Health Research and Educational Trust, Chicago, IL 60606, USA.
Public Health Rep. 2013 May-Jun;128(3):161-9. doi: 10.1177/003335491312800306.
The Centers for Disease Control and Prevention recommends HIV screening in U.S. health-care settings unless providers document a yield of undiagnosed HIV infections of <1 per 1,000 population. However, implementation of this guidance has not been widespread and little is known of the characteristics of hospitals with screening practices in place. We assessed how screening practices vary with hospital characteristics.
We used a national hospital survey of HIV testing practices, linked to HIV prevalence for the county, parish, borough, or city where the hospital was located, to assess HIV screening of some or all patients by hospitals. We used multivariate logistic regression analysis to assess the association between screening practices and hospital characteristics that were significantly associated with screening in bivariate analyses.
Of 376 hospitals in areas of prevalence ≥0.1%, only 25 (6.6%) reported screening all patients for HIV and 131 (34.8%) reported screening some or all patients. Among 638 hospitals included, screening some or all patients was significantly (p<0.05) more common at teaching hospitals, hospitals with higher numbers of annual admissions, and hospitals with a high proportion of Medicaid admissions. In multivariable analysis, screening some or all patients was independently associated with admitting more than 15% of Medicaid patients and receiving resources or reimbursement for screening tests.
We found that few hospitals surveyed reported screening some or all patients, and failure to screen is common across all types of hospitals in all regions of the country. Expanded reimbursement for screening may increase compliance with the recommendations.
美国疾病控制与预防中心建议在美国医疗保健环境中进行 HIV 筛查，除非提供者记录到未经诊断的 HIV 感染率<每 1000 人 1 例。然而，该指南的实施并未广泛普及，对于已经实施筛查的医院的特征，我们知之甚少。我们评估了筛查实践如何随医院特征而变化。
我们使用了一项全国性的医院 HIV 检测实践调查，将其与医院所在地的县、堂区、自治市或城市的 HIV 流行率相关联，以评估医院对部分或全部患者进行 HIV 筛查的情况。我们使用多变量逻辑回归分析，评估了与筛查相关的医院特征与在双变量分析中与筛查显著相关的医院特征之间的关联。
在流行率≥0.1%的 376 家医院中，只有 25 家（6.6%）报告对所有患者进行 HIV 筛查，131 家（34.8%）报告对部分或所有患者进行筛查。在纳入的 638 家医院中，对部分或所有患者进行筛查的医院在教学医院、每年住院人数较多的医院和 Medicaid 住院人数比例较高的医院中更为常见（p<0.05）。在多变量分析中，对部分或所有患者进行筛查与收治 Medicaid 患者比例超过 15%以及接受筛查测试的资源或报销独立相关。
我们发现，调查的少数医院报告对部分或所有患者进行了筛查，而且全国各地所有类型的医院都普遍存在未进行筛查的情况。扩大对筛查的报销范围可能会提高对建议的遵守率。
