Bhatt Seema R, Eckerle Michelle D, Reed Jennifer L, Robinson Venita, Brown Angela, Lippe Joyce, Holland Carolyn, Iyer Srikant
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Pediatr Qual Saf. 2020 Jan 10;5(1):e248. doi: 10.1097/pq9.0000000000000248. eCollection 2020 Jan-Feb.
HIV infection rates are increasing among adolescents. Despite guidelines recommending annual HIV screening among sexually active adolescents, 3.6% of adolescents tested for other sexually transmitted infections (STI) in a pediatric emergency department (PED) were screened for HIV. The aim was to increase HIV screening to 90%.
Interventions were designed to address 4 key drivers thought to be critical in reliably offering HIV testing. The primary outcome measure was the proportion of adolescents offered HIV testing among those being tested for common STIs. Statistical process control charts were used to measure performance over time and differentiate common versus special cause variation.
We instituted point of care (POC) HIV testing in the PED in January 2012. The proportion of STI tested patients offered HIV testing was increased to >87% and sustained this performance. Implementation of a clinical decision support tool had the highest impact. The majority offered testing agreed, and the most common reason for refusal was a recent negative test. We identified eleven HIV positive patients over 5 years. Eight were newly diagnosed, and 3 had prior positive tests but were not connected to care. All 11 were successfully connected to providers with HIV care expertise.
POC HIV testing is feasible, acceptable, and sustainable in a PED setting. The implementation of targeted HIV POC testing in the PED increased the number of HIV tests being offered, the number of high-risk patients being screened, and the number diagnosed and connected to care.
青少年中的艾滋病毒感染率正在上升。尽管指南建议对性活跃的青少年进行年度艾滋病毒筛查，但在儿科急诊科（PED）接受其他性传播感染（STI）检测的青少年中，只有3.6%接受了艾滋病毒筛查。目标是将艾滋病毒筛查率提高到90%。
设计干预措施以解决4个被认为对可靠提供艾滋病毒检测至关重要的关键驱动因素。主要结局指标是在接受常见性传播感染检测的青少年中接受艾滋病毒检测的比例。使用统计过程控制图来衡量随时间的表现，并区分常见变异与特殊原因变异。
我们于2012年1月在儿科急诊科开展了即时检验（POC）艾滋病毒检测。接受性传播感染检测的患者中接受艾滋病毒检测的比例提高到了87%以上，并保持了这一表现。临床决策支持工具的实施产生了最大影响。大多数被提供检测的人表示同意，最常见的拒绝原因是最近检测结果为阴性。我们在5年中发现了十一名艾滋病毒阳性患者。八名是新诊断出的，三名之前检测呈阳性但未接受治疗。所有11名患者都成功地与具有艾滋病毒护理专业知识的提供者取得了联系。
即时检验艾滋病毒检测在儿科急诊科环境中是可行、可接受且可持续的。在儿科急诊科实施有针对性的即时检验艾滋病毒检测增加了艾滋病毒检测的数量、接受筛查的高危患者数量以及被诊断并接受治疗的患者数量。
