Directorate of HIV/GU Medicine, Chelsea and Westminster Hospital NHS Foundation Trust.
HIV Med. 2013 Oct;14 Suppl 3:6-9. doi: 10.1111/hiv.12069.
Routine HIV testing in nonspecialist settings has been shown to be acceptable to patients and staff in pilot studies. The question of how to embed routine HIV testing, and make it sustainable, remains to be answered.
We established a service of routine HIV testing in an emergency department (ED) in London, delivered by ED staff as part of routine clinical care. All patients aged 16 to 65 years were offered an HIV test (latterly the upper age limit was removed). Meetings were held weekly and two outcome measures examined: test offer rate (coverage) and test uptake. Sustainability methodology (process mapping; plan-do-study-act (PDSA) cycles) was applied to maximize these outcome measures.
Over 30 months, 44,582 eligible patients attended the ED. The mean proportion offered an HIV test was 14%, varying from 6% to 54% per month over the testing period. The mean proportion accepting a test was 63% (range 33-100%). A total of 4327 HIV tests have been performed. Thirteen patients have been diagnosed with HIV infection (0.30%). PDSA cycles having the most positive and sustained effects on the outcome measures include the expansion to offer blood-based HIV tests in addition to the original oral fluid tests, and the engagement of ED nursing staff in the programme.
HIV testing can be delivered in the ED, but constant innovation and attention have been required to maintain it over 30 months. Patient uptake remains high, suggesting acceptability, but time will be required before true embedding in routine clinical practice is achieved.
在试点研究中，已证明在非专业环境中进行常规 HIV 检测可被患者和工作人员接受。但是，如何将常规 HIV 检测纳入并使其可持续发展的问题仍有待解答。
我们在伦敦的急诊科设立了常规 HIV 检测服务，由急诊科工作人员作为常规临床护理的一部分提供。所有年龄在 16 至 65 岁的患者都接受了 HIV 检测（后来取消了最高年龄限制）。每周举行一次会议，检查了两个结果指标：检测提供率（覆盖率）和检测接受率。应用可持续性方法学（流程映射；计划-执行-研究-行动（PDSA）循环）来最大程度地提高这些结果指标。
在 30 个月的时间里，共有 44582 名符合条件的患者到急诊科就诊。平均提供 HIV 检测的比例为 14％，在检测期间每月从 6％到 54％不等。平均接受检测的比例为 63％（范围为 33％至 100％）。共进行了 4327 次 HIV 检测。发现了 13 例 HIV 感染患者（0.30％）。对结果指标具有最积极和最持久影响的 PDSA 循环包括除最初的口腔液检测外，还提供基于血液的 HIV 检测，以及急诊科护理人员参与该计划。
可以在急诊科提供 HIV 检测，但是在 30 个月的时间里，需要不断创新和关注才能维持下去。患者的接受率仍然很高，表明其可接受性，但要实现真正嵌入常规临床实践，还需要时间。
