Kelen G D, Shahan J B, Quinn T C
Department of Emergency Medicine and the Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA. gkelen@.jhmi.edu
Ann Emerg Med. 1999 Feb;33(2):147-55. doi: 10.1016/s0196-0644(99)70387-2.
We sought to (1) determine whether some emergency departments could play an important role in the national strategy of early HIV detection through the implementation of a voluntary HIV screening program and (2) describe the experience with standard and rapid HIV testing.
Consenting adults were enrolled during 3 distinct phases between 1993 and 1995 for the assessment of routine testing only, routine versus rapid testing, and rapid testing only. Patients administered the rapid test were given information at the time of the visit. We assessed the cost of the program.
Of 3,048 patients approached, 1,448 (48%) consented, 981 to standard and 467 to rapid testing. Of these, 6.4% and 3.2%, respectively, were newly identified as being HIV seropositive. More than twice as many new infections were diagnosed among those discharged from the ED as among those admitted (55 versus 21). Even among those previously tested, 5% proved seropositive. The mean+/-SD time to obtain results for the rapid assay performed in the hospital's main laboratory was 107+/-52 minutes, with 55% leaving the ED before receiving the results. Rapid assays performed in the ED satellite laboratory required 48+/-37 minutes, and only 20% left before getting the results. Follow-up among HIV-seropositive patients was 64% for the standard protocol and 73% for the rapid protocol (P >. 20). The prearranged HIV clinic intake appointment was kept by 62%. Rapid test sensitivity and specificity were 100% and 98.9%, respectively, with 5 initial false-positives and no false-negatives. Cost per patient enrolled and counseled was $38. Cost per infection detected was $601 for the routine test and $1,124 with the rapid test; these prices are competitive with those incurred at other sites.
Emergency department-based HIV testing was well accepted and detected a significant number of new HIV infections earlier than might have otherwise been, particularly among patients sent home. The rapid test is best performed on-site and is very sensitive. Confirmation of initial results is required because of the occurrence of occasional false-positive results. With relatively high HIV detection and return rates, it is evident that some EDs could play a major role in the national strategy of early HIV detection.
我们试图（1）确定一些急诊科能否通过实施自愿性艾滋病毒筛查计划在国家早期艾滋病毒检测战略中发挥重要作用，以及（2）描述标准艾滋病毒检测和快速艾滋病毒检测的经验。
在1993年至1995年的3个不同阶段，招募了同意参与的成年人，仅用于评估常规检测、常规检测与快速检测对比以及仅快速检测的情况。接受快速检测的患者在就诊时获得了相关信息。我们评估了该计划的成本。
在3048名接触的患者中，1448名（48%）同意参与，981名接受标准检测，467名接受快速检测。其中，分别有6.4%和3.2%的患者新被确定为艾滋病毒血清阳性。急诊科出院患者中诊断出的新感染病例是入院患者的两倍多（55例对21例）。即使在之前接受过检测的患者中，也有5%被证明血清呈阳性。在医院主实验室进行的快速检测获得结果的平均时间（均值±标准差）为107±52分钟，55%的患者在收到结果前离开急诊科。在急诊科卫星实验室进行的快速检测需要48±37分钟，只有20%的患者在得到结果前离开。艾滋病毒血清阳性患者的标准方案随访率为64%，快速方案随访率为73%（P>.20）。预先安排的艾滋病毒门诊就诊预约的遵守率为62%。快速检测的敏感性和特异性分别为100%和98.9%，最初有5例假阳性，无假阴性。每位登记并接受咨询的患者成本为38美元。常规检测每检测到一例感染的成本为601美元，快速检测为1124美元；这些价格与其他机构的成本具有竞争力。
基于急诊科的艾滋病毒检测很容易被接受，并且比其他方式更早地检测到大量新的艾滋病毒感染病例，尤其是在被送回家的患者中。快速检测最好在现场进行，且非常敏感。由于偶尔会出现假阳性结果，需要对初始结果进行确认。鉴于艾滋病毒检测率和回访率相对较高，显然一些急诊科可以在国家早期艾滋病毒检测战略中发挥重要作用。
