我们对在美国(US)儿科急诊科(PEDs)进行的HIV筛查计划的同行评审期刊上发表的研究进行了系统回顾,目的是描述方法。在这些程序中测试产量和挑战。
我们搜索了全文,英语语言,原始的研究文章专注于行为,发展,通过八个在线数据库(Pubmed(MEDLINE),在美国PED中启动或实施任何HIV筛查计划,Scopus,Embase,科克伦,WebofScience,CINAHL,PsycInfo和GoogleScholar)从成立到2020年7月。我们还在13种急诊医学期刊的网站上搜索了文章,24种儿科和青少年健康期刊,和十本艾滋病研究期刊,并使用通过这些搜索找到的文章的参考。由一名研究者独立提取关于HIV检测计划组分和检测产量的数据,并由另一名研究者验证。对每个程序进行了总结和批评。
在符合纳入标准的八篇文章中,大多数涉及他们的艾滋病毒测试计划的描述,除了一个专注于质量改进他们的计划。五个描述了选择加入和三个选择退出艾滋病毒筛查方法。程序因使用的HIV测试类型以及发起或执行测试的人而大不相同。提供(4.0%至96.7%)和接受(42.7%至86.7%)HIV检测的患者百分比差异很大,研究中的HIV血清阳性为0-0.6%。八项研究中有五项报告艾滋病毒血清阳性超过0.1%,上述疾病控制和预防中心建议在医疗保健环境中进行测试的阈值。
这些研究说明了进一步优化美国PED中HIV筛查计划的整合并减少检测障碍的机会。提高测试结果的效率,提高识别案例的程序的有效性。未来的研究应侧重于推进可行性研究之外的筛查计划的方法,并对其实施和长期可持续性进行调查。
We conducted a systematic
review of studies published in peer-reviewed journals on HIV screening programs conducted in pediatric emergency departments (PEDs) in the United States (US) with the objective of describing the methods, testing yields and challenges in these programs.
We searched for full-text, English-language, original research articles focused on the conduct, development, initiation or implementation of any HIV screening program in a US PED through eight online databases (Pubmed (MEDLINE), Scopus, Embase, Cochrane, Web of Science, CINAHL, PsycInfo and Google Scholar) from their inception through July 2020. We also searched for articles on the websites of thirteen emergency medicine journals, 24 pediatric and adolescent health journals, and ten HIV research journals, and using the references of articles found through these searches. Data on HIV testing program components and yield of testing was extracted by one investigator independently and verified by a second investigator. Each program was summarized and critiqued.
Of the eight articles that met inclusion criteria, most involved descriptions of their HIV testing program, except for one that was focused on quality improvement of their program. Five described an opt-in and three an opt-out approach to HIV screening. Programs differed greatly by type of HIV test utilized and who initiated or performed testing. There were large variations in the percentage of patients offered (4.0% to 96.7%) and accepting (42.7% to 86.7%) HIV testing, and HIV seropositivity in the studies ranged from 0 to 0.6%. Five of the eight studies reported an HIV seropositivity greater than 0.1%, above Centers for Disease Control and Prevention recommended threshold for testing in a healthcare setting.
The studies illustrate opportunities to further optimize the integration of HIV screening programs within US PEDs and reduce barriers to testing, improve efficiency of testing results and increase effectiveness of programs to identify cases. Future research should focus on advancing the methodology of screening programs beyond feasibility studies as well as conducting investigations on their implementation and longer-term sustainability.