Comparison of HIV Screening Strategies in the Emergency Department: A Randomized Clinical Trial.

Autor:	Haukoos JS; Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado.; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora.; Department of Epidemiology, Colorado School of Public Health, Aurora., Lyons MS; Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio., Rothman RE; Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland., White DAE; Department of Emergency Medicine, Highland Hospital, Oakland, California., Hopkins E; Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado.; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora., Bucossi M; Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado.; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora., Ruffner AH; Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio., Ancona RM; Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio., Hsieh YH; Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland., Peterson SC; Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland., Signer D; Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland., Toerper MF; Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland., Saheed M; Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland., Pfeil SK; Department of Emergency Medicine, Highland Hospital, Oakland, California., Todorovic T; Department of Emergency Medicine, Highland Hospital, Oakland, California., Al-Tayyib AA; Department of Epidemiology, Colorado School of Public Health, Aurora.; Denver Public Health, Denver, Colorado., Bradley-Springer L; Division of Infectious Diseases, University of Colorado School of Medicine, Aurora., Campbell JD; Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado., Gardner EM; Denver Public Health, Denver, Colorado.; Division of Infectious Diseases, University of Colorado School of Medicine, Aurora., Rowan SE; Denver Public Health, Denver, Colorado.; Division of Infectious Diseases, University of Colorado School of Medicine, Aurora., Sabel AL; Department of Patient Safety and Quality, Denver Health, Denver, Colorado.; Department of Biostatistics, Colorado School of Public Health, Aurora., Thrun MW; Denver Public Health, Denver, Colorado.; Division of Infectious Diseases, University of Colorado School of Medicine, Aurora.; Gilead Sciences, Inc, Foster City, California.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2021 Jul 01; Vol. 4 (7), pp. e2117763. Date of Electronic Publication: 2021 Jul 01.
DOI:	10.1001/jamanetworkopen.2021.17763
Abstrakt:	Importance: The National HIV Strategic Plan for the US recommends HIV screening in emergency departments (EDs). The most effective approach to ED-based HIV screening remains unknown. Objective: To compare strategies for HIV screening when integrated into usual ED practice. Design, Setting, and Participants: This randomized clinical trial included patients visiting EDs at 4 US urban hospitals between April 2014 and January 2016. Patients included were ages 16 years or older, not critically ill or mentally altered, not known to have an HIV positive status, and with an anticipated length of stay 30 minutes or longer. Data were analyzed through March 2021. Interventions: Consecutive patients underwent concealed randomization to either nontargeted screening, enhanced targeted screening using a quantitative HIV risk prediction tool, or traditional targeted screening as adapted from the Centers for Disease Control and Prevention. Screening was integrated into clinical practice using opt-out consent and fourth-generation antigen-antibody assays. Main Outcomes and Measures: New HIV diagnoses using intention-to-treat analysis, absolute differences, and risk ratios (RRs). Results: A total of 76 561 patient visits were randomized; median (interquartile range) age was 40 (28-54) years, 34 807 patients (51.2%) were women, and 26 776 (39.4%) were Black, 22 131 (32.6%) non-Hispanic White, and 14 542 (21.4%) Hispanic. A total of 25 469 were randomized to nontargeted screening; 25 453, enhanced targeted screening; and 25 639, traditional targeted screening. Of the nontargeted group, 6744 participants (26.5%) completed testing and 10 (0.15%) were newly diagnosed; of the enhanced targeted group, 13 883 participants (54.5%) met risk criteria, 4488 (32.3%) completed testing, and 7 (0.16%) were newly diagnosed; and of the traditional targeted group, 7099 participants (27.7%) met risk criteria, 3173 (44.7%) completed testing, and 7 (0.22%) were newly diagnosed. When compared with nontargeted screening, targeted strategies were not associated with a higher rate of new diagnoses (enhanced targeted and traditional targeted combined: difference, -0.01%; 95% CI, -0.04% to 0.02%; RR, 0.7; 95% CI, 0.30 to 1.56; P = .38; and enhanced targeted only: difference, -0.01%; 95% CI, -0.04% to 0.02%; RR, 0.70; 95% CI, 0.27 to 1.84; P = .47). Conclusions and Relevance: Targeted HIV screening was not superior to nontargeted HIV screening in the ED. Nontargeted screening resulted in significantly more tests performed, although all strategies identified relatively low numbers of new HIV diagnoses. Trial Registration: ClinicalTrials.gov Identifier: NCT01781949.
Databáze:	MEDLINE
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