Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
PLoS One. 2011;6(11):e27701. doi: 10.1371/journal.pone.0027701. Epub 2011 Nov 16.
To estimate the prevalence of undiagnosed HIV, the prevalence of diagnosed HIV, and proportion of HIV that is undiagnosed in populations with similar demographics as the Universal Screening for HIV in the Emergency Room (USHER) Trial and the Brigham and Women's Hospital (BWH) Emergency Department (ED) in Boston, MA. We also sought to estimate these quantities within demographic and risk behavior subgroups.
We used data from the USHER Trial, which was a randomized clinical trial of HIV screening conducted in the BWH ED. Since eligible participants were HIV-free at time of enrollment, we were able to calculate the prevalence of undiagnosed HIV. We used data from the Massachusetts Department of Public Health (MA/DPH) to estimate the prevalence of diagnosed HIV since the MA/DPH records the number of persons within MA who are HIV-positive. We calculated the proportion of HIV that is undiagnosed using these estimates of the prevalence of undiagnosed and diagnosed HIV. Estimates were stratified by age, sex, race/ethnicity, history of testing, and risk behaviors.
The overall expected prevalence of diagnosed HIV in a population similar to those presenting to the BWH ED was 0.71% (95% CI: 0.63%, 0.78%). The prevalence of undiagnosed HIV was estimated at 0.22% (95% CI: 0.10%, 0.42%) and resultant overall prevalence was 0.93%. The proportion of HIV-infection that is undiagnosed in this ED-based setting was estimated to be 23.7% (95% CI: 11.6%, 34.9%) of total HIV-infections.
Despite different methodology, our estimate of the proportion of HIV that is undiagnosed in an ED-setting was similar to previous estimates based on national surveillance data. Universal routine testing programs in EDs should use these data to help plan their yield of HIV detection.
估计与波士顿布莱根妇女医院（BWH）急诊部（ED）的普遍筛查艾滋病毒（HIV）在急诊室（USHER）试验和类似人群中未确诊 HIV 的流行率、已确诊 HIV 的流行率以及未确诊 HIV 的比例。我们还试图在人口统计学和风险行为亚组内估计这些数量。
我们使用了 USHER 试验的数据，这是一项在 BWH ED 进行的 HIV 筛查随机临床试验。由于合格的参与者在入组时 HIV 为阴性，因此我们能够计算未确诊 HIV 的流行率。我们使用马萨诸塞州公共卫生部（MA/DPH）的数据来估计已确诊 HIV 的流行率，因为 MA/DPH 记录了马萨诸塞州内 HIV 阳性的人数。我们使用这些未确诊和已确诊 HIV 的流行率估计值来计算未确诊 HIV 的比例。估计值按年龄、性别、种族/民族、检测史和风险行为分层。
在类似于 BWH ED 就诊人群中，总体预期已确诊 HIV 的流行率为 0.71%（95%CI：0.63%，0.78%）。未确诊 HIV 的流行率估计为 0.22%（95%CI：0.10%，0.42%），总流行率为 0.93%。在这个基于 ED 的环境中，HIV 感染未确诊的比例估计为总 HIV 感染的 23.7%（95%CI：11.6%，34.9%）。
尽管方法不同，但我们在 ED 环境中估计未确诊 HIV 的比例与基于国家监测数据的先前估计值相似。ED 中的通用常规检测计划应使用这些数据来帮助规划其 HIV 检测的效果。
