Emergency Department Staff Satisfaction With Rapid Human Immunodeficiency Virus Testing

Objectives: The authors sought to determine staff satisfaction with an emergency department (ED) rapid human immunodeficiency virus (HIV) testing program. Methods: A survey was conducted in an urban ED that has provided rapid HIV testing (routine screening and physician‐initiated testing) since August 2007. From May 1, 2008, to August 31, 2008, the survey was administered to all ED staff involved with HIV testing. The primary outcome was satisfaction, and secondary outcomes were the staff attitudes toward the program. Results: Surveys were administered to 215 of the 217 staff members, and 207 surveys were returned (96% response rate); 201 surveys had complete data available for analysis. The response rate by staffing type was as follows: physicians 64/64 (100%), nurses 124/134 (93%), and registration staff 16/19 (84%). The majority of ED staff (99%; 95% confidence interval [CI] = 95% to 100%) were satisfied with the HIV testing program. Physicians, however, rated the program more favorably than nurses or registration staff. Most staff members agreed that HIV testing improved overall care (93%; 95% CI = 89% to 96%) and felt that HIV testing did not interfere with their ability to provide care (82%; 95% CI = 76% to 87%). The majority of staff perceived that patients were satisfied with the procedures for obtaining consent (73%; 95% CI = 67% to 79%) and with the way HIV testing was performed (83%; 95% CI = 77% to 87%). Conclusions: Emergency department staff satisfaction and overall attitudes with the HIV testing program is high. ED staff does not appear to be a barrier to program implementation. ACADEMIC EMERGENCY MEDICINE 2010; 17:561–565 © 2010 by the Society for Academic Emergency Medicine     

Nomenclature and Definitions for Emergency Department Human Immunodeficiency Virus (HIV) Testing: Report from the 2007 Conference of the National Emergency Department HIV Testing Consortium

Early diagnosis of persons infected with human immunodeficiency virus (HIV) through diagnostic testing and screening is a critical priority for individual and public health. Emergency departments (EDs) have an important role in this effort. As EDs gain experience in HIV testing, it is increasingly apparent that implementing testing is conceptually and operationally complex. A wide variety of HIV testing practice and research models have emerged, each reflecting adaptations to site-specific factors and the needs of local populations. The diversity and complexity inherent in nascent ED HIV testing practice and research are associated with the risk that findings will not be described according to a common lexicon. This article presents a comprehensive set of terms and definitions that can be used to describe ED-based HIV testing programs, developed by consensus opinion from the inaugural meeting of the National ED HIV Testing Consortium. These definitions are designed to facilitate discussion, increase comparability of future reports, and potentially accelerate wider implementation of ED HIV testing.     

Availability of Rapid Human Immunodeficiency Virus Testing in Academic Emergency Departments

Objectives:  The Centers for Disease Control and Prevention (CDC) recommends routine human immunodeficiency virus (HIV) screening of emergency department (ED) patients aged 13 to 64 years. The study objectives were to determine the accessibility of rapid HIV testing in academic EDs, to identify factors that influence an ED's adoption of testing, and to describe current HIV testing practices.
Methods:  Online surveys were sent to EDs affiliated with emergency medicine (EM) residency programs ( n  = 128), excluding federal hospitals and facilities in U.S. territories. Eighty percent ( n  = 102) responded. Most e-mail recipients ( n  = 121) were Emergency Medicine Network (EMNet) investigators; remaining contacts were obtained from residency-related Web sites.
Results:  Most academic EDs ( n  = 58; 57%; 95% confidence interval (CI) = 47% to 66%) offer rapid HIV testing. Among this group, 26 (45%) allow providers to order tests without restrictions. Of the other 32 EDs, 100% have policies allowing for rapid HIV testing following occupational exposures, but less than 10% have guidelines for testing in other clinical situations. Forty-seven percent expect to routinely offer HIV testing in the next 2 to 3 years. Only 59% of the EDs that offered rapid tests in any situation could link an HIV-positive patient to subspecialty care. The facility characteristic most important to availability of rapid HIV testing was the presence of on-site HIV counselors.
Conclusions:  Most academic EDs now offer rapid HIV testing (57%), but few use it in situations other than occupational exposure. Less than half of academic EDs expect to implement CDC guidelines regarding routine screening within the next few years. The authors identified facility characteristics (e.g., counseling, ability to refer) that may influence adoption of rapid HIV testing.     

HIV-慢病毒载体有效转导人肺动脉平滑肌细胞的实验研究

目的使用不同的HIV-载体感染人肺动脉平滑肌细胞,并使用HIV慢病毒载体将外源基因转入人肺动脉平滑肌细胞。方法应用ADA/Luc、HXB2/Luc、VSV-G/Luc和VSV-G/GFP感染人肺动脉平滑肌细胞U87.CD4.CCR5和U87.CD4.CX-CR4。结果ADA/Luc和HXB2/Luc均能感染具有相应复合受体的U87.CD4,但不能感染人肺动脉平滑肌细胞。VSV-G/Luc和VSV-G/GFP能有效转导至人肺动脉平滑肌细胞中,于感染第3天,表达VSV-G/GFP的人肺动脉平滑肌细胞的阳性率为18%。结论应用HIV慢病毒载体能够向人肺动脉平滑肌细胞中导入外源基因。     

Design and Implementation of a Controlled Clinical Trial to Evaluate the Effectiveness and Efficiency of Routine Opt-out Rapid Human Immunodeficiency Virus Screening in the Emergency Department

