Increasing Viral Testing in the Emergency Department (InVITED)

描述（由申请人提供）：急诊科（EDs）可能为滥用药物的人提供艾滋病、乙肝和丙肝的联合快速筛查，并作为必要的初级和专业医疗护理的渠道。目前可进行艾滋病毒即时快速筛查，但还不能进行乙型/丙型肝炎筛查。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”的方式（不到一小时）进行传统的乙型/丙型肝炎检测。在这项创新的R21研究中，增加急诊科的病毒检测（特邀），我们将抓住这个独特的机会进行模拟的即时快速乙型/丙型肝炎筛查。此外，我们将进行真正的快速艾滋病毒筛查，预计未来可对滥用药物的ED患者中所有三种感染进行真正的快速筛查。在邀请书中测量的主要结果是滥用药物的ED患者对所有这三种感染的筛查（即接受检测的意愿）。我们还将调查一些与这个早期阶段研究相称的过程度量。这些措施将有助于确定在所有滥用药物的ED患者中进行HIV和乙型/丙型肝炎联合筛查是否值得，即使在不注射药物的ED患者中也是如此。作为受邀项目的一部分，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）与艾滋病毒和乙型/丙型肝炎风险行为风险评估是否会增加艾滋病毒和乙型/丙型肝炎联合筛查的接受度。如果BI和风险评估比单独的风险评估更有效，那么我们可以在未来更大的研究努力中进一步发展和完善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来评估筛查经验、ED联合筛查的产量以及提供给参与者的BI。我们将：(1)调查影响HIV和乙型/丙型肝炎筛查的因素；(2)检查BI对自我认知和接受筛选的准备程度的影响；(3)了解该人群中未被识别的艾滋病毒和乙型/丙型肝炎感染的流行情况；(4)了解这一人群对乙肝疫苗接种的需求和接受情况；(5)量化艾滋病毒和乙型/丙型肝炎患者的病毒载量和疾病严重程度；(6)评估急诊科为这些感染提供的筛检服务；(7)理解BI的主观体验。我们还将展示一个将这些感染的患者直接与医疗护理联系起来的系统。

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.