Walensky Rochelle P, Losina Elena, Steger-Craven Kathleen A, Freedberg Kenneth A
Division of Infectious Disease and Partners AIDS Research Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Staniford St, Ninth Floor, Boston, MA 02114, USA.
Arch Intern Med. 2002 Apr 22;162(8):887-92. doi: 10.1001/archinte.162.8.887.
Despite current recommendations for human immunodeficiency virus (HIV) counseling and testing among patients admitted to hospitals with at least a 1% prevalence of HIV infection, an estimated 300 000 people in the United States remain unaware of their HIV infection.
We implemented the Think HIV program, which offered voluntary HIV counseling and testing to patients admitted to the medical service of a Boston, Mass, teaching hospital. We compared the results of this effort with testing results from a 15-month historical control period.
Patients admitted during the program period were 3.4 times more likely to undergo testing for HIV than those admitted during the control period (95% confidence interval [CI], 2.8-4.1). The testing program detected approximately 2 new diagnoses of HIV infection per month, compared with 1 per month during the control period. Patients who underwent testing during the program, and who likely would not have done so without this initiative, had an estimated prevalence of HIV infection of 3.8% (95% CI, 1.8%-5.8%).
Testing efforts for HIV targeted to only symptomatic patients are inadequate to identify the one third of HIV-seropositive people in the United States who are unaware of their infection. We have shown that in a single urban hospital, offering voluntary, routine inpatient HIV counseling and testing can be successful as a screening program by identifying a substantial number of patients with undiagnosed HIV. These patients then can be informed, counseled, and linked to care and treatment. Seventy-two hospitals nationwide have demographics similar to those of the study hospital, suggesting that these results are generalizable to many urban hospitals.
尽管目前建议对入住医院且人类免疫缺陷病毒（HIV）感染率至少为1%的患者进行HIV咨询和检测，但在美国估计仍有30万人未意识到自己感染了HIV。
我们实施了“思考HIV”项目，为入住马萨诸塞州波士顿一家教学医院内科的患者提供自愿HIV咨询和检测。我们将这一举措的结果与15个月历史对照期的检测结果进行了比较。
项目期间入院的患者接受HIV检测的可能性是对照期入院患者的3.4倍（95%置信区间[CI]，2.8 - 4.1）。检测项目每月检测出约2例新的HIV感染病例，而对照期每月为1例。在项目期间接受检测且若没有这一举措可能不会接受检测的患者，其HIV感染估计患病率为3.8%（95%CI，1.8% - 5.8%）。
仅针对有症状患者进行HIV检测的力度不足以识别出美国三分之一未意识到感染的HIV血清阳性者。我们已表明，在一家城市医院，通过识别大量未确诊HIV的患者，提供自愿、常规的住院HIV咨询和检测作为筛查项目可以取得成功。然后可以让这些患者了解情况、接受咨询并与护理和治疗建立联系。全国有72家医院的人口统计学特征与研究医院相似，这表明这些结果可推广到许多城市医院。
