Feasibility of an emergency department-based, risk-targeted voluntary HIV screening program

被引:61
作者
Kelen, GD [1 ]
Hexter, DA [1 ]
Hansen, KN [1 ]
Humes, R [1 ]
Vigilance, PND [1 ]
Baskerville, M [1 ]
Quinn, TC [1 ]
机构
[1] JOHNS HOPKINS UNIV,SCH MED,DEPT EMERGENCY MED,BALTIMORE,MD 21205
关键词
D O I
10.1016/S0196-0644(96)70184-1
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Study objective: To assess the feasibility and effectiveness of an emergency department-based, risk-targeted voluntary HIV screening program. Methods: We prospectively enrolled consenting adult IV drug users (IDUs) not known to have HIV infection in the ED of a large inner-city hospital with a high rate of HIV infection among patients during a 10-week trial. Study patients were given confidential HIV pretest and risk-reduction counseling, with 10- to 14-day on-site ED follow-up. Follow-up included posttest counseling, reinforcement of risk-reduction practices, and a $10 incentive to cover transportation costs. HIV seropositive patients were referred to the hospital HIV clinic for further evaluation and treatment. Results: Of 200 eligible IDUs, 168 (84%) consented to HIV testing. Of the 104 (62%) who re-turned for follow-up, 17 (16%) tested positive for HIV. Of these patients, 6 (35%) kept their initial hospital HIV clinic referral appointment, a rate consistent with the experience of the hospital HIV clinic. Of nine patients in whom CD4+ counts were performed at time of the visit, three (33%) had counts less than 200. At 3-month follow-up, 4 of 20 active IDUs (20%) had reportedly ceased drug use because of the program. The complete program cost was an estimated $16,659, $99 per enrolled patient and $521 per HIV-positive patient. Conclusion: An ED-based, risk-targeted HIV screening program is feasible and over time could detect a significant number of asymptomatic HIV-infected individuals, including those who should receive antiretroviral therapy and prophylaxis for Pneumocystis carinii pneumonia therapy (CD4+ count less than 200). An additional benefit of ED-based HIV screening in high-prevalence EDs is the opportunity to conduct successful risk-reduction counseling in some high-risk individuals.
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收藏
页码:687 / 692
页数:6
相关论文
共 18 条
[1]   PREVALENCE OF HIV ANTIBODY IN A NONINNER-CITY UNIVERSITY HOSPITAL EMERGENCY DEPARTMENT [J].
BARAFF, LJ ;
TALAN, DA ;
TORRES, M .
ANNALS OF EMERGENCY MEDICINE, 1991, 20 (07) :782-786
[2]   HEALTH-INSURANCE COVERAGE AMONG PERSONS WITH AIDS - RESULTS FROM A MULTISTATE SURVEILLANCE PROJECT [J].
DIAZ, T ;
CHU, SY ;
CONTI, L ;
NAHLEN, BL ;
WHYTE, B ;
MOKOTOFF, E ;
SHIELDS, A ;
CHECKO, PJ ;
HERR, M ;
MUKHTAR, Q ;
RIETMEIJER, CA ;
LEVY, A ;
HERMANN, P ;
BUEHLER, JW .
AMERICAN JOURNAL OF PUBLIC HEALTH, 1994, 84 (06) :1015-1018
[3]   EVIDENCE FOR THE EFFECTS OF HIV ANTIBODY COUNSELING AND TESTING ON RISK BEHAVIORS [J].
HIGGINS, DL ;
GALAVOTTI, C ;
OREILLY, KR ;
SCHNELL, DJ ;
MOORE, M ;
RUGG, DL ;
JOHNSON, R .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1991, 266 (17) :2419-2429
[4]   HIV SEROPREVALENCE AND REASONS FOR REFUSING AND ACCEPTING HIV TESTING [J].
JONES, JL ;
HUTTO, P ;
MEYER, P ;
DOWDA, H ;
GAMBLE, WB ;
GUNN, RA .
SEXUALLY TRANSMITTED DISEASES, 1993, 20 (06) :334-337
[5]   HUMAN IMMUNODEFICIENCY VIRUS-INFECTION IN EMERGENCY DEPARTMENT PATIENTS - EPIDEMIOLOGY, CLINICAL PRESENTATIONS, AND RISK TO HEALTH-CARE WORKERS - THE JOHNS-HOPKINS EXPERIENCE [J].
KELEN, GD ;
DIGIOVANNA, T ;
BISSON, L ;
KALAINOV, D ;
SIVERTSON, KT ;
QUINN, TC .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1989, 262 (04) :516-522
[6]   TRENDS IN HUMAN-IMMUNODEFICIENCY-VIRUS (HIV) INFECTION AMONG A PATIENT POPULATION OF AN INNER-CITY EMERGENCY DEPARTMENT - IMPLICATIONS FOR EMERGENCY DEPARTMENT-BASED SCREENING PROGRAMS FOR HIV-INFECTION [J].
KELEN, GD ;
HEXTER, DA ;
HANSEN, KN ;
TANG, N ;
PRETORIUS, S ;
QUINN, TC .
CLINICAL INFECTIOUS DISEASES, 1995, 21 (04) :867-875
[7]   PROFILE OF PATIENTS WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION PRESENTING TO AN INNER-CITY EMERGENCY DEPARTMENT - PRELIMINARY-REPORT [J].
KELEN, GD ;
JOHNSON, G ;
DIGIOVANNA, TA ;
LORING, K ;
SIVERTSON, KT .
ANNALS OF EMERGENCY MEDICINE, 1990, 19 (09) :963-969
[8]   UNRECOGNIZED HUMAN IMMUNODEFICIENCY VIRUS-INFECTION IN EMERGENCY DEPARTMENT PATIENTS [J].
KELEN, GD ;
FRITZ, S ;
QAQISH, B ;
BROOKMEYER, R ;
BAKER, JL ;
KLINE, RL ;
CUDDY, RM ;
GOESSEL, TK ;
FLOCCARE, D ;
WILLIAMS, KA ;
SIVERTSON, KT ;
ALTMAN, S ;
QUINN, TC .
NEW ENGLAND JOURNAL OF MEDICINE, 1988, 318 (25) :1645-1650
[9]   RISK OF HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION AMONG EMERGENCY DEPARTMENT WORKERS [J].
MARCUS, R ;
CULVER, DH ;
BELL, DM ;
SRIVASTAVA, PU ;
MENDELSON, MH ;
ZALENSKI, RJ ;
FARBER, B ;
FLIGNER, D ;
HASSETT, J ;
QUINN, TC ;
SCHABLE, CA ;
SLOAN, EP ;
TSUI, P ;
KELEN, GD .
AMERICAN JOURNAL OF MEDICINE, 1993, 94 (04) :363-370
[10]   HEALTH-CARE ACCESS PROBLEMS OF MEDICALLY INDIGENT EMERGENCY DEPARTMENT WALK-IN PATIENTS [J].
PANE, GA ;
FARNER, MC ;
SALNESS, KA .
ANNALS OF EMERGENCY MEDICINE, 1991, 20 (07) :730-733