Comparison of HIV Screening Strategies in the Emergency Department: A Randomized Clinical Trial.
JAMA Netw Open
; 4(7): e2117763, 2021 07 01.
Article
en En
| MEDLINE
| ID: mdl-34309668
ABSTRACT
Importance The National HIV Strategic Plan for the US recommends HIV screening in emergency departments (EDs). The most effective approach to ED-based HIV screening remains unknown. Objective:
To compare strategies for HIV screening when integrated into usual ED practice. Design, Setting, andParticipants:
This randomized clinical trial included patients visiting EDs at 4 US urban hospitals between April 2014 and January 2016. Patients included were ages 16 years or older, not critically ill or mentally altered, not known to have an HIV positive status, and with an anticipated length of stay 30 minutes or longer. Data were analyzed through March 2021.Interventions:
Consecutive patients underwent concealed randomization to either nontargeted screening, enhanced targeted screening using a quantitative HIV risk prediction tool, or traditional targeted screening as adapted from the Centers for Disease Control and Prevention. Screening was integrated into clinical practice using opt-out consent and fourth-generation antigen-antibody assays. Main Outcomes andMeasures:
New HIV diagnoses using intention-to-treat analysis, absolute differences, and risk ratios (RRs).Results:
A total of 76â¯561 patient visits were randomized; median (interquartile range) age was 40 (28-54) years, 34â¯807 patients (51.2%) were women, and 26â¯776 (39.4%) were Black, 22â¯131 (32.6%) non-Hispanic White, and 14â¯542 (21.4%) Hispanic. A total of 25â¯469 were randomized to nontargeted screening; 25â¯453, enhanced targeted screening; and 25â¯639, traditional targeted screening. Of the nontargeted group, 6744 participants (26.5%) completed testing and 10 (0.15%) were newly diagnosed; of the enhanced targeted group, 13â¯883 participants (54.5%) met risk criteria, 4488 (32.3%) completed testing, and 7 (0.16%) were newly diagnosed; and of the traditional targeted group, 7099 participants (27.7%) met risk criteria, 3173 (44.7%) completed testing, and 7 (0.22%) were newly diagnosed. When compared with nontargeted screening, targeted strategies were not associated with a higher rate of new diagnoses (enhanced targeted and traditional targeted combined difference, -0.01%; 95% CI, -0.04% to 0.02%; RR, 0.7; 95% CI, 0.30 to 1.56; P = .38; and enhanced targeted only difference, -0.01%; 95% CI, -0.04% to 0.02%; RR, 0.70; 95% CI, 0.27 to 1.84; P = .47). Conclusions and Relevance Targeted HIV screening was not superior to nontargeted HIV screening in the ED. Nontargeted screening resulted in significantly more tests performed, although all strategies identified relatively low numbers of new HIV diagnoses. Trial Registration ClinicalTrials.gov Identifier NCT01781949.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Infecciones por VIH
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Tamizaje Masivo
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Servicio de Urgencia en Hospital
Tipo de estudio:
Clinical_trials
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Diagnostic_studies
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Etiology_studies
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Prognostic_studies
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Screening_studies
Límite:
Adolescent
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Adult
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Female
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Humans
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Male
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Middle aged
País como asunto:
America do norte
Idioma:
En
Año:
2021
Tipo del documento:
Article