Department of Emergency Medicine, Denver Health Medical Center, Denver, CO 80204, USA.
Ann Emerg Med. 2011 Jul;58(1 Suppl 1):S96-103. doi: 10.1016/j.annemergmed.2011.03.017.
Casual review of existing literature reveals a multitude of individualized approaches to emergency department (ED) HIV testing. Cataloging the operational options of each approach could assist translation by disseminating existing knowledge, endorsing variability as a means to address testing barriers, and laying a foundation for future work in the area of operational models and outcomes investigation. The objective of this study is to provide a detailed account of the various models and operational constructs that have been described for performing HIV testing in EDs.
Systematic review of PUBMED, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Web of Science through February 6, 2009 was performed. Three investigators independently reviewed all potential abstracts and identified all studies that met the following criteria for inclusion: original research, performance of HIV testing in an ED in the United States, description of operational methods, and reporting of specific testing outcomes. Each study was independently assessed and data from each were abstracted with standardized instruments. Summary and pooled descriptive statistics were reported by using recently published nomenclature and definitions for ED HIV testing.
The primary search yielded 947 potential studies, of which 25 (3%) were included in the final analysis. Of the 25 included studies, 13 (52%) reported results using nontargeted screening as the only patient selection method. Most programs reported using voluntary, opt-in consent and separate, signed consent forms. A variety of assays and communication methods were used, but relatively limited outcomes data were reported.
Currently, limited evidence exists to inform HIV testing practices in EDs. There appears to be recent progression toward the use of rapid assays and nontargeted patient selection methods, with the rate at which reports are published in the peer-reviewed literature increasing. Additional research will be required, including controlled clinical trials, more structured program evaluation, and a focus on an expanded profile of outcome measures, to further improve our understanding of which HIV testing methods are most effective in the ED.
对现有文献的简要回顾表明，急诊科（ED）艾滋病毒检测存在多种个性化方法。对每种方法的操作选项进行分类可以通过传播现有知识、认可变异性作为解决检测障碍的一种手段，以及为运营模式和结果调查领域的未来工作奠定基础来提供帮助。本研究的目的是详细说明已在 ED 中进行 HIV 检测的各种模型和操作结构。
通过 2009 年 2 月 6 日之前的 PUBMED、EMBASE、护理学及相关健康文献累积索引（CINAHL）和 Web of Science 对文献进行系统回顾。三位研究者独立审查了所有可能的摘要，并确定了所有符合以下纳入标准的研究：原始研究、在美国 ED 中进行 HIV 检测、描述操作方法以及报告具体检测结果。对每项研究进行独立评估，并使用标准化工具提取每项研究的数据。根据最近发布的 ED HIV 检测命名法和定义报告总结和汇总描述性统计数据。
主要搜索产生了 947 项潜在研究，其中 25 项（3%）被纳入最终分析。在纳入的 25 项研究中，有 13 项（52%）报告仅使用非目标筛查作为唯一的患者选择方法的结果。大多数方案报告使用自愿、选择加入的同意书和单独的、签名的同意书。使用了各种检测方法和沟通方法，但报告的结果数据相对有限。
目前，关于 ED 艾滋病毒检测实践的证据有限。似乎最近朝着使用快速检测方法和非目标患者选择方法的方向发展，同行评议文献中的报告数量也在增加。需要开展更多的研究，包括对照临床试验、更具结构性的方案评估以及重点关注更广泛的结果衡量标准，以进一步提高我们对 ED 中哪些 HIV 检测方法最有效的理解。
