Operational Methods of HIV Testing in Emergency Departments: A Systematic Review - 22/06/13
National Emergency Department HIV Testing Consortium
Résumé |
Objectives |
Casual review of existing literature reveals a multitude of individualized approaches to emergency department (ED) HIV testing. Cataloging the operational options of each approach could assist translation by disseminating existing knowledge, endorsing variability as a means to address testing barriers, and laying a foundation for future work in the area of operational models and outcomes investigation. The objective of this study is to provide a detailed account of the various models and operational constructs that have been described for performing HIV testing in EDs.
Methods |
Systematic review of PUBMED, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Web of Science through February 6, 2009 was performed. Three investigators independently reviewed all potential abstracts and identified all studies that met the following criteria for inclusion: original research, performance of HIV testing in an ED in the United States, description of operational methods, and reporting of specific testing outcomes. Each study was independently assessed and data from each were abstracted with standardized instruments. Summary and pooled descriptive statistics were reported by using recently published nomenclature and definitions for ED HIV testing.
Results |
The primary search yielded 947 potential studies, of which 25 (3%) were included in the final analysis. Of the 25 included studies, 13 (52%) reported results using nontargeted screening as the only patient selection method. Most programs reported using voluntary, opt-in consent and separate, signed consent forms. A variety of assays and communication methods were used, but relatively limited outcomes data were reported.
Conclusion |
Currently, limited evidence exists to inform HIV testing practices in EDs. There appears to be recent progression toward the use of rapid assays and nontargeted patient selection methods, with the rate at which reports are published in the peer-reviewed literature increasing. Additional research will be required, including controlled clinical trials, more structured program evaluation, and a focus on an expanded profile of outcome measures, to further improve our understanding of which HIV testing methods are most effective in the ED.
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Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). This work was supported, in part, by an Independent Scientist Award (K02 HS017526) from the Agency for Healthcare Research and Quality and a cooperative agreement (U18 PS000314) from the Centers for Disease Control and Prevention (CDC) to Dr. Haukoos; a cooperative agreement (U18 PS000321) from the CDC to Dr. White; a mentored, patient-oriented career development award (K23 AI068453) from the National Institute for Allergy and Infectious Diseases to Dr. Lyons; a mentored, patient-oriented career development award (K23 HD054315) from the National Institute of Child Health and Human Development to Dr. Calderon; and a grant from the Maryland Department of Health and Mental Hygiene to Dr. Rothman. The 2007 Conference of the National Emergency Department HIV Testing Consortium was supported by an unrestricted grant from Gilead Sciences, Inc. and with organizational support from the Health Research and Educational Trust of the American Hospital Association. |
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Publication of this article was supported by Centers for Disease Control and Prevention, Atlanta, GA. |
Vol 58 - N° 1S
P. S96-S103 - juillet 2011 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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