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Ann Emerg Med. 2018 Jul;72(1):41-53.e9. doi: 10.1016/j.annemergmed.2017.09.011. Epub 2017 Oct 31.

Targeted HIV Screening in Eight Emergency Departments: The DICI-VIH Cluster-Randomized Two-Period Crossover Trial.

Author information

1
Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Center of East of Paris, Paris, France; Université Paris Saclay-Université Versailles St Quentin, INSERM UMR 1173, Garches, France. Electronic address: judith.leblanc@aphp.fr.
2
Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique UMRS 1136, Paris, France.
3
Assistance Publique-Hôpitaux de Paris, Hôpital Hôtel-Dieu, URC Eco Île-de-France, Paris, France, and Université Paris Diderot, Univ Paris 07, INSERM, ECEVE, UMR 1123, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Henri-Mondor, Santé publique, Créteil, France.
4
Université Paris Sud, Univ Paris 11, INSERM, Centre for Research in Epidemiology and Population Health, U 1018, Villejuif, France.
5
Assistance Publique-Hôpitaux de Paris, Hôpital Raymond-Poincaré, Infectious Diseases Department, Garches, France.
6
Interuniversity Institute for Biostatistics and Statistical Bioinformatics, KU Leuven, Leuven, Belgium, and UHasselt, Hasselt, Belgium.
7
Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Unit of East of Paris, Paris, France.
8
Assistance Publique-Hôpitaux de Paris, Hôpital St Antoine, Emergency Department, Paris, France.
9
Assistance Publique-Hôpitaux de Paris, Hôpital St Louis, Microbiology Department, INSERM U941, Paris, France.
10
Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Center of East of Paris, Paris, France; Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Department of Clinical Pharmacology and Clinical Research Platform of East of Paris, and Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR 1148, Paris, France.
11
Université Paris Saclay-Université Versailles St Quentin, INSERM UMR 1173, Garches, France; Assistance Publique-Hôpitaux de Paris, Hôpital Saint Louis, Infectious Diseases Department, Université Paris Diderot, Univ Paris 07, Paris, France.

Abstract

STUDY OBJECTIVE:

This study compares the effectiveness and cost-effectiveness of nurse-driven targeted HIV screening alongside physician-directed diagnostic testing (intervention strategy) with diagnostic testing alone (control strategy) in 8 emergency departments.

METHODS:

In this cluster-randomized, 2-period, crossover trial, 18- to 64-year-old patients presenting for reasons other than potential exposure to HIV were included. The strategy applied first was randomly assigned. During both periods, diagnostic testing was prescribed by physicians following usual care. During the intervention periods, patients were asked to complete a self-administered questionnaire. According to their answers, the triage nurse suggested performing a rapid test to patients belonging to a high-risk group. The primary outcome was the proportion of new diagnoses among included patients, which further refers to effectiveness. A secondary outcome was the intervention's incremental cost (health care system perspective) per additional diagnosis.

RESULTS:

During the intervention periods, 74,161 patients were included, 16,468 completed the questionnaire, 4,341 belonged to high-risk groups, and 2,818 were tested by nurses, yielding 13 new diagnoses. Combined with 9 diagnoses confirmed through 97 diagnostic tests, 22 new diagnoses were established. During the control periods, 74,166 patients were included, 92 were tested, and 6 received a new diagnosis. The proportion of new diagnoses among included patients was higher during the intervention than in the control periods (3.0 per 10,000 versus 0.8 per 10,000; difference 2.2 per 10,000, 95% CI 1.3 to 3.6; relative risk 3.7, 95% CI 1.4 to 9.8). The incremental cost was €1,324 per additional new diagnosis.

CONCLUSION:

The combined strategy of targeted screening and diagnostic testing was effective.

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