MMWR Morb Mortal Wkly Rep. 2001 Jun 29;50(25):538-41.
In 1993, CDC recommended that hospitals and associated clinics in areas with high human immunodeficiency virus (HIV) prevalence offer HIV testing routinely to all patients aged 15-54 years (1). Although voluntary routine screening among hospitalized (2) and emergency department patients (3) can identify many undiagnosed HIV-infected persons, few screening programs have been implemented in these settings. A 1997 study at Grady Memorial Hospital, Atlanta, Georgia, found that nearly two thirds of inpatients newly diagnosed with acquired immunodeficiency syndrome (AIDS) had received medical care within the Grady health system during the 12 months preceding admission (4 ); these previous encounters were missed opportunities for earlier diagnosis of HIV. In response to the 1997 study, investigators studied routinely recommending HIV testing to patients presenting to the urgent-care clinic, an ambulatory clinic that provides episodic medical care to indigent and low income adults. This report summarizes the results of that study in which, compared with 1999 when testing was based on symptoms or risk behaviors, more patients were tested for HIV, more HIV infections were detected, and more infected persons learned their diagnosis and entered into care. These results reflect the benefits of recommending HIV testing routinely to patients in medical facilities located in areas with high HIV prevalence.
1993年，美国疾病控制与预防中心（CDC）建议，在人类免疫缺陷病毒（HIV）感染率较高的地区，医院及相关诊所应为所有15至54岁的患者常规开展HIV检测（1）。尽管在住院患者（2）和急诊科患者中开展自愿常规筛查（3）能够发现许多未被诊断出的HIV感染者，但在这些环境中实施的筛查项目却很少。1997年在佐治亚州亚特兰大市格雷迪纪念医院开展的一项研究发现，近三分之二新诊断为获得性免疫缺陷综合征（AIDS）的住院患者在入院前12个月内曾在格雷迪医疗系统接受过治疗（4）；这些之前的就诊机会是早期诊断HIV的错失良机。针对1997年的这项研究，研究人员对向紧急护理诊所就诊的患者常规推荐HIV检测进行了研究，该诊所是一家为贫困和低收入成年人提供间歇性医疗服务的门诊诊所。本报告总结了该项研究的结果，与1999年基于症状或风险行为进行检测时相比，接受HIV检测的患者更多，检测出的HIV感染病例更多，更多感染者知晓了自己的诊断并开始接受治疗。这些结果反映了在HIV感染率较高地区的医疗机构中向患者常规推荐HIV检测的益处。
