Increasing Viral Testing in the Emergency Department (InVITED)

描述(由申请人提供)：急诊科(ED)有可能为滥用药物的人提供艾滋病毒、乙肝和丙型肝炎的联合快速筛查，并充当需要初级和专科医疗护理的渠道。医疗点快速筛查可以用于艾滋病毒，但还不能用于乙肝/丙型肝炎。然而，米里亚姆医院临床实验室可以在工作日的正常工作时间使用自动化系统以“快速”的方式(不到一小时)进行常规的乙肝/丙型肝炎检测。在这项创新的R21研究中，增加急诊室的病毒检测(邀请)，我们将抓住这一独特的机会进行模拟护理点快速乙肝/丙型肝炎筛查。此外，我们将进行真正的快速艾滋病毒筛查，以期未来能够对滥用药物的ED患者的所有三种感染进行真正的快速筛查。在INVITED中衡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(即接受测试的意愿)。我们还将调查一些与这一早期研究相称的过程措施。这些措施将有助于确定在所有滥用药物的ED患者中联合筛查艾滋病毒和乙肝病毒是否值得，即使是在没有注射毒品的ED患者中也是如此。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，短暂干预(BI)加上对艾滋病毒和乙肝/丙型肝炎危险行为的风险评估是否会增加对艾滋病毒和乙肝/丙型肝炎的联合筛查。如果BI和风险评估比单独的风险评估更有效地增加对邀请的筛查的接受，那么我们可以在未来更大的研究努力中进一步开发和改进BI方法。在这项R21早期研究的次要目标中，我们将考虑几个流程和支持措施，以评估筛查体验、ED联合筛查的效果以及向参与者提供的BI。我们将：(1)调查影响艾滋病毒感染和乙肝筛查的因素；(2)检查BI对自我认知和接受筛查的准备情况；(3)了解这一人群中未被识别的艾滋病毒和乙肝病毒感染的流行率；(4)了解这一人群对乙肝疫苗接种的需求和接受；(5)量化艾滋病毒感染者和乙肝/丙型肝炎患者的病毒载量和疾病严重程度；(6)评估ED为这些感染提供筛查的情况；以及(7)了解BI的主观体验。我们还将演示一种将感染这些疾病的患者直接联系到医疗保健中的系统。 公共卫生相关性：急诊科可以作为一个重要的场所，通过联合快速筛查来识别药物滥用者中未被识别的艾滋病毒、乙肝和丙型肝炎感染。为增加联合筛查的接受而进行的短暂干预可能会进一步促进对未识别的感染的识别，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.