Whalen Madeleine, Mda Pamela, Parrish Andy, Quinn Thomas C, Rothman Richard, Stead David, Hansoti Bhakti
Johns Hopkins Hospital, United States.
Department of Medicine, Faculty of Health Sciences, Walter Sisulu University, South Africa.
South Afr J HIV Med. 2018 Jul 16;19(1):793. doi: 10.4102/sajhivmed.v19i1.793. eCollection 2018.
HIV is a worldwide health problem with continuing high rates of new infections in many parts of the world. This lack of progress in decreasing overall incidence rates has sparked innovative HIV testing strategies, including expansion of testing into the emergency department (ED) setting. Emergency departments have been shown to be high-yield testing venues in the United States and other developed world settings. The feasibility of expanding public health HIV services in the ED in limited-resource countries is unclear.
We performed a cross-sectional feasibility assessment of a convenience sample of four hospitals in the Eastern Cape, South Africa. We administered three adapted interview tools from a previously field-tested survey instrument at each facility (total of 10 interviews) to gather an overview of the health facility, their HIV counselling and testing services, and their laboratory services.
All of the health facilities had access to basic commodities such as water and electricity. Many had severe human resource limitations and provided care to wide population catchment areas. In addition, there was little integration of HIV testing into current daily ED operations. Hospital staff identified numerous barriers to future ED testing efforts.
Although control of the HIV epidemic requires innovative testing strategies and treatment, specific assessments are warranted on how to incorporate routine HIV testing into an acute care facility like the ED, which typically has many competing priorities. The use of a prospective structured tool incorporating both barriers and benefits can provide valuable field-tested guidance for increased programme planning for HIV testing.
艾滋病毒是一个全球性的健康问题，在世界许多地区新感染率持续居高不下。在降低总体发病率方面缺乏进展，这引发了创新的艾滋病毒检测策略，包括将检测扩展到急诊科（ED）。在美国和其他发达国家，急诊科已被证明是高效的检测场所。在资源有限的国家，在急诊科扩大公共卫生艾滋病毒服务的可行性尚不清楚。
我们对南非东开普省四家医院的便利样本进行了横断面可行性评估。我们在每个机构使用了三种改编自先前经过实地测试的调查工具的访谈工具（共10次访谈），以收集医疗机构的概况、其艾滋病毒咨询和检测服务以及其实验室服务。
所有医疗机构都能获得水和电等基本物资。许多机构存在严重的人力资源限制，为广泛的人口集水区提供护理。此外，艾滋病毒检测几乎没有融入当前急诊科的日常运作中。医院工作人员确定了未来急诊科检测工作的众多障碍。
尽管控制艾滋病毒流行需要创新的检测策略和治疗方法，但有必要对如何将常规艾滋病毒检测纳入像急诊科这样通常有许多相互竞争的优先事项的急性护理机构进行具体评估。使用一种包含障碍和益处的前瞻性结构化工具，可以为加强艾滋病毒检测的项目规划提供有价值的实地测试指导。
