Guenter D, Greer J, Barbara A, Robinson G, Roberts J, Browne G
Deparment of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
AIDS Patient Care STDS. 2008 Mar;22(3):195-204. doi: 10.1089/apc.2007.0137.
Our goal was to determine whether introducing rapid point-of-care (POC) whole-blood HIV testing as alternative to standard laboratory-based testing is acceptable and changes the rate of receiving test results at an anonymous testing program. From December 2001 through April 2002 all patients requesting HIV testing at Hassle Free Clinic in Toronto were offered rapid POC or standard testing. Routine clinical data was collected. All patients were invited to complete a questionnaire evaluating testing procedure. Test counselors also completed evaluation questionnaires. HIV-positive patients were invited to an in-depth interview. There were 1610 patients, 91% chose the rapid POC test. Overall 98.9% of patients received final results, compared with 93% in the previous year. Among the rapid testers, 100% received an initial result, and 18 of 22 testing positive returned for confirmatory results. Among standard testers 90.8% returned for results (p < 0.001 compared to rapid testers) including all of the 4 with positive tests. There were 1257 (79%) patients who completed questionnaires, 4 with positive tests agreed to interviews, and test counselors evaluated every visit. Standard testers indicated significantly greater difficulty than rapid testers with the testing procedure. Test counselors also indicated that standard testers had greater difficulty. HIV-positive patients coped well with the testing procedure and indicated high quality counseling was important. Rapid HIV testing was acceptable to patients and test counselors, provided more patients with test results and reduced total time and number of visits. High-quality pretest and posttest counseling is particularly important for rapid testers with positive results. The impact of false-positive results requires further study.
我们的目标是确定引入即时快速全血HIV检测作为基于实验室的标准检测的替代方法是否可接受，以及在一个匿名检测项目中是否会改变获得检测结果的比率。从2001年12月到2002年4月，在多伦多的无忧诊所，所有要求进行HIV检测的患者都可以选择快速即时检测或标准检测。收集了常规临床数据。邀请所有患者填写一份评估检测程序的问卷。检测咨询师也完成了评估问卷。邀请HIV阳性患者进行深入访谈。共有1610名患者，91%选择了快速即时检测。总体而言，98.9%的患者收到了最终结果，而前一年这一比例为93%。在快速检测者中，100%收到了初步结果，22名检测呈阳性者中有18人回来获取确认结果。在标准检测者中，90.8%回来获取结果（与快速检测者相比，p<0.001），其中包括所有4名检测呈阳性者。有1257名（79%）患者完成了问卷，4名检测呈阳性者同意接受访谈，检测咨询师对每次就诊进行了评估。标准检测者表示在检测程序上比快速检测者困难得多。检测咨询师也指出标准检测者困难更大。HIV阳性患者很好地应对了检测程序，并表示高质量的咨询很重要。快速HIV检测对患者和检测咨询师来说是可接受的，它为更多患者提供了检测结果，减少了总时间和就诊次数。对于检测结果呈阳性的快速检测者来说，高质量的检测前和检测后咨询尤为重要。假阳性结果的影响需要进一步研究。
