Feasibility of an Emergency Department‐based Tuberculosis Counseling and Screening Program

Kirsch, Thomas D.; Chanmugam, Arjun; Keyl, Penelope M.; Regan, Linda; Shahan, Judy B.; Hexter, David; Kelen, Gabor D.

doi:10.1111/j.1553-2712.1999.tb00161.x

Cited by 12 publications

(12 citation statements)

References 19 publications

(11 reference statements)

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“…Although EDs have not been explicitly mentioned in the NICE guidance for HBV and HCV, it is a setting which has been explored for HIV and TB testing, and so could be considered for HBV and HCV. The ED setting is universally accessible to all people [16–18], and therefore could be potentially effective at reaching more vulnerable and underserved populations [4].…”

Section: Introductionmentioning

confidence: 99%

Seroprevalence of HCV, HBV and HIV in two inner-city London emergency departments

et al. 2019

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Summary: In this paper we build on work investigating the feasibility of human immunodeficiency virus (HIV) testing in emergency departments (EDs), estimating the prevalence of hepatitis B, C and HIV infections among persons attending two inner-London EDs, identifying factors associated with testing positive in an ED. We also undertook molecular characterisation to look at the diversity of