Hansoti Bhakti, Kelen Gabor D, Quinn Thomas C, Whalen Madeleine M, DesRosiers Taylor T, Reynolds Steven J, Redd Andrew, Rothman Richard E
Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
Division of Intramural Research, NIAID/NIH, Baltimore, Maryland, United States of America.
PLoS One. 2017 Nov 2;12(11):e0187443. doi: 10.1371/journal.pone.0187443. eCollection 2017.
Only 45% of people currently living with HIV infection in sub-Saharan Africa are aware of their HIV status. Unmet testing needs may be addressed by utilizing the Emergency Department (ED) as an innovative testing venue in low and middle-income countries (LMICs). The purpose of this review is to examine the burden of HIV infection described in EDs in LMICs, with a focus on summarizing the implementation of various ED-based HIV testing strategies.
We performed a systematic review of Pubmed, Embase, Scopus, Web of Science and the Cochrane Library on June 12, 2016. A three-concept search was employed with emergency medicine (e.g., Emergency department, emergency medical services), HIV/AIDS (e.g., human immunodeficiency virus, acquired immunodeficiency syndrome), and LMIC terms (e.g., developing country, under developed countries, specific country names). The search returned 2026 unique articles. Of these, thirteen met inclusion criteria and were included in the final review. There was a large variation in the reported prevalence of HIV infection in the ED population ranging from to 2.14% in India to 43.3% in Uganda. The proportion HIV positive patients with previously undiagnosed infection ranged from 90% to 65.22%.
In the United States ED-based HIV testing strategies have been front and center at curbing the HIV epidemic. The limited number of ED-based studies we observed in this study may represent the paucity of HIV testing in this venue in LMICs. All of the studies in this review demonstrated a high prevalence of HIV infection in the ED and an extraordinarily high percentage of previously undiagnosed HIV infection. Although the numbers of published reports are few, these diverse studies imply that in HIV endemic low resource settings EDs carry a large burden of undiagnosed HIV infections and may offer a unique testing venue.
在撒哈拉以南非洲地区，目前仅有45%的艾滋病毒感染者知晓自己的感染状况。在低收入和中等收入国家（LMICs），可通过将急诊科（ED）作为创新的检测场所来满足未得到满足的检测需求。本综述的目的是研究低收入和中等收入国家急诊科中所描述的艾滋病毒感染负担，重点是总结各种基于急诊科的艾滋病毒检测策略的实施情况。
2016年6月12日，我们对PubMed、Embase、Scopus、科学网和考克兰图书馆进行了系统综述。采用了三概念检索，即急诊医学（如急诊科、紧急医疗服务）、艾滋病毒/艾滋病（如人类免疫缺陷病毒、获得性免疫缺陷综合征）和低收入和中等收入国家术语（如发展中国家、不发达国家、具体国家名称）。检索返回2026篇独特文章。其中，13篇符合纳入标准并被纳入最终综述。所报告的急诊科人群中艾滋病毒感染率差异很大，从印度的2.14%到乌干达的43.3%不等。既往未诊断感染的艾滋病毒阳性患者比例从90%到65.22%不等。
在美国，基于急诊科的艾滋病毒检测策略一直是遏制艾滋病毒流行的前沿和核心。我们在本研究中观察到的基于急诊科的研究数量有限，这可能代表了低收入和中等收入国家该场所艾滋病毒检测的匮乏。本综述中的所有研究均表明急诊科中艾滋病毒感染率很高，既往未诊断的艾滋病毒感染比例异常高。尽管已发表的报告数量很少，但这些不同的研究表明，在艾滋病毒流行的低资源环境中，急诊科承担着大量未诊断的艾滋病毒感染负担，并且可能提供一个独特的检测场所。
