Baylor College of Medicine, Houston, TX, USA.
Ann Emerg Med. 2011 Jul;58(1 Suppl 1):S79-84. doi: 10.1016/j.annemergmed.2011.03.030.
We implement an opt-out routine screening program in a high-volume, urban emergency department (ED), using conventional (nonrapid) technology as an alternative to rapid HIV tests.
We performed a retrospective cohort study. Since October 2008, all patients who visited Ben Taub General Hospital ED and had blood drawn were considered eligible for routine opt-out HIV screening. The hospital is a large, publicly funded, urban, academic hospital in Houston, TX. The ED treats approximately 8,000 patients monthly. Screening was performed with standard chemiluminescence technology, batched hourly. Patients with positive screening test results were informed of their likely status, counseled by a service linkage worker, and offered follow-up care at an HIV primary care clinic. Confirmatory Western blot assays were automatically performed on all new HIV-positive samples.
Between October 1, 2008, and April 30, 2009, 14,093 HIV tests were performed and 39 patients (0.3%) opted out. Two hundred sixty-two (1.9%) HIV test results were positive and 80 new diagnoses were made, for an incidence of new diagnoses of 0.6%. There were 22 false-positive chemiluminescence results and 7 indeterminate Western blot results. Nearly half the patients who received a new diagnosis were not successfully linked to HIV care in our system.
Opt-out screening using standard nonrapid technology, rather than rapid testing, is feasible in a busy urban ED. This method of HIV screening has cost benefits and a low false-positivity rate, but aggressive follow-up and referral of patients with new diagnoses for linkage to care is required.
我们在一家大容量的城市急诊室（ED）实施了一项选择退出常规筛查计划，使用常规（非快速）技术作为快速 HIV 检测的替代方法。
我们进行了一项回顾性队列研究。自 2008 年 10 月以来，所有在德克萨斯州休斯顿本塔布综合医院 ED 就诊并接受血液检测的患者均被视为常规选择退出 HIV 筛查的合格对象。该医院是一家大型的、由公共资金资助的、城市性的学术医院。ED 每月治疗约 8000 名患者。使用标准的化学发光技术进行筛查，每小时分批进行。对筛查检测结果呈阳性的患者，告知他们可能的状态，由服务联络工作人员进行咨询，并在 HIV 初级保健诊所提供后续护理。对所有新的 HIV 阳性样本自动进行确认性 Western blot 检测。
在 2008 年 10 月 1 日至 2009 年 4 月 30 日期间，共进行了 14093 次 HIV 检测，有 39 名患者（0.3%）选择退出。262 份（1.9%）HIV 检测结果呈阳性，有 80 例新诊断病例，新诊断病例发生率为 0.6%。有 22 例化学发光假阳性结果和 7 例 Western blot 不确定结果。接受新诊断的患者中，近一半未能成功在我们的系统中获得 HIV 护理。
在繁忙的城市 ED 中，使用标准的非快速技术而不是快速检测进行选择退出筛查是可行的。这种 HIV 筛查方法具有成本效益和较低的假阳性率，但需要对新诊断的患者进行积极的随访和转介，以确保其与护理的联系。
