Pandiselvam Sathishkumar, Jena Narendra N, Ghatak-Roy Aditi, Dreyer Nicholas, Naik Nehal, Blanchard Janice, Davey Kevin
Meenakshi Mission Hospital and Research Center Institute of Emergency Medicine Madurai Tamil Nadu India.
Department of Emergency Medicine George Washington University Washington DC USA.
J Am Coll Emerg Physicians Open. 2020 Dec 7;2(1):e12328. doi: 10.1002/emp2.12328. eCollection 2021 Feb.
HIV, hepatitis B, and hepatitis C remain significant causes of morbidity and mortality in low resource settings. Emergency department (ED)-based screening has proven effective in decreasing the spread of undiagnosed disease, although such programs are rare in low-middle income countries.
A prospective, cross sectional study of all adult patients presenting to the ED in a 600-bed teaching hospital in Tamil Nadu, India. This study used an opt-in strategy in which patients were offered testing at the end of their ED visit. Costs of testing were paid out of pocket by patients. Patients with known HIV, hepatitis B, or hepatitis C were excluded from the study.
During the study period 26,465 patients presented to the ED, and 18,286 patients consented to participate (68.9%). Among the 18,286 patients tested, 174 were positive for either HIV (39, 0.21%), hepatitis C (52, 0.28%), or hepatitis B (83, 0.45%). Three patients tested positive for both HIV and hepatitis C, and 1 patient tested positive for both HIV and hepatitis B. A total of 69.2% of patients with HIV, 61.2% of patients with hepatitis B, and 83% of patients with hepatitis C presented for reasons unrelated to their underlying diagnosis.
Although limited to only 1 hospital in southern India, this study represents the largest ED-based screening program for HIV, hepatitis B, and hepatitis C ever conducted in India or any other low-middle income countries. The majority of patients presented for reasons unrelated to their underlying diagnosis. Future research is needed on implementation strategies, cost feasibility, and linkage to care.
在资源匮乏地区，艾滋病毒、乙型肝炎和丙型肝炎仍然是发病和死亡的重要原因。基于急诊科（ED）的筛查已被证明在减少未诊断疾病的传播方面有效，尽管此类项目在中低收入国家很少见。
对印度泰米尔纳德邦一家拥有600张床位的教学医院急诊科的所有成年患者进行一项前瞻性横断面研究。本研究采用主动选择策略，即在患者急诊就诊结束时提供检测。检测费用由患者自掏腰包支付。已知感染艾滋病毒、乙型肝炎或丙型肝炎的患者被排除在研究之外。
在研究期间，26465名患者到急诊科就诊，18286名患者同意参与（68.9%）。在接受检测的18286名患者中，174名患者艾滋病毒、丙型肝炎或乙型肝炎检测呈阳性（艾滋病毒39例，0.21%；丙型肝炎52例，0.28%；乙型肝炎83例，0.45%）。3名患者艾滋病毒和丙型肝炎检测均呈阳性，1名患者艾滋病毒和乙型肝炎检测均呈阳性。艾滋病毒患者中69.2%、乙型肝炎患者中61.2%以及丙型肝炎患者中83%就诊的原因与他们的基础诊断无关。
尽管该研究仅限于印度南部的一家医院，但它是印度或任何其他中低收入国家有史以来最大规模的基于急诊科的艾滋病毒、乙型肝炎和丙型肝炎筛查项目。大多数患者就诊的原因与他们的基础诊断无关。未来需要对实施策略、成本可行性以及与护理的联系进行研究。
