Domínguez-Berjón M Felicitas, Pichiule-Castañeda Myrian, García-Riolobos M Carmen, Esteban-Vasallo María D, Arenas-González Sonia M, Morán-Arribas Mónica, Verdejo-Ortés José, Zoni Ana Clara, Álvarez-Castillo M Carmen, Astray Jenaro
Public Health Directorate, Madrid Regional Health Authority, Madrid, Spain.
Barcelona Primary Health Care Centre, Móstoles, Spain.
J Eval Clin Pract. 2017 Dec;23(6):1408-1414. doi: 10.1111/jep.12813. Epub 2017 Oct 2.
Late diagnosis of HIV infection is a public health problem. Framed by the international guidelines for improving HIV testing, in 2014, the Spanish Ministry of Health published a guide of recommendations to promote early diagnosis of HIV in health care settings. In the Community of Madrid, in order to implement these recommendations, we defined 3 new HIV testing strategies in primary health care. The objectives of this study were to know the interest of professionals and the acceptability for patients towards these strategies.
We performed a quasi-experimental study to assess the feasibility of the implementation of new strategies (indicator condition, risk based, and universal offer) to promote early detection of HIV infection in the framework of the ESTVIH project. The centres participating in this project were randomly chosen among centres located in the health areas with the highest incidence of HIV infection. The feasibility was assessed in 6 centres. We considered outcomes by strategy in relation to the participation of professionals (family physician and nursing) and patients.
Overall, 56.9% of eligible professionals agreed to take part in the study; however, the percentage of professionals who recruited patients was 25.9%. This percentage was higher in the indicator condition strategy (47.2%, versus 18.5% in the universal offer and 14.3% in the risk-based strategy, P-value < 0.05). The test uptake percentage was greater than 80%, and there were no statistically significant differences between strategies.
Different strategies promoting HIV testing in primary care had different acceptability among professionals and similar among patients. At the end of the ESTVIH project, these results will be complemented with others related to the contribution of each strategy to improving the early diagnosis of HIV infection.
HIV感染的晚期诊断是一个公共卫生问题。依据国际上改善HIV检测的指南，2014年西班牙卫生部发布了一份建议指南，以促进在医疗机构中对HIV进行早期诊断。在马德里自治区，为了实施这些建议，我们在初级卫生保健中定义了3种新的HIV检测策略。本研究的目的是了解专业人员对这些策略的兴趣以及患者对其的接受程度。
我们进行了一项准实验研究，以评估在ESTVIH项目框架内实施新策略（指标条件法、基于风险法和普遍提供法）以促进HIV感染早期检测的可行性。参与该项目的中心是从HIV感染发病率最高的健康区域中的中心随机选取的。在6个中心评估了可行性。我们根据策略考虑了与专业人员（家庭医生和护士）及患者参与情况相关的结果。
总体而言，56.9%符合条件的专业人员同意参与研究；然而，招募患者的专业人员比例为25.9%。该比例在指标条件法策略中更高（47.2%，而普遍提供法为18.5%，基于风险法为14.3%，P值<0.05）。检测接受率大于80%，各策略之间无统计学显著差异。
在初级保健中促进HIV检测的不同策略在专业人员中的接受程度不同，而在患者中相似。在ESTVIH项目结束时，这些结果将与其他与各策略对改善HIV感染早期诊断的贡献相关的结果相互补充。
