Centre for Clinical Infection, The James Cook University Hospital, Middlesbrough.
Leadgate Medical Centre, Consett.
AIDS. 2021 Sep 1;35(11):1845-1850. doi: 10.1097/QAD.0000000000002935.
Late diagnosis of HIV, hepatitis B (HBV) and hepatitis C (HCV) remains relatively common in the UK and many people who present late have missed opportunities for testing in primary care. The objective was to assess the effectiveness and acceptance of a prototype application (BBV_TP1), embedded in a primary care electronic health record (EHR), to increase real-time blood-borne virus (BBV) testing.
This prospective cohort study assessed BBV_TP1 in 14 general practices in North East England, in comparison with 54 similar practices in 2019. Rates of HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) testing in practices were measured before and after the application was activated. Patient and clinician acceptance of the technology was assessed by surveys.
In the 6 months following the intervention, HIV testing rates increased 555% and combined HBV/HCV testing rates increased 362%. No significant differences were observed for any BBV testing rates in the nonintervention practices over the same period. Monthly testing rates declined towards baseline after initial increases. Clinician's perceptions of the prompt system were positive, with average additional time required for BBV test discussion in consultations estimated at 2 min. The patient survey also showed high acceptance of the technology.
This pilot study demonstrated that BBV_TP1 increased BBV testing rates in primary care via targeted screening, although testing rates subsequently fell whilst the application remained active. Such systems can potentially reduce late diagnoses, while having high acceptance by clinicians and patients. Larger studies with longer follow-up are needed to demonstrate efficacy and cost-effectiveness.
在英国，艾滋病毒（HIV）、乙型肝炎（HBV）和丙型肝炎（HCV）的晚期诊断仍然较为常见，许多晚期就诊的患者错过了在初级保健中进行检测的机会。本研究旨在评估一种原型应用程序（BBV_TP1）的有效性和可接受性，该应用程序嵌入在初级保健电子健康记录（EHR）中，以增加实时血液传播病毒（BBV）检测。
本前瞻性队列研究在英格兰东北部的 14 家全科诊所中评估了 BBV_TP1，并与 2019 年的 54 家类似诊所进行了比较。在应用程序激活前后，测量了实践中 HIV、乙型肝炎病毒（HBV）和丙型肝炎病毒（HCV）检测的比率。通过调查评估了患者和临床医生对该技术的接受程度。
在干预后的 6 个月内，HIV 检测率增加了 555%，HBV/HCV 联合检测率增加了 362%。在同期，非干预实践中没有观察到任何 BBV 检测率的显著差异。在最初的增加之后，每月的检测率下降到基线。临床医生对即时系统的看法是积极的，估计每次咨询中额外用于 BBV 测试讨论的时间平均为 2 分钟。患者调查也显示出对该技术的高度接受。
本试点研究表明，通过有针对性的筛查，BBV_TP1 提高了初级保健中的 BBV 检测率，尽管在应用程序保持活跃的情况下，检测率随后下降。此类系统有可能减少晚期诊断，同时得到临床医生和患者的高度接受。需要进行更大规模、随访时间更长的研究来证明其疗效和成本效益。
