Tai Miao, Merchant Roland C
a Department of Biostatistics, Center for Statistical Sciences, School of Public Health , Brown University , Providence , RI , USA.
AIDS Care. 2014;26(9):1105-8. doi: 10.1080/09540121.2013.871220. Epub 2014 Jan 2.
In 1993, 2001, and 2006, the US Centers for Disease Control and Prevention (CDC) released revised recommendations aimed to expand HIV screening in health-care settings, increase the number of people who are aware of their infection, improve the health of those who are infected, and reduce HIV transmission. It is unclear how responsive health-care settings have been on a national level to these three successively revised sets of CDC recommendations. This study estimated the extent of HIV testing in US emergency departments (EDs), outpatient ambulatory medical care departments (OPDs), and physician offices among 13- to 64-year-olds from 1992 to 2010 to determine their responsiveness to CDC recommendations to expand HIV testing. The report includes data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) and the National Ambulatory Medical Care Survey (NAMCS), which are national probability sample surveys conducted by the National Center for Health Statistics (NCHS) for CDC. Over the entire study period, HIV testing was significantly greater in OPDs than in EDs (p < 0.01) and physician offices (p < 0.01). Multivariable logistic regression analysis showed that Hispanic and Black patients and those receiving Medicaid were more likely to be tested for HIV. Logistic regression tests of trend for the entire study period did not demonstrate significant increases in testing at EDs (Odds ratios [OR] 1.00 [0.97-1.03]) or OPDs (OR 1.01 [0.98-1.04]). For physician offices, there was no change in HIV testing for 1993-1999 (OR 1.03 [0.99-1.06]), but there was a relative increase for the entire study period (OR 1.04 [1.02-1.06]) because of more HIV testing in 2009 and 2010 in this setting. However, there were no differences in HIV testing for each setting for the interval years after revised CDC HIV testing recommendations were released for 1993-2001, 2002-2006, and 2007-2010.
1993年、2001年和2006年，美国疾病控制与预防中心（CDC）发布了修订后的建议，旨在扩大医疗保健机构中的艾滋病毒检测范围，增加知晓自身感染情况的人数，改善感染者的健康状况，并减少艾滋病毒传播。尚不清楚在国家层面上，医疗保健机构对这三套先后修订的CDC建议的响应情况如何。本研究估计了1992年至2010年期间美国急诊科（ED）、门诊流动医疗部门（OPD）和医生办公室中13至64岁人群的艾滋病毒检测程度，以确定它们对CDC扩大艾滋病毒检测建议的响应情况。该报告包括来自国家医院门诊医疗调查（NHAMCS）和国家门诊医疗调查（NAMCS）的数据，这两项调查是由国家卫生统计中心（NCHS）为CDC开展的全国概率抽样调查。在整个研究期间，OPD中的艾滋病毒检测显著高于ED（p < 0.01）和医生办公室（p < 0.01）。多变量逻辑回归分析表明，西班牙裔和黑人患者以及接受医疗补助的患者接受艾滋病毒检测的可能性更大。整个研究期间的趋势逻辑回归测试未显示ED（优势比[OR] 1.00 [0.97 - 1.03]）或OPD（OR 1.01 [0.98 - 1.04]）的检测有显著增加。对于医生办公室，1993 - 1999年艾滋病毒检测没有变化（OR 1.03 [0.99 - 1.06]），但由于2009年和2010年该环境下检测增多，整个研究期间有相对增加（OR 1.04 [1.02 - 1.06]）。然而，在1993 - 2001年、2002 - 2006年和2007 - 2010年发布修订后的CDC艾滋病毒检测建议后的各间隔年份中，各机构的艾滋病毒检测没有差异。
