Seballos Spencer S, Lopez Rocio, Hustey Fredric M, Schold Jesse D, Kadkhoda Kamran, McShane Adam J, Phelan Michael P
From the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University.
Center for Populations Health Research and Quantitative Health Sciences.
Sex Transm Dis. 2022 Aug 1;49(8):546-550. doi: 10.1097/OLQ.0000000000001642. Epub 2022 May 16.
The Centers for Disease Control and Prevention (CDC) and US Preventive Services Task Force (USPSTF) guidelines recommend screening for human immunodeficiency virus (HIV) in patients aged 15 to 65 years, as well as those at increased risk. Patients screened in the emergency department (ED) for gonorrhea (GC) and/or chlamydia represent an increased-risk population. Our aim was to assess compliance with CDC and USPSTF guidelines for HIV testing in a national sample of EDs.
We examined data from the 2010 to 2018 Nationwide Emergency Department Sample, which can be used to create national estimates of ED care to query tests for GC, chlamydia, HIV, and syphilis testing. Weighted proportions and 95% confidence intervals (CIs) were reported, and Rao-Scott χ 2 tests were used.
We identified 13,443,831 (weighted n = 3,094,214) high-risk encounters in which GC/chlamydia testing was performed. HIV screening was performed in 3.9% (95% CI, 3.4-4.3) of such visits, and syphilis testing was performed in 2.9% (95% CI, 2.7-3.2). Only 1.5% of patients with increased risk encounters received both HIV and syphilis cotesting.
Despite CDC and USPSTF recommendations for HIV and syphilis screening in patients undergoing STI evaluation, only a small proportion of patients are being tested. Further studies exploring the barriers to HIV screening in patients undergoing STI assessment in the ED may help inform future projects aimed at increasing guidance compliance.
美国疾病控制与预防中心（CDC）和美国预防服务工作组（USPSTF）的指南建议，对15至65岁的患者以及高危人群进行人类免疫缺陷病毒（HIV）筛查。在急诊科（ED）接受淋病（GC）和/或衣原体筛查的患者属于高危人群。我们的目的是评估在全国急诊科样本中，对HIV检测遵循CDC和USPSTF指南的情况。
我们检查了2010年至2018年全国急诊科样本的数据，这些数据可用于创建全国急诊科护理估计值，以查询GC、衣原体、HIV和梅毒检测情况。报告加权比例和95%置信区间（CI），并使用Rao-Scott χ2检验。
我们确定了13443831次（加权n = 3094214次）进行GC/衣原体检测的高危就诊情况。在这些就诊中，3.9%（95%CI，3.4 - 4.3）的患者进行了HIV筛查，2.9%（95%CI，2.7 - 3.2）的患者进行了梅毒检测。只有1.5%的高危就诊患者同时接受了HIV和梅毒联合检测。
尽管CDC和USPSTF建议对接受性传播感染评估的患者进行HIV和梅毒筛查，但只有一小部分患者接受了检测。进一步研究急诊科接受性传播感染评估的患者中HIV筛查的障碍，可能有助于为未来旨在提高指南遵循率的项目提供信息。
