欢迎来到艾兰博曼,请 登录 | 立即注册
查看: 1384|回复: 3

【资讯翻译】UK: Opt-out HIV/HBV/HCV testing for patients attending emer...

[复制链接]

10

听众

10

收听

1954

积分

管理员

Rank: 9Rank: 9Rank: 9

积分
1954
发表于 2016-3-24 08:55:27 | 显示全部楼层 |阅读模式
UK: Opt-out HIV/HBV/HCV testing for patients attending emergency departments identifies significant number of new infections

A week-long pilot study involving nine UK emergency departments has shown that routine, opt-out testing for HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) can identify a significant number of previously undiagnosed infections. The results are published in HIV Medicine. Adult patients having blood tests as part of their care were offered opt-out screening for HIV/HBV/HCV. Over a quarter of patients consented to be tested and 3% of these individuals were identified as being infected with a blood-borne virus (BBV), and 45% of these infections were new diagnoses.

“We identified a high number of newly diagnosed viral hepatitis cases, especially hepatitis C, in addition to the HIV diagnoses,” comment the authors. “Had these patients only been tested for HIV during the campaign week (as per UK guidance), and not for HCV or HBV, these viral hepatitis diagnoses may well have been missed.”

In the UK, blood-borne viruses, especially HIV and HCV, are often diagnosed late. Guidelines recommend routine, opt-out, HIV testing for all patients accessing primary care in settings where local HIV prevalence exceeds 0.2%. Research conducted in other countries has shown that hospital emergency (or casualty) departments can be feasible settings for routine screening for blood-borne viruses. A team of investigators therefore designed a pilot study to determine the prevalence of HIV, HBV and HCV among patients accessing emergency care in the UK.

The 'Going Viral' campaign was conducted for one week between 13-19 October 2014 and involved nine hospital emergency departments in UK areas with high HIV prevalence: five of the participating hospital emergency departments were in London, two were in Essex, one was in Leeds and one was in Glasgow.

All adult patients having blood tests as part of their care were offered opt-out testing for blood-borne viruses. Demographic data were obtained. Patients newly diagnosed with a blood-borne virus were linked to care.

During the campaign, 7807 patients attended the nine emergency departments and had blood tests. Uptake of testing for blood-borne viruses was 27% (2118), but this varied between participating hospitals (10-60%). Overall, 52% of those testing were women, the median age was 47 years and 42% identified as white.

A total of 71 blood-borne viral infections were detected, and 32 of these were new diagnoses.

There were 39 HCV diagnoses (15 new), 15 HBV diagnoses (eleven new) and 17 HIV diagnoses (six new). One person was newly diagnosed with HIV and HCV co-infection.

Prevalence of the three infections varied: 1.84% for HCV (0.71% newly diagnosed), 0.71% for HBV (0.51% newly diagnosed) and 0.8% for HIV (0.52% newly diagnosed).

Individuals aged 25-54 years had the highest prevalence: HCV, 2.46% (1.18% newly diagnosed), HIV, 1.36% (0.5% newly diagnosed) and HBV, 1.09% (0.5% newly diagnosed).

The investigators assumed that each test for a blood-borne virus cost £7. This meant that it cost £988 per new HCV diagnosis; each new HBV diagnosis cost £1351 and each new HIV diagnosis cost £2478.

Most of the new diagnoses would have been missed if only patients presenting with symptoms suggestive of possible HIV infection were tested.

The investigators were able to contact 23 of the 32 individuals (71%) with a newly diagnosed infection; two-thirds of these patients attended for a follow-up appointment and 59% remained in care after six months. Ten patients with a previously diagnosed infection but who were lost to follow-up were also identified. The investigators were able to contact six of these patients, five were linked to care and two were retained in care after six months.

“These pilot data on BBV need to be corroborated with longer term data and much more detailed analysis of feasibility, sustainability and acceptability to staff and patients in a longer study,” conclude the authors. “However, this snapshot of BBV testing in some UK emergency departments suggests that perhaps a year-round BBV screening policy in certain age groups and geographical locations may diagnose many more new viral hepatitis as well as new HIV infections.”


信源地址:http://www.eatg.org/news/173939/ ... r_of_new_infections

0

听众

0

收听

387

积分

中级会员

Rank: 3Rank: 3

积分
387
发表于 2016-3-24 09:06:10 | 显示全部楼层
领了。。。。。

0

听众

0

收听

387

积分

中级会员

Rank: 3Rank: 3

积分
387
发表于 2016-3-24 18:52:34 | 显示全部楼层
英国:急诊室病人艾滋病毒/乙肝病毒/丙型肝炎病毒选择退出试验确诊大量新感染病例

       最近,在《HIV Medicine》上报道了一项在英国9个急诊室进行的为其一周的试点试验,该试验结果表明艾滋病毒(HIV)/乙肝病毒(HBV)/丙型肝炎病毒(HCV)选择退出试验可以鉴别大量未确诊的感染病例。研究人员对那些血液测试作为护理内容一部分的成年病人进行了HIV/HBV/HCV选择退出筛选。
       累计超过1/4的患者同意进行这样测试,其中的3%的患者被确诊感染血源性病毒(BBV),而这些感染的45%为新诊断的。
       “除了艾滋病感染新诊病例外,我们还鉴别出大量的病毒性肝炎新诊病例,特别是丙型肝炎,”作者指出。“这些患者在活动周(按照英国指南)中仅进行了HIV测试,而没有进行HCV或HBV测试,这些病毒性肝炎的诊断可能就这样被错过了。”
       在英国,血液传播的病毒,特别是HIV和HCV,往往在疾病晚期才被诊断出来。指南推荐,在HIV感染率超过0.2%的地区进行主要护理的所有的患者都需要进行常规,选择退出的HIV测试。其他国家的研究已经表明医院急诊(或重伤)部门是血液传播病毒常规筛查的合适场所。因此,一组研究人员设计了一项试点研究,以确定在英国接受急诊护理病人中,HIV,HBV和HCV的流行率。
       2014年10月13日-10月19日,在英国HIV高感染率地区的9个医院急诊部门举行了为其一周的“流行中的病毒”(Going Viral)活动:其中5个在伦敦,2个在埃塞克斯郡,1个在利兹和1个在格拉斯哥。
       对所有血液测试作为护理内容一部分的成年患者提供了血液传播病毒的选择退出测试。收集人口统计数据。对血传播病毒感染新诊患者进行护理对接。
       在活动期间,9个急救部门的7807名患者进行了血液测试。对血源性病毒检测率为27%(2118),但在参与的医院中比例有所差异(10-60%)。总体而言,52%的测试为女性,平均年龄为47岁,42%为白人。
       共检测到71例血液传播病毒感染,其中32例为新诊断。
       确诊39例HCV感染患者(新诊15例),确诊15例HBV感染患者(新诊7例)和确诊17例HIV感染患者(新诊6例)。一人被新诊为HIV和HCV共感染病例。
       三种病毒的感染的感病率不同:HCV为1.84%(新诊0.71%),HBV为0.71%(新诊0.51%)和HIV为0.8%的艾滋病毒(新诊0.52%)。
       25-54岁人群的发病率最高:HCV,2.46%(新诊1.18%);HIV,1.36%(新诊0.5%),新诊断);HBV,1.09%(新诊0.5%)。
       研究人员假定每个血源性病毒的测试成本为£7。这意味着每一个新诊HCV病例的诊断成本为£988;每一个新诊HBV病例的诊断成本为£1351;每一个新诊HIV病例的诊断成本为£2478。
       如果只对那些具有疑似HIV感染症状的病人进行检测的话,那么大多数新诊病例将会被错过。
       研究者能够联系到32个新诊感染患者中的23人(71%);2/3患者签订了随访协议, 59%的患者在6个月后仍在进行护理。10例先前诊断为感染但后续随访丢失的患者被重新确定。研究者能够联系到这10例患者中的6例,5例患者进行了护理对接,和2例患者在6个月后仍被保留并进行护理。
       “这些BBV的试点数据需要长期数据的支持;并在更长的研究中,对这种筛查方式在工作人员和病人中的有效性,可持续性和可接受性进行更加详细的分析,”作者总结。“然而,这个在英国一些急诊部门的BBV的快照式测试表明,或许在一定的年龄组和地理位置的患者进行为期一整年的BBV筛查政策可以确定更多的病毒性肝炎新诊病例,以及艾滋病毒感染的新诊病例。”

10

听众

10

收听

1954

积分

管理员

Rank: 9Rank: 9Rank: 9

积分
1954
 楼主| 发表于 2016-3-25 10:44:38 | 显示全部楼层
收了
您需要登录后才可以回帖 登录 | 立即注册

本版积分规则

© 2013 艾兰博曼 All Rights Reserved.
( 浙ICP备07020270号-8 )
 
快速回复 返回顶部 返回列表