Evolution and Escalation of an Emergency Department Routine, Opt-out HIV Screening and Linkage-to-Care Program
Evolution and Escalation of an Emergency Department Routine, Opt-out HIV Screening and Linkage-to-Care Program
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DOI：
10.1177/00333549161310s112
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发表时间：
2016-01-01
影响因子：
3.3
通讯作者：
Heath, Sonya L.
中科院分区：
文献类型：
--
作者：
Galbraith, James W.;Willig, James H.;Heath, Sonya L.
客观的。自 2006 年以来，疾病控制与预防中心一直建议急诊科 (ED) 选择退出 HIV 筛查。由于急诊科的复杂性和优先事项的相互竞争，常规筛查可能具有挑战性。本研究考察了自 2011 年 8 月以来阿拉巴马州城市学术急诊室常规、综合、可选择退出的 HIV 筛查计划的实施和演变。方法。 2011 年 9 月，急诊科实施了常规、选择退出的 HIV 筛查作为护理标准。为了描述筛查计划的结果和升级，我们对三个单独的数据查询进行了数据分析：(1) 2011 年 9 月 21 日至 2013 年 12 月 31 日期间的遭遇级 HIV 筛查问卷和测试结果； (2) 2013年7月9日至12月31日检测水平的第四代HIV结果； (3) 2011 年 9 月 9 日至 2014 年 6 月 30 日期间的每日 HIV 检测率和趋势。结果。在进行的 46,385 项 HIV 筛查测试中，252 项（0.5%）被确认呈阳性。使用第四代 HIV 筛查方法发现的所有 HIV 患者中，急性 HIV 感染者占 11.8%。百分之七十六的确诊艾滋病毒阳性患者成功获得了护理服务。第四代 HIV 仪器检测的实施使每周 HIV 检测率下降了 15.0%。护理人员将 HIV 检测服务从分类转移到床边，导致每周 HIV 检测率下降 31.6%。结论。该计划展示了大批量、常规、选择性退出艾滋病毒筛查的能力。急诊室不断变化的挑战需要项目监测和调整，以维持急诊室中可扩展的艾滋病毒筛查。
Objective. The Centers for Disease Control and Prevention has recommended emergency department (ED) opt-out HIV screening since 2006. Routine screening can prove challenging due to the ED's complexity and competing priorities. This study examined the implementation and evolution of a routine, integrated, opt-out HIV screening program at an urban academic ED in Alabama since August 2011.Methods. ED routine, opt-out HIV screening was implemented as a standard of care in September 2011. To describe the outcomes and escalation of the screening program, data analyses were performed from three separate data queries: (1) encounter-level HIV screening questionnaire and test results from September 21, 2011, through December 31, 2013; (2) test-level, fourth-generation HIV results from July 9 through December 31, 2013; and (3) daily HIV testing rates and trends from September 9, 2011, through June 30, 2014.Results. Of the 46,385 HIV screening tests performed, 252 (0.5%) were confirmed to be positive. Acute HIV infection accounted for 11.8% of all HIV patients identified using the fourth-generation HIV screening assay. Seventy-six percent of confirmed HIV-positive patients had successful linkage to care. Implementation of fourth-generation HIV instrument-based testing resulted in a 15.0% decline in weekly HIV testing rates. Displacement of nursing provider HIV test offers from triage to the bedside resulted in a 31.6% decline in weekly HIV testing rates.Conclusion. This program demonstrated the capacity for high-volume, routine, opt-out HIV screening. Evolving ED challenges require program monitoring and adaptation to sustain scalable HIV screening in EDs.