Abstract
OBJECTIVES: The objective of this study was to estimate the seroprevalence of HIV infection and the acceptability of point-of-care HIV testing in an innercity Canadian emergency department.
METHODS: We conducted a prospective cohort study in an urban tertiary care emergency department between August 2009 and January 2011. Randomly selected patients were enrolled using probabilistic sampling based on patient volumes. Inclusion criteria were age 19–75 years and ability to provide informed consent. Patients who were intoxicated or in extremis were excluded. After informed consent and brief pre-test counselling, participants’ HIV status was obtained using the INSTI HIV-1/HIV-2 Antibody Test. Participants completed a questionnaire on HIV risk behaviours and satisfaction with emergency department HIV testing. Participants with a positive result or those having other blood tests received confirmatory Western blot testing. HIV-positive participants were offered immediate referral to an HIV specialty clinic.
RESULTS: A total of 2,077 patients were approached, and 1,402 (67.5%) agreed to participate. Participants’ mean age was 43.3 years, and 58.4% of participants were male. The HIV antibody seroprevalence based on the point-of-care test was 65/1,402 (4.6%; 95% confidence interval: 3.5%–5.8%). No new diagnoses of HIV were identified in our cohort. Patient satisfaction with point-of-care HIV testing was high (mean satisfaction score 9.6/10).
CONCLUSION: On the basis of a rapid, point-of-care HIV antibody test, the seroprevalence rate of HIV in an inner city emergency department was 4.6%. Point-of-care testing in the emergency department is acceptable, and patients’ satisfaction with the testing procedure was high.
Key Words: Diagnostic testing, emergency medicine, acceptability, HIV, point of care test
Résumé
OBJECTIFS : Cette étude visait à estimer la séroprévalence de l’infection à VIH et l’acceptabilité du dépistage du VIH aux points de service au service d’urgence d’un quartier central d’une ville canadienne.
MÉTHODE : Nous avons mené une étude prospective de cohortes au service d’urgence d’un hôpital de soins tertiaires en milieu urbain entre août 2009 et janvier 2011. Des patients sélectionnés au hasard ont été inscrits par échantillonnage probabiliste fondé sur les volumes de patients. Les critères d’inclusion étaient l’âge (19–75 ans) et la capacité de fournir un consentement éclairé. Les patients en état d’ébriété ou in extremis ont été exclus. Après avoir obtenu le consentement éclairé des patients et leur avoir donné un bref counseling pré-dépistage, nous avons obtenu leur état sérologique relativement au VIH à l’aide du test d’anticorps INSTI HIV-1/HIV-2. Les participants ont rempli un questionnaire sur les comportements présentant un risque pour le VIH et sur leur satisfaction à l’égard du dépistage du VIH au service d’urgence. Les participants ayant obtenu un résultat positif et ceux ayant eu d’autres analyses sanguines ont subi un test de transfert western pour confirmer les résultats. Les participants séropositifs pour le VIH se sont fait offrir un aiguillage immédiat vers une clinique de VIH spécialisée.
RÉSULTATS : Nous avons approché 2 077 patients, dont 1 402 (67,5 %) ont accepté de participer. L’âge moyen des participants était de 43,3 ans; 58,4% des participants étaient des hommes. La séroprévalence des anticorps anti-VIH d’après le dépistage au point de service était de 65/1 402 (4,6 %; intervalle de confiance de 95%: 3,5%–5,8 %). Aucun nouveau diagnostic de VIH n’a été identifié dans notre cohorte. La satisfaction des patients à l’égard du dépistage du VIH au point de service était élevée (note de satisfaction moyenne de 9,6/10).
CONCLUSION : D’après un test de détection rapide des anticorps anti-VIH au point de service, le taux de séroprévalence du VIH au service d’urgence d’un quartier central d’une ville était de 4,6 %. Le dépistage au point de service dans un service d’urgence est acceptable, et la satisfaction des patients à l’égard de la procédure de dépistage était élevée.
Mots Clés: tests diagnostiques, médecine d’urgence, acceptabilité, VIH, dépistage aux points de service
Footnotes
Funding: The research was supported by a grant from the British Columbia Ministry of Health.
Conflict of Interest: None to declare.
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