Ha S, Foley S, Paquette D, Seto J
Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON.
Can Commun Dis Rep. 2014 Nov 20;40(18):408-419. doi: 10.14745/ccdr.v40i18a06.
BACKGROUND: In Canada, it is estimated that 71,300 persons were living with HIV at the end of 2011. Approximately 25% (14,500 to 21,500) of prevalent cases were unaware of their HIV infection. Expanded use of HIV rapid tests may increase the detection of undiagnosed infections, enable earlier treatment and support services and prevent the onward transmission of HIV. OBJECTIVE: To examine patient acceptability, impact (defined as receipt of test results and linkage to care) and cost-effectiveness of HIV rapid tests. METHODS: A search was conducted for systematic reviews on HIV rapid testing, with studies from both developed and developing countries, published in English and between 2000 and 2013. The (AMSTAR) tool was used to assess the included systematic reviews for methodological quality. Results were summarized narratively for each of the outcomes. RESULTS: Eight systematic reviews were included. Acceptability of HIV rapid tests was generally high in medical settings (69% to 98%) especially among pregnant women and youth attending emergency rooms but was lower in non-medical settings (14% to 46%). The percentage of people who obtained their test results was variable. It was high (83% to 93%) in emergency rooms but was low in a rapid care setting with regular business hours (27%). Impact on linkage to care was limited. Only one systematic review examined cost-effectiveness of rapid testing and concluded that HIV rapid tests were cost-effective in comparison to traditional methods; however, results were all based on static models. CONCLUSION: Overall, HIV rapid tests demonstrated generally high acceptability, variability in receiving test results and limited impact on linkage to care. While these findings suggest that HIV rapid tests may be useful, further research is needed to confirm in whom, when and where they are best used and how to ensure better linkage to care.
背景:据估计,2011年底加拿大有71300人感染艾滋病毒。约25%(14500至21500)的艾滋病毒感染者不知自己已感染。扩大使用艾滋病毒快速检测可能会增加未诊断感染的检出率,使治疗和支持服务能更早开展,并预防艾滋病毒的进一步传播。 目的:研究艾滋病毒快速检测的患者接受度、影响(定义为收到检测结果并与医疗服务建立联系)和成本效益。 方法:检索了2000年至2013年期间发表的、来自发达国家和发展中国家、以英文撰写的关于艾滋病毒快速检测的系统评价。使用评估系统评价方法学质量的工具(AMSTAR)对纳入的系统评价进行评估。对每个结果进行叙述性总结。 结果:纳入了八项系统评价。艾滋病毒快速检测在医疗环境中的接受度普遍较高(69%至98%),尤其是在孕妇和前往急诊室的年轻人中,但在非医疗环境中的接受度较低(14%至46%)。获得检测结果的人群比例各不相同。在急诊室这一比例较高(83%至93%),但在正常营业时间的快速护理环境中较低(27%)。对与医疗服务建立联系的影响有限。只有一项系统评价研究了快速检测的成本效益,并得出结论,与传统方法相比,艾滋病毒快速检测具有成本效益;然而,结果均基于静态模型。 结论:总体而言,艾滋病毒快速检测显示出普遍较高的接受度、在获取检测结果方面存在差异以及对与医疗服务建立联系的影响有限。虽然这些结果表明艾滋病毒快速检测可能有用,但仍需进一步研究以确定哪些人、在何时何地最适合使用这些检测,以及如何确保更好地与医疗服务建立联系。
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