In 2006, the Centers for Disease Control and Prevention (CDC) released revised recommendations for performing human immunodeficiency virus (HIV) testing in health care settings, including implementing routine rapid HIV screening, the use of an integrated opt-out consent, and limited prevention counseling. Emergency departments (EDs) have been a primary focus of these efforts. These revised CDC recommendations were primarily based on feasibility studies and have not been evaluated through the application of rigorous research methods. This article describes the design and implementation of a large prospective controlled clinical trial to evaluate the CDC's recommendations in an ED setting. From April 15, 2007, through April 15, 2009, a prospective quasi-experimental equivalent time-samples clinical trial was performed to compare the clinical effectiveness and efficiency of routine (nontargeted) opt-out rapid HIV screening (intervention) to physician-directed diagnostic rapid HIV testing (control) in a high-volume urban ED. In addition, three nested observational studies were performed to evaluate the cost-effectiveness and patient and staff acceptance of the two rapid HIV testing methods. This article describes the rationale, methodologies, and study design features of this program evaluation clinical trial. It also provides details regarding the integration of the principal clinical trial and its nested observational studies. Such ED-based trials are rare, but serve to provide valid comparisons between testing approaches. Investigators should consider similar methodology when performing future ED-based health services research.     

Comparison of non-radioactive DNA hybridization probes to detect human immunodeficiency virus nucleic acid

Simple and sensitive methods to directly detect the human immunodeficiency virus (HIV) are needed for routine use in the clinical laboratory. In this study, we compared DNA probes prepared by: (1) nick translation with biotinylated dATP; (2) direct covalent biotinylation with photobiotin; (3) direct covalent reaction with 2-acetylaminofluorene (AAF); and (4) a standard radioactive (32P) nick translation procedure. These four DNA probes were hybridized with dilutions of purified target HIV DNA blotted onto nitrocellulose strips. Hybridization was detected using a complex of strepavidin-alkaline phosphatase [for (1) and (2)], alkaline phosphatase-tagged antibodies [for (3)] and by autoradiography [for (4)]. Alkaline phosphatase was detected colorimetrically using nitroblue tetrazolium and 5-bromo-4-chloro-3-indolyl phosphate. After 1 h, AAF probes were most sensitive (amount detected less than 5 pg), followed by biotin (10 pg), photobiotinylated probes (20 pg) and the radioactive probe (10 pg). The AAF probes were then used to detect HIV DNA in infected CEM cells. We conclude that non-radioactive DNA labelling methods can be used to directly detect HIV DNA under conditions compatible with present clinical laboratory procedures.     

A Model for Increasing Access to Preexposure Prophylaxis (PrEP) Services in the Substance Use Population

In 2017, a low-resource substance use treatment center in Baltimore, Maryland, noted that at least 38% of patients, ranging from 18 to 76 years old, with substance use disorders (SUD) met the criteria for preexposure prophylaxis (PrEP) therapy. PrEP therapy consists of a daily medication to prevent transmission of human immunodeficiency virus. A conceptual framework model was developed linking eligible patients with SUD to PrEP services based on current Centers for Disease Control and Prevention PrEP recommendations. Three tools were developed for PrEP service planning, implementation, and evaluation. The focus of this report is to increase access to and uptake of comprehensive PrEP services in those with SUD who are at risk for acquiring human immunodeficiency virus.     

Human Immunodeficiency Virus: What Primary Care Clinicians Need to Know

Human immunodeficiency virus (HIV) has evolved from an illness that consistently led to death to a chronic disease that can be medically managed. Primary care clinicians can provide beneficial care to the individual patient and potentially decrease the transmission of HIV to others through appropriate HIV screening and recognition of clinical clues to both chronic and acute HIV. Most patients who take combination antiretroviral therapy experience immune reconstitution and resume normal lives. These patients benefit from the care of an experienced primary care clinician in addition to a clinician with HIV expertise. Primary care clinicians have expertise providing preventive care, including counseling regarding healthier lifestyle choices and managing cardiovascular risk factors, osteoporosis, hypertension, and diabetes, all of which have become increasingly important for individuals with HIV as they age. This article reviews the many important roles of primary care clinicians with regard to the HIV epidemic and care of patients with HIV.     

Comparative evaluation of 14 immunoassays for detection of antibodies to the human T-lymphotropic virus types I and II using panels of sera from Sweden and West Africa

BACKGROUND: A new generation of assays for the detection of human T-lymphotropic virus types I and II (HTLV-I/II) antibodies has been released. These assays incorporate HTLV-I- and HTLV-II-specific antigens, and some are based on new assay principles. Comparative evaluation data that include these new as well as previous assays are limited. STUDY DESIGN AND METHODS: Fourteen HTLV antibody assays were evaluated by using well-characterized panels of sera from Guinea-Bissau, West Africa, and Sweden. The sera included 127 HTLV-I-positive and 62 HTLV-II-positive specimens, as well as 919 consecutive negative samples. RESULTS: The sensitivity for HTLV-I was 100 percent for all assays, except one, which repeatedly missed one sample. The sensitivity for HTLV-II varied between 86 percent and 100 percent. In general, new-generation assays incorporating HTLV-II-specific antigens, and some of which are based on new assay principles, had a higher sensitivity for HTLV-II than previous assays, which mainly are based on HTLV-I antigens. The specificity was generally higher for new assays than for the previous versions. Testing of Swedish blood donor sera gave higher specificities (94-100%) than did that of African specimens (90-99.7%). Most assays had low delta values (DVs), although there was a tendency toward increased DVs for the new generation of assays. Only two of the new generation of assays came close to a combination of high sensitivity for both HTLV-I and HTLV-II, high specificity, positive and negative predictive values, and high DVs. CONCLUSION: The sensitivity for HTLV-I was generally high and appears to have improved for HTLV-II with the introduction of a new generation of assays incorporating HTLV-II-specific antigens. However, some assays still give false-negative results on HTLV-II-positive specimens. The specificities and the DVs were generally higher for the new assays than for the previous versions.