Mehta Avani S, Goyal Monika K, Dowshen Nadia, Mistry Rakesh D
From the *Division of Emergency Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; †Emergency Medicine and Trauma Services, Children's National Medical Center, Washington, DC; ‡Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA; and §Section of Emergency Medicine, Children's Hospital Colorado, Aurora, CO.
Pediatr Emerg Care. 2015 Sep;31(9):621-6. doi: 10.1097/PEC.0000000000000370.
Limited data exist regarding knowledge of and compliance to the Centers for Disease Control and Prevention's universal adolescent human immunodeficiency virus (HIV) screening recommendations. Our objective was to assess current guideline knowledge, practice, and perceived barriers to emergency department (ED)-based adolescent HIV screening.
We administered an anonymous Web-based cross-sectional survey from May 1, 2012, to June 30, 2012, to 1073 physicians from the American Academy of Pediatrics Section on Emergency Medicine LISTSERV. Survey participants were included if they (1) practiced as attending-level physicians, (2) practiced primarily in pediatric emergency medicine or general emergency medicine, and (3) provided clinical care for patients younger than the age of 21 years. The survey examined respondent demographics, knowledge, attitudes, beliefs, practices, and barriers to ED-based HIV screening. Standard descriptive statistics and comparative analyses were performed.
A total of 220 responses were obtained; 29 responses were excluded and 191 responses were included in the study. Most of the participants were from urban, free-standing children's hospitals and had an annual ED volume of more than 61,000 patient visits. Respondent knowledge of the Centers for Disease Control and Prevention guidelines was low; less than 40% of the respondents identified correct consent requirements. Only 15.4% of the respondents reported screening for HIV more than 10 times for the prior 6 months. Most frequently cited barriers included concerns for privacy (67.4%), follow-up (67%), and cost-effectiveness (65.4%). Human immunodeficiency virus screening facilitators included availability of health educators (83%), established follow-up (74.7%), and rapid HIV tests (65.2%).
Emergency department clinicians exhibit poor knowledge of adolescent HIV screening recommendations. Current universal screening practices remain low; barriers to screening are numerous. Future efforts should disseminate guideline knowledge, increase rapid HIV testing and health educator availability, as well as reduce adolescent-specific barriers.
关于对疾病控制与预防中心（Centers for Disease Control and Prevention）青少年人类免疫缺陷病毒（HIV）普遍筛查建议的了解和遵循情况的数据有限。我们的目的是评估当前基于急诊科（ED）的青少年HIV筛查的指南知识、实践情况以及感知到的障碍。
我们在2012年5月1日至2012年6月30日期间，对美国儿科学会急诊医学分会邮件列表中的1073名医生进行了一项基于网络的匿名横断面调查。如果调查参与者满足以下条件则被纳入：（1）作为主治医生执业；（2）主要从事儿科急诊医学或普通急诊医学工作；（3）为21岁以下患者提供临床护理。该调查考察了受访者的人口统计学特征、知识、态度、信念、实践情况以及基于急诊科的HIV筛查的障碍。进行了标准描述性统计和比较分析。
共获得220份回复；29份回复被排除，191份回复纳入研究。大多数参与者来自城市独立儿童医院，急诊科年就诊量超过61000人次。受访者对疾病控制与预防中心指南的了解程度较低；不到40%的受访者能识别正确的同意要求。在前6个月中，只有15.4%的受访者报告进行了超过10次的HIV筛查。最常被提及的障碍包括对隐私的担忧（67.4%）、后续跟进（67%）和成本效益（65.4%）。HIV筛查的促进因素包括有健康教育工作者（83%）、既定的后续跟进（74.7%）和快速HIV检测（65.2%）。
急诊科临床医生对青少年HIV筛查建议的了解较差。当前的普遍筛查实践水平仍然较低；筛查障碍众多。未来的努力应传播指南知识，增加快速HIV检测和健康教育工作者的可及性，并减少针对青少年的障碍。
