Sawe Hendry R, Mfinanga Juma A, Ringo Faith H, Mwafongo Victor, Reynolds Teri A, Runyon Michael S
Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania.
Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, Tanzania.
BMJ Open. 2016 Feb 15;6(2):e010298. doi: 10.1136/bmjopen-2015-010298.
To describe the HIV counselling and testing practices for children presenting to an emergency department (ED) in a low-income country.
The ED of a large east African national referral hospital.
This retrospective review of all paediatric (<18 years old) ED visits in 2012 enrolled patients who had an HIV test ordered and excluded those without testing. Files were available for 5540/5774 (96%) eligible patients and 1632 (30%) were tested for HIV, median age 1.3 years (IQR 9 months to 4 years), 58% <18 months old and 61% male.
The primary outcome measure was documentation of pretest and post-test counselling, or deferral of counselling, for children tested for HIV in the ED. Secondary measures included the overall rate of HIV testing, rate of counselling documented in the inpatient record when deferred in the ED, rate of counselling documented when testing was initiated by the inpatient service, rate of counselling documented by test result (positive vs negative) and the rate of referral to follow-up HIV care among patients testing positive.
Of 418 patients tested in the ED, counselling, or deferral of counselling, was documented for 70 (17%). When deferred to the ward, subsequent counselling was documented for 15/42 (36%). Counselling was documented in 33% of patients testing positive versus 1.1% patients testing negative (OR 43 (95% CI 23 to 83). Of 199 patients who tested positive and survived to hospital discharge, 76 (38%) were referred for follow-up at the HIV clinic on discharge.
Physicians documented the provision, or deferral, of counselling for <20% of children tested for HIV in the ED. Counselling was much more likely to be documented when the test result was positive. Less than 40% of those testing positive were referred for follow-up care.
描述在一个低收入国家急诊科就诊儿童的艾滋病毒咨询和检测情况。
东非一家大型国家级转诊医院的急诊科。
对2012年所有儿科（<18岁）急诊科就诊病例进行回顾性研究，纳入接受艾滋病毒检测的患者，排除未检测者。有5540/5774（96%）符合条件的患者有档案记录，其中1632例（30%）接受了艾滋病毒检测，中位年龄1.3岁（四分位间距9个月至4岁），58%小于18个月，61%为男性。
主要结局指标是对急诊科接受艾滋病毒检测儿童的检测前和检测后咨询记录，或咨询延迟情况。次要指标包括艾滋病毒检测总体率、在急诊科延迟咨询时住院记录中的咨询记录率、住院服务启动检测时的咨询记录率、按检测结果（阳性与阴性）记录的咨询率以及检测阳性患者中被转诊至后续艾滋病毒护理的比例。
在急诊科接受检测的418例患者中，有70例（17%）记录了咨询或咨询延迟情况。延迟至病房后，有15/42（36%）记录了后续咨询情况。检测阳性患者中有33%记录了咨询，而检测阴性患者中这一比例为1.1%（比值比43（95%可信区间23至83））。在199例检测阳性且存活至出院的患者中，76例（38%）在出院时被转诊至艾滋病毒诊所进行随访。
医生对急诊科接受艾滋病毒检测儿童中不到20%的咨询或延迟咨询情况进行了记录。检测结果为阳性时，咨询记录的可能性要大得多。检测阳性者中不到40%被转诊接受后续护理。
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