (DHRS), the first multivariable tool to estimate risk of HIV infection. The DHRS combines 3 demographic and 5 behavioral characteristics, and classifies patients into distinct strata with increasing HIV prevalence. To build on this work, we propose the following specific aims: (1) to evaluate and compare the effectiveness of 3 modern rapid HIV screening strategies when fully-integrated into routine ED care; (2) to measure and compare program costs of each HIV screening strategy; and (3) to measure and compare ED operational processes of each strategy. In doing so, we will perform a multi-center prospective clinical trial using a quasi-experimental equivalent time-samples design to test the following hypotheses: (1) targeted rapid HIV screening using the DHRS to identify high-risk patients is significantly associated with new HIV diagnoses when compared to traditional targeted rapid HIV screening and nontargeted rapid HIV screening; (2) targeted rapid HIV screening is more cost effective per newly-identified patient than nontargeted rapid HIV screening; and (3) targeted rapid HIV screening does not significantly impact ED processes of care when compared to nontargeted rapid HIV screening. We will leverage an outstanding interdisciplinary research team to conduct the largest and most comprehensive evaluation of HIV screening in EDs. The results will substantially improve our understanding of how to provide effective and efficient rapid HIV screening in EDs and to predominantly underserved populations, and will inform similar practices in other high-risk care settings.

描述（由申请人提供）：早期识别未确诊的艾滋病毒感染是一个关键的公共卫生优先事项。在美国，尽管采取了多项与艾滋病毒相关的重大公共卫生举措，但仍有约250，000名艾滋病毒感染者未被诊断出来，每年新增感染病例50，000例。虽然艾滋病毒检测是一项重要的干预措施，但对于如何实施仍然存在争议。2006年，疾病控制和预防中心（CDC）建议在未确诊患病率为0.1%的临床环境中进行非靶向选择性退出HIV筛查。急诊科（ED）一直是这些建议的主要焦点，这是因为美国每年有超过1.2亿艾德就诊，他们为大部分服务不足的患者提供服务，并且是错过HIV感染诊断机会的最常见场所。相比之下，2007年，美国预防服务工作组建议进行有针对性的艾滋病毒筛查（即，检测高危亚群）作为艾滋病毒检测的主要方法，因为没有足够的证据支持CDC的建议。由Jason Haukoos，MD，MSc领导，我们的研究团队自2004年以来一直在这一领域开展研究，最近发表了迄今为止最大的临床试验，结论是与诊断检测相比，艾德中的非靶向选择退出快速HV筛查与新发现的HIV感染患者数量的小幅增加有关（即，基于临床体征或症状的测试）。我们的团队最近还开发了丹佛艾滋病毒风险评分（DHRS），这是第一个评估艾滋病毒感染风险的多变量工具。DHRS结合了3个人口统计学特征和5个行为特征，并将患者分为不同的分层，随着艾滋病毒流行率的增加。在此基础上，我们提出了以下具体目标：（1）评估和比较3种现代快速艾滋病毒筛查策略完全整合到常规艾德护理中的有效性;（2）测量和比较每种艾滋病毒筛查策略的项目成本;（3）测量和比较每种策略的艾德操作流程。在此过程中，我们将使用准实验等效时间样本设计进行多中心前瞻性临床试验，以检验以下假设：（1）与传统的靶向快速HIV筛查和非靶向快速HIV筛查相比，使用DHRS识别高危患者的靶向快速HIV筛查与新的HIV诊断显著相关;（2）与非靶向快速HIV筛查相比，靶向快速HIV筛查对每个新发现的患者更具成本效益;（3）与非靶向快速HIV筛查相比，靶向快速HIV筛查不会显著影响艾德的护理过程。我们将利用一支优秀的跨学科研究团队，对急诊室的艾滋病毒筛查进行最大和最全面的评估。这些结果将大大提高我们对如何在急诊室和主要服务不足的人群中提供有效和高效的快速艾滋病毒筛查的理解，并将为其他高风险护理环境中的类似做法提供信息。

项目成果

期刊论文数量（14）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

In reply to: "Validating an HIV risk score".

回复：“验证艾滋病毒风险评分”。

DOI：
10.1016/j.ajem.2014.09.016
发表时间：
2014
期刊：
The American journal of emergency medicine
影响因子：
0
作者：
Hsieh,Yu-Hsiang;Rothman,RichardE;Haukoos,JasonS
通讯作者：
Haukoos,JasonS

Screening for HIV infection.

筛查艾滋病毒感染。

DOI：
10.1136/bmj.i1
发表时间：
2016
期刊：
BMJ (Clinical research ed.)
影响因子：
0
作者：
Haukoos,JasonS;Rowan,SarahE
通讯作者：
Rowan,SarahE

Understanding HIV Screening in the Emergency Department: Is Perception Reality?

DOI：
10.1111/acem.12082
发表时间：
2013-03-01
期刊：
ACADEMIC EMERGENCY MEDICINE
影响因子：
4.4
作者：
Haukoos, Jason S.;Hopkins, Emily
通讯作者：
Hopkins, Emily

Denver ED Trauma Organ Failure Score predicts healthcare resource utilization in adult trauma patients.

丹佛急诊科创伤器官衰竭评分可预测成年创伤患者的医疗资源利用率。

DOI：
10.1016/j.ajem.2018.08.073
发表时间：
2019
期刊：
The American journal of emergency medicine
影响因子：
0
作者：
Vogel,JodyA;GannonSungar,W;Boatright,Dowin;Ryan,Jordan;Murphy,Benjamin;Loar,Jesse;Adams,Sabrina;Haukoos,JasonS
通讯作者：
Haukoos,JasonS

The Propensity Score.