美國急診個案中只有不到 1% 的人接受了 HIV 檢測

CDC 和美國預防服務工作小組建議進行常規、選擇性退出測試

羅傑‧佩博迪 / 2023 年 11 月 22 日 / 愛滋病地圖

安德烈_波波夫/Shutterstock.com

根據《愛滋病》雜誌發表的一份報告，儘管建議進行全民篩檢，但在美國，只有不到 1% 的急診患者接受了愛滋病毒檢測，而且近年來沒有任何改善。

在美國，大約 13% 的愛滋病毒感染者不知道自己感染了病毒。 急診是增加愛滋病毒檢測和減少未確診愛滋病毒的關鍵場所。 在美國，它們通常為那些沒有保險或在使用其他醫療服務方面存在障礙的人提供安全網，且其可能不成比例地受到愛滋病毒的影響。 血液樣本是常規採集的，因此愛滋病毒可以很容易地包含在一系列測試中。

大量先期試點計畫和實施研究顯示，當注意力和資源集中在愛滋病毒篩檢上時，急診可以提高檢測率，做出新的診斷，並幫助先前診斷的人重新接受愛滋病毒照護。 雖然其中許多研究來自美國，但英國幾個城市的一個大型計畫最近報告稱，57% 到急診室就診的人接受了愛滋病毒檢測。

急診室選擇退出測試正在徹底改變英格蘭的愛滋病毒和肝炎診斷

自 2006 年以來，美國疾病管制與預防中心 (CDC) 建議在當地 HIV 感染率大於 0.1% 的急診室和其他醫療機構中，對 13 至 64 歲的患者進行選擇性退出 HIV 檢測 (opt-out HIV testing)。 有愛滋病毒危險因子的人應該每年至少接受一次篩檢。 美國預防服務工作組 ( USPSTF) 的類似建議應意味著保險公司承擔愛滋病毒檢測的費用。

在 2006 年指引出台之前的幾年裡，只有 0.3% 的急診病患接受了 HIV 篩檢。 最新數據顯示，自那時以來，情況僅略有改善。

數據來自國家醫院流動醫療照護調查(NHAMCS)，這是一項具有全國代表性的年度調查，其中包括2014 年至2020 年急診科提供的服務數據。在這項分析中，僅考慮了13 歲至64 歲之間先前未確診的患者就診的情況。

2014 年至2017 年間，每年都有0.5% 至0.7% 的進入急診者接受了愛滋病毒檢測，2018 年上升至1.1%。2019 年檢測率下降至0.8%，儘管這年發起了「終結美國愛滋病毒流行」倡議，並重新強調檢測計畫，以減少未確診的愛滋病毒。2020 年，新冠疫情大流行意味著急診就診的人數減少，急診室工作人員也不堪重負——HIV 檢測的絕對數量有所下降，但接受檢測的患者比例仍穩定在 0.8%。

2020年，城市地區的愛滋病毒檢測頻率高於農村地區（0.9% vs 0.2%），東北地區高於南方地區（1.6% vs 0.5%）。 在南部農村地區，接受檢測的人數不到0.1%。 與 35 歲以上族群相比，35 歲以下族群的 HIV 檢測頻率更高（0.9% 對 0.7%），黑人與拉丁裔或白人相比（1.5% 對 0.8% 或對 0.5%），醫療補助涵蓋人口比有商業保險的人高（1.0% 對0.6%）。

在患有可能與愛滋病毒相關的問題（例如性傳染感染、懷孕或有被性虐待）的人中，5.1% 接受了檢測。

作者表示，系統層級介入措施，例如加強選擇性退出程序和檢測平台，或對電子健康記錄進行程式編修，以便在患者有危險因素時建議進行愛滋病毒檢測，可以提高檢測率。 但他們表示，急診部門需要額外的資源——資金、人員和支持系統——來實現這一目標。

參考文獻：

Clay CE 等。 2014-2020 年美國急診就診時的 HIV 檢測估算。 《愛滋病》，印刷前線上版，2023 年 10 月 11 日。

DOI：10.1097/QAD.0000000000003750

Less than 1% in US emergency departments are tested for HIV

Routine, opt-out testing is recommended by CDC and US Preventive Services Task Force

Roger Pebody / 22 November 2023 / aidsmap

Andrey_Popov/Shutterstock.com

Despite recommendations for universal screening, less than 1% of people attending emergency departments in the United States are tested for HIV, with no improvement in recent years, according to a report published in the journal AIDS.

In the US, about 13% of people living with HIV don’t know they have it. Emergency departments are key settings for increasing HIV testing and reducing undiagnosed HIV. In the US, they often serve as a safety net for people who are uninsured or have barriers to using other health services, and may be disproportionately affected by HIV. Blood samples are routinely taken, so HIV can easily be included in a battery of tests.

Numerous pilot projects and implementation studies have shown that when attention and resources are focused on HIV screening, emergency departments can achieve a high uptake of testing, make new diagnoses, and help previously diagnosed people re-engage with HIV care. While many of those studies have come from the US, a large programme in several English cities recently reported that 57% of people attending emergency departments were tested for HIV.

Emergency department opt-out testing is revolutionising HIV and hepatitis diagnosis in England

Since 2006, the Centers for Disease Control and Prevention (CDC) has recommended opt-out HIV testing for patients aged 13 to 64 in emergency departments and other healthcare settings where the local prevalence of HIV infection is greater than 0.1%. People with risk factors for HIV should be screened at least once a year. A similar recommendation from the US Preventive Services Task Force (USPSTF) should mean that insurers cover the cost of HIV testing.

In the years before the 2006 guideline, just 0.3% of people attending emergency departments were screened for HIV. The latest data show only a small improvement since then.

Data come from National Hospital Ambulatory Medical Care Survey (NHAMCS), a nationally representative annual survey that includes data on services provided in emergency departments, from 2014 to 2020. For this analysis, only visits by people previously undiagnosed aged 13 to 64 were considered.

Each year between 2014 and 2017, between 0.5% and 0.7% of attendees were tested for HIV, rising to 1.1% in 2018. Testing then decreased to 0.8% in 2019, although this was the year in which the Ending the HIV Epidemic in the US initiative was launched and put a new emphasis on testing programmes in order to reduce undiagnosed HIV. In 2020 the COVID pandemic meant that fewer people used emergency departments and their staff were overstretched – the absolute number of HIV tests declined but the proportion of patients tested remained stable at 0.8%.

In 2020, HIV testing was more frequent in urban than rural areas (0.9% vs 0.2%) and in the north-east than in the south (1.6% vs 0.5%). In rural areas of the south, less than 0.1% were tested. HIV testing was more frequent for people under the age of 35 compared to people over 35 (0.9% vs 0.7%), Black people compared to Latino or White people (1.5% vs 0.8% vs 0.5%), and people covered by Medicaid than people with commercial insurance (1.0% vs 0.6%).

Of people attending with a problem that might be associated with HIV – such as a sexually transmitted infection, pregnancy or sexual abuse – 5.1% were tested.

The authors say that system-level interventions, such as strengthening opt-out procedures and testing platforms, or programming electronic health records to suggest HIV testing when patients have risk factors, can boost testing rates. But they say that emergency departments will need extra resources – funding, staffing, and support systems – to achieve this.

References

Clay CE et al. Estimates of HIV testing at Visits to U.S. emergency departments, 2014–2020. AIDS, online ahead of print, 11 October 2023.

DOI: 10.1097/QAD.0000000000003750