研究支持對自願的住院患者進行HIV篩檢

堅持CDC的建議,可以使檢出率加倍

  2002年4月24日──4月22日的《Archives of Internal Medicine》雜誌報導的一篇文章說,美國疾病控制中心(CDC)推薦對所有住院患者進行HIV的自願篩檢。在波士頓醫學中心此項每月檢測項目上可檢測到兩個新病例,而提供常規篩檢時,每月只能檢出一個新病例。

   HIV感染所帶來的污名,仍然在妨礙著為檢出HIV患者所作的努力,波士頓哈佛醫學院以及麻薩諸塞州公立醫院的Rochelle P. Walensky醫師,MPH及其同事寫道:「我們希望通過廣泛開展對HIV的篩檢以及對感染者的治療,檢測所引起的汙名就會減少。」

  由於目前對HIV的檢測只是針對有症狀的患者,這使美國有1/3的HIV血清陽性但沒有症狀的的患者沒有得到檢出,此次Think HIV項目為所有接受波士頓醫學中心醫療服務的患者,提供自願的HIV諮詢與檢測。

  在此次為期15個月的項目期間,住院的患者願意接受HIV檢測的比率是具有可比性的對照時間的3.4倍(6.4% 比 2%)。此檢測項目每月大約可檢出兩個新的HIV病例,而對照期間每個月只檢出一個新發HIV病例。估計在項目進行期間,檢測的患者中HIV感染的患病率為3.8%,而如果不採取這種新措施的話,檢測率很有可能會降低。

  此次研究探討了實施CDC所推薦的,住院患者例行HIV檢查的政策的效果,作者寫道,並且提到他們對結果的分析,投入大量經費支持在全國範圍內,進一步開展此項新的檢測措施。如果這樣的一個檢測項目有效的話,那麼臨床醫師必須承擔促使患者參與這樣的專案的義務。此次研究可以作為其他機構開展類似的篩檢活動的樣本,這樣在美國估計300000位感染HIV但未被檢出的患者,就能夠被檢出並且得到適宜的處理。

Study Supports Voluntary Inpatient HIV Screening

Adhering to CDC Recommendation Could Double Detection

By Laurie Barclay, MD
WebMD Medical News

Reviewed by Gary D. Vogin, MD

April 24, 2002 -- The CDC recommends voluntarily screening all inpatients for HIV, according to an article in the April 22 issue of the Archives of Internal Medicine. At Boston Medical Center, this testing program detected two new cases per month, compared with one case per month before testing was routinely offered.

"The stigma associated with HIV infection continues to plague aggressive testing endeavors," write Rochelle P. Walensky, MD, MPH, from Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues. "It is our hope that with widespread screening for HIV and treatment of infected persons, the stigma associated with testing will decrease."

Because testing efforts for HIV targeted to only symptomatic patients fail to identify the one-third of HIV-seropositive people in the U.S. who are asymptomatic, the Think HIV program offered voluntary HIV counseling and testing to all patients admitted to the medical service of Boston Medical Center.

Patients admitted during the 15-month program period were 3.4 times more likely to undergo testing for HIV than were those admitted during a comparable control period (6.4% vs. 2%). This testing program detected approximately two new cases of HIV infection monthly, compared with one per month during the control period. Estimated prevalence of HIV infection was 3.8% in patients tested during the program, who likely would have declined testing without this initiative.

"This study explores the impact of implementing the recommended CDC policy of routine inpatient HIV testing," the authors write, noting that their outcomes analysis supports the vast expense of expanding this testing initiative nationally. "Physicians must make the commitment to enroll patients in such a testing program if it is to have an impact. This study can serve as an example for other facilities to establish similar screening efforts so that most of the estimated 300,000 people with undiagnosed HIV infection in the United States can be identified and provided with appropriate care."

© 2002 WebMD Inc. All rights reserved.

    
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