Division of Infectious Diseases, Department of Internal Medicine and Pediatrics, Columbia University Medical Center , New York, New York.
AIDS Patient Care STDS. 2018 Nov;32(11):432-437. doi: 10.1089/apc.2018.0127.
Even though over the last 25 years, the Centers for Disease Control and Prevention recommendations for HIV screening have expanded to encompass population-wide screening in all healthcare settings, and despite the availability of pre-exposure prophylaxis (PrEP), a large proportion of individuals at risk of infection are not linked to prevention care. We evaluated missed opportunities for HIV screening and linkage to PrEP from 2006 through 2017 at an urban academic medical center serving a predominantly minority community. A missed opportunity for HIV screening was a provider visit that did not include HIV testing and occurred within the 12 months before the first positive HIV test. A missed opportunity for prevention was a visit after 2012 that included a negative HIV test, no evaluation for PrEP, and was followed by a positive HIV test. Univariate analysis was performed to assess characteristics of individuals with missed opportunities for screening and prevention services. Between 2006 and 2017, 721 patients were newly diagnosed with HIV. Two hundred forty-seven diagnoses were made in the early period (2006-2010), 236 in the middle period (2010-2013), and 238 in the late period (2014-2017). Overall 60% of patients had at least one missed opportunity, 36% for HIV screening, and 42% for PrEP. There was no improvement in the rates of individuals with a missed opportunity for HIV screening over time. Ending the HIV epidemic will require concerted efforts to bolster access to testing and ensure that all individuals are offered screening, counseling, and linkage to prevention and care services.
尽管在过去的 25 年中，疾病控制与预防中心（Centers for Disease Control and Prevention）的建议已将艾滋病毒筛查扩展到所有医疗保健环境中的全民筛查，并且尽管有暴露前预防（PrEP），但仍有很大一部分有感染风险的个体未与预防护理联系起来。我们评估了在服务于主要少数族裔社区的城市学术医疗中心，从 2006 年到 2017 年期间艾滋病毒筛查和与 PrEP 联系的错失机会。艾滋病毒筛查的错失机会是指在首次艾滋病毒检测前 12 个月内，未进行艾滋病毒检测的就诊，并且未进行艾滋病毒检测。预防的错失机会是指在 2012 年之后的就诊，包括阴性艾滋病毒检测、未进行 PrEP 评估，随后艾滋病毒检测呈阳性。进行单变量分析以评估具有筛查和预防服务错失机会的个体的特征。在 2006 年至 2017 年期间，有 721 名患者新诊断出患有 HIV。247 例诊断发生在早期（2006-2010 年），236 例发生在中期（2010-2013 年），238 例发生在晚期（2014-2017 年）。总体而言，有 60％的患者至少有一次错失机会，其中 36％是艾滋病毒筛查，42％是 PrEP。随着时间的流逝，艾滋病毒筛查错失机会的个体比率没有改善。要结束艾滋病毒流行，需要共同努力，加强检测的获取，并确保向所有人提供筛查，咨询以及与预防和护理服务的联系。
