Routine HIV testing in acute care hospitals: Changing practice to curb a local HIV epidemic in Vancouver, BC.

Autor: Gustafson R; Vancouver Coastal Health, Communicable Disease Control, Vancouver, BC, Canada; University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada., Demlow SE; Vancouver Coastal Health, Public Health Surveillance Unit, Vancouver, BC, Canada., Nathoo A; Vancouver Coastal Health, Prevention, Vancouver, BC, Canada., McKee G; Vancouver Coastal Health, Communicable Disease Control, Vancouver, BC, Canada. Electronic address: geoff.mckee@vch.ca., MacDonald LE; British Columbia Centre for Disease Control, Immunizations and Vaccine Preventable Diseases, Vancouver, BC, Canada., Chu T; Vancouver Coastal Health, Public Health Surveillance Unit, Vancouver, BC, Canada., Sandhu J; University of British Columbia, School of Population and Public Health, Vancouver, British Columbia, Canada; Vancouver Coastal Health, Public Health Surveillance Unit, Vancouver, BC, Canada., Grafstein E; St. Paul's Hospital, Department of Emergency Medicine, Vancouver, BC, Canada; University of British Columbia, Department of Emergency Medicine, Vancouver, BC, Canada., Hull M; British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada; University of British Columbia, Department of Medicine, Vancouver, Canada., Chittock D; University of British Columbia, Department of Medicine, Vancouver, Canada; Vancouver Coastal Health, Critical Care Medicine, Vancouver, BC, Canada., Carere R; Providence Health Care, Medical Affairs, Vancouver, British Columbia, Canada., Krajden M; University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, BC, Canada; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada., Sherlock CH; University of British Columbia, Department of Pathology and Laboratory Medicine, Vancouver, BC, Canada., Harrison S; Providence Health Care, HIV/AIDS and Addictions, Vancouver, BC, Canada., Buchner CS; Fraser Health, Population and Public Health, Surrey, BC, Canada., Montaner JSG; British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada; University of British Columbia, Department of Medicine, Vancouver, Canada., Daly P; Vancouver Coastal Health, Office of the Chief Medical Health Officer, Vancouver, British Columbia, Canada.
Jazyk: angličtina
Zdroj: Preventive medicine [Prev Med] 2020 Aug; Vol. 137, pp. 106132. Date of Electronic Publication: 2020 May 19.
DOI: 10.1016/j.ypmed.2020.106132
Abstrakt: Early treatment of HIV infection increases life expectancy and reduces infectivity; however, delayed HIV diagnosis remains common. Implementation and sustainability of hospital-based routine HIV testing in Vancouver, British Columbia, was evaluated to address a local HIV epidemic by facilitating earlier diagnosis and treatment. Public health issued a recommendation in 2011 to offer HIV testing to all patients presenting to three Vancouver hospitals as part of routine care, including all patients admitted to medical/surgical units with expansion to emergency departments (ED). We evaluated acceptability, feasibility, and effectiveness from 2011 to 2014 and continued monitoring through 2016 for sustainability. Between October 2011-December 2016, 114,803 HIV tests were administered at the three hospitals; an 11-fold increase following implementation of routine testing. The rate of testing was sustained and remained high through 2018. Of those tested, 151 patients were diagnosed with HIV for a testing yield of 0.13%. Review of 12,996 charts demonstrated 4935/5876 (96·9%) of admitted patients agreed to have an HIV test when offered. People diagnosed in hospital were significantly more likely to be diagnosed with acute stage (aOR 1·96, 95% CI 1·19, 3·23) infection, particularly those diagnosed in the ED. This study provides practice-based evidence of the feasibility, acceptability, and effectiveness of implementing a recommendation for routine HIV testing among inpatient and emergency department admissions, as well as the ability to normalize and sustain this change. Routine hospital-based HIV testing can increase diagnoses of acute HIV infection and facilitate earlier initiation of antiretroviral treatment.
Competing Interests: Declaration of competing interest JM is supported with grants paid to his institution by the British Columbia Ministry of Health and by the US National Institutes of Health (R01DA036307). He has also received limited unrestricted funding, paid to his institution, from AbbVie, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, and ViiV Healthcare.
(Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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