Juan González Del Castillo, Begoña Espinosa, Nayra Cabrera, María Teresa Sánchez Moreno, Plácido Mayán, Alexis Rebollo, Julio Javier Gamazo, Hugo Martinez Faya, María Esperanza Puga Montalvo, Isidro Baez, Rocío de Paz, Javier Cabañas, Jesús Álvarez Manzanares, Òscar Miró
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引用次数: 0
Abstract
Objectives: Undiagnosed HIV infection remains the main driver of new HIV cases in Western countries. Emergency Departments (EDs) offer a key opportunity for detection. In 2020, Spanish emergency and infectious diseases societies recommended an opt-in strategy for targeted conditions for HIV testing in EDs. This study evaluates the efficacy of three strategies for targeted HIV testing.
Methods: Twelve Spanish EDs, selected based on predefined structural criteria, assessed HIV testing from April to June 2024. Hospitals applied: no strategy (control, three EDs), an educational programme (strategy A, three EDs), strategy A plus preconfigured electronic orders (strategy B, three EDs) or strategy B plus electronic alerts in medical records (strategy C, three EDs). The impact on HIV testing was measured overall and by targeted condition, using absolute differences with 95% confidence intervals (CIs).
Results: Of the 612 909 ED visits, 210 039 occurred in control hospitals (1232 patients [0.59%] had targeted conditions), 172 806 in hospitals applying strategy A (1497 [0.87%]), 132 835 in strategy B hospitals (1761 [1.33%]) and 97 229 in hospitals applying strategy C (1269 [1.31%]). Testing rates were 0.16%, 0.38%, 1.17% and 2.16% in the control, and strategy A, B and C EDs., respectively. Among patients with targeted conditions, testing reached 13.1%, 22.9%, 30.7% and 78.1%. Compared to no strategy, testing increased by 0.22% (95% CI = 0.18-0.25) with strategy A, 0.79% (95% CI = 0.73-0.86) with B, and 0.98% (95% CI = 0.88-1.09) with C. In targeted conditions, testing rose by 9.8%, 7.8% and 47.5% for strategies A, B and C, respectively. All strategies improved testing in sexually transmitted infections (STI), meningitis/neurological syndromes and community-acquired pneumonia (CAP); strategy C also increased testing in herpes zoster (HZ) and post-exposure prophylaxis.
Conclusion: All the strategies evaluated enhanced targeted HIV testing, especially strategy C (electronic alerts), which was associated with the highest testing rates observed, particularly in STI, CAP and HZ.
期刊介绍:
HIV Medicine aims to provide an alternative outlet for publication of international research papers in the field of HIV Medicine, embracing clinical, pharmocological, epidemiological, ethical, preclinical and in vitro studies. In addition, the journal will commission reviews and other feature articles. It will focus on evidence-based medicine as the mainstay of successful management of HIV and AIDS. The journal is specifically aimed at researchers and clinicians with responsibility for treating HIV seropositive patients.