Departamento de Enfermedades Infecciosas, Hospital Universitario Germans Trias I Pujol, Barcelona, España.
Departamento de Enfermedades Infecciosas, Hospital Universitario La Paz, Madrid, España.
Emergencias. 2022 Feb;34(1):21-28.
To evaluate the potential epidemiologic and economic impact of applying an HIV screening protocol in hospital emergency departments (ED) and compare it to current clinical practice in Spain.
We estimated the cumulative incidence of human immunodeficiency virus (HIV) infections and associated costs in Spain for a 20-year time horizon based on a model comprised of various health states with different risks for HIV transmission. The impact of current clinical practices in Spain, in which there is no established protocol for HIV screening, was compared to the potential impact of applying a targeted screening protocol in persons who come to the ED with certain conditions suggestive of HIV infection (diagnosis of a sexually transmitted infection, mononucleosis, herpes zoster infection, community-acquired pneumonia; practice of chemsex, and need for postexposure prophylaxis).
Screening all persons with a condition suggestive of HIV infection in hospital EDs would require an investment of €20 million over 20 years, but it would prevent 13 615 new infections (reducing the incidence by 20.6%, down from 66 265 to 52 650 cases) in comparison with the current diagnostic approaches. Such a reduction in the incidence of HIV infection would potentially save €4411 million over 20 years, giving a return of €224 per euro invested.
A protocol for targeted screening of persons in circumstances suggestive of risk for HIV infection in Spain would increase diagnoses, avert new infections, and generate savings in comparison with screening practices currently in effect.
评估在医院急诊部门（ED）应用 HIV 筛查方案的潜在流行病学和经济影响，并将其与西班牙当前的临床实践进行比较。
我们根据一个包含不同 HIV 传播风险的健康状态的模型，估算了在西班牙 20 年时间范围内 HIV 感染的累积发病率和相关成本。将目前西班牙没有 HIV 筛查标准方案的临床实践的影响与在具有某些提示 HIV 感染的条件的患者中应用有针对性的筛查方案的潜在影响进行了比较（诊断为性传播感染、单核细胞增多症、带状疱疹感染、社区获得性肺炎；实践化学性行为，以及需要暴露后预防）。
在医院 ED 筛查所有具有 HIV 感染提示症状的患者，在 20 年内需要投资 2000 万欧元，但与目前的诊断方法相比，它将预防 13615 例新感染（发病率降低 20.6%，从 66265 例降至 52650 例）。与目前的诊断方法相比，这种 HIV 感染发病率的降低可能会在 20 年内节省 4.411 亿欧元，投资回报率为每欧元 224 欧元。
在西班牙，针对具有 HIV 感染风险提示条件的人群进行有针对性的筛查方案，与目前的筛查实践相比，将增加诊断，避免新的感染，并节省成本。
