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Nurse-delivered universal point-of-care testing for HIV in an open-access returning traveller clinic

机译:护士在开放式回程旅行社诊所提供的艾滋病毒通用护理点测试

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Background: Early diagnosis of HIV infection reduces morbidity and mortality associated with late presentation. Despite UK guidelines, the HIV testing rate has not increased. We have introduced universal HIV screening in an open-access returning traveller clinic. Methods: Data were prospectively recorded for all patients attending the open-access returning traveller clinic between August 2008 and December 2010. HIV testing was offered to all patients from May 2009; initially testing with laboratory samples (phase 1) and subsequently a point-of-care test (POCT) (phase 2). Results: A total of 4965 patients attended the clinic; 1342 in phase 0, 792 in phase 1 and 2831 in phase 2. Testing rates for HIV increased significantly from 2% (38 of 1342) in phase 0 to 23.1% (183 of 792) in phase 1 and further increased to 44.5% (1261 of 2831) during phase 2 (P<0.0001). Two new diagnoses of HIV-1 were identified in phase 1 (1.1% of tested); seven patients had a reactive POCT test in phase 2, of whom five (0.4% of those tested) were confirmed in a 4th generation assay. The patients with false reactive tests had a concurrent Plasmodium falciparum infection. Patients travelling to the Middle East and Europe were less likely to accept an HIV test with POCT. Conclusions: A nurse-delivered universal point-of-care HIV testing service has been successfully introduced and sustained in an acute medical clinic in a low-prevalence country. Caution is required in communicating reactive results in low-prevalence settings where there may be alternative diagnoses or a low population prevalence of HIV infection.
机译:背景:HIV感染的早期诊断可降低与迟发症状相关的发病率和死亡率。尽管有英国的指导方针,但艾滋病毒检测率并未增加。我们已经在开放式回程旅客诊所引入了艾滋病毒普查。方法:前瞻性记录2008年8月至2010年12月间所有在开放式回程旅行诊所就诊的患者的数据。最初使用实验室样品进行测试(阶段1),然后进行即时检验(POCT)(阶段2)。结果:共有4965名患者就诊。第0阶段的1342,第1阶段的792和第2阶段的2831。HIV的检测率从第0阶段的2%(占1342的38)增加到第1阶段的23.1%(占792的183),并进一步提高到44.5%(第2阶段(P <0.0001)。在阶段1中确定了两个新的HIV-1诊断(占测试的1.1%); 7例患者在第2阶段接受了反应性POCT测试,其中5例(占被测者的0.4%)在第4代测定中得到确认。反应测试错误的患者并发恶性疟原虫感染。前往中东和欧洲的患者接受POCT进行艾滋病毒检测的可能性较小。结论:在低患病率的国家中,护士提供的通用即时医疗HIV检测服务已成功引入并维持在急性医疗诊所中。在低流行度环境中传达反应性结果时需要谨慎,在这种情况下,可能会有其他诊断或艾滋病毒感染的人群低度流行。

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