Randomized Comparison of Universal and Targeted HIV Screening in the Emergency Department
| Autor: | Kimberly W. Hart, Matthew Sperling, Andrew H. Ruffner, Alexander T. Trott, Christopher J. Lindsell, Michael S. Lyons, Carl J. Fichtenbaum, D. Beth Wayne |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Male Pediatrics medicine.medical_specialty Adolescent Referral HIV Infections Article Hospitals Urban Seroepidemiologic Studies Informed consent Cluster Analysis Humans Mass Screening Medicine Seroprevalence Pharmacology (medical) Mass screening Ohio Informed Consent business.industry Patient Selection HIV screening Emergency department Middle Aged Patient Acceptance of Health Care United States Confidence interval Early Diagnosis Infectious Diseases Lower prevalence Female Emergency Service Hospital business |
| Zdroj: | JAIDS Journal of Acquired Immune Deficiency Syndromes. 64:315-323 |
| ISSN: | 1525-4135 |
| Popis: | OBJECTIVE Universal HIV screening is recommended but challenging to implement. Selectively targeting those at risk is thought to miss cases, but previous studies are limited by narrow risk criteria, incomplete implementation, and absence of direct comparisons. We hypothesized that targeted HIV screening, when fully implemented and using maximally broad risk criteria, could detect nearly as many cases as universal screening with many fewer tests. METHODS This single-center cluster-randomized trial compared universal and targeted patient selection for HIV screening in a lower prevalence urban emergency department. Patients were excluded for age ( 64 years), known HIV infection, or previous approach for HIV testing that day. Targeted screening was offered for any risk indicator identified from charts, staff referral, or self-disclosure. Universal screening was offered regardless of risk. Baseline seroprevalence was estimated from consecutive deidentified blood samples. RESULTS There were 9572 eligible visits during which the patient was approached. For universal screening, 40.8% (1915/4692) consented with 6 being newly diagnosed [0.31%, 95% confidence interval (CI): 0.13% to 0.65%]. For targeted screening, 37% (1813/4880) had no testing indication. Of the 3067 remaining, 47.4% (1454) consented with 3 being newly diagnosed (0.22%, 95% CI: 0.06% to 0.55%). Estimated seroprevalence was 0.36% (95% CI: 0.16% to 0.70%). Targeted screening had a higher proportion consenting (47.4% vs. 40.8%, P < 0.002), but a lower proportion of ED encounters with testing (29.7% vs. 40.7%, P < 0.002). CONCLUSIONS Targeted screening, even when fully implemented with maximally permissive selection, offered no important increase in positivity rate or decrease in tests performed. Universal screening diagnosed more cases, because more were tested, despite a modestly lower consent rate. |
| Databáze: | OpenAIRE |
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