Strategies to Identify Undiagnosed HIV Infection in the Emergency Department

职业发展：候选人是丹佛健康中心急诊医学助理教授 医学中心（DHMC）和科罗拉多大学丹佛分校和健康科学中心。他的主要 长期职业目标是进行高质量的合作卫生服务研究，重点是 提供紧急医疗服务、预防艾滋病毒和改善公共卫生。要实现这一 目标，候选人将获得健康服务研究博士学位;将进行一系列相关研究 DHMC是一家城市安全网医院和综合医疗保健系统，为大部分 服务不足的患者;并受益于持续的高质量指导。研究计划：估计 在美国，每年有40，000例新的艾滋病毒感染，这一比率在2009年几乎没有变化。 过去十年。新的艾滋病毒感染似乎在非传统风险群体中增加最多，包括种族 和少数民族。大多数艾滋病毒感染者直到病程后期才接受检测， 这主要是因为其无症状期长，而且他们获得常规医疗护理的机会相对较少。超过 每年有1亿人到急诊室（ED）就诊，而艾德通常充当患者的 这是医疗保健的唯一来源，因此也是检测艾滋病毒感染的唯一潜在机会。还有， 最有可能使用艾德作为其唯一护理来源的患者通常是那些 疫情蔓延最快。为了提高对未确诊的艾滋病毒感染的识别，疾病中心 控制和预防最近呼吁在大多数医疗保健中广泛进行非针对性的选择退出艾滋病毒筛查 设置，包括ED。这一战略仍然未经检验，对广大发展中国家来说可能是次优的。 在美国的大多数ED。本研究的具体目标是：（1）利用大型， 前瞻性收集来自丹佛公共卫生的STD诊所数据库，以得出临床预测 准确识别HIV血清阳性的工具;（2）进行巢式前瞻性队列研究， 在DHMC的艾德外部验证该临床预测工具;以及（3）进行准 实验性等效时间样本临床试验，以评估使用经验性 衍生的临床预测工具，传统的艾滋病毒行为风险筛查工具，或没有 筛查作为一种手段，将艾德患者分为在ED中有HIV感染风险的组。 这些研究将提高我们对如何在ED中提供有效的快速HIV检测的理解， 导致在其他“高风险”医疗护理环境中提供此类服务的新方法。

Career Development: The candidate is an Assistant Professor in Emergency Medicine at Denver Health Medical Center (DHMC) and the University of Colorado at Denver and Health Sciences Center. His principal ong-term career goal is to conduct high-quality collaborative health services research with emphasis on emergency medical care delivery, HIV prevention, and improved public health. In order to accomplish this goal, the candidate will obtain his PhD in Health Services Research; will perform a series of related studies at DHMC, an urban, safety-net hospital and integrated healthcare system that serves a large proportion of underserved patients; and benefit from continued high-quality mentorship. Research Plan: An estimated 40,000 new HIV infections occur annually in the United States, and this rate has changed very little in the last decade. New HIV infections appear to be increasing most in non-traditional risk groups, including racial and ethnic minorities. Most persons infected with HIV still do not get tested until late in their disease courses, primarily due to its long asymptomatic period and their relatively poor access to routine medical care. Over 100 million people visit emergency departments (EDs) annually, and the ED commonly serves as a patient's only source for medical care, and thus the only potential opportunity to be tested for HIV infection. Also, patients who are most likely to use the ED as their only source of care are often those for whom the HIV epidemic is spreading most. To improve identification of undiagnosed HIV infection, the Centers for Disease Control and Prevention recently called for widespread non-targeted opt-out HIV screening in most healthcare settings, including EDs. This strategyJiowever, remains untested and is likely to be suboptimal for the vast majority of EDs in the United States./The specific aims of the proposed research are: (1) to use a large, prospectiveiy-coliected STD Clinic database from Denver Public Health to derive a clinical prediction instrument to accurately identify HIV seropositivity; (2) to conduct a nested prospective cohort study to externally validate this clinical prediction instrument in the ED at DHMC; and (3) to conduct a quasi- experimental equivalent time-samples clinical trial to assess the clinical effectiveness of using an empirically- derived clinical prediction instrument, a conventional HIV behavioral risk screening instrument, or no screening as a means to stratify ED patients into groups at risk for HIV infection in the ED. The results of these studies will improve our understanding of how to provide effective rapid HIV testing in EDs and may lead to novel approaches to providing such services in other "high-risk" medical care settings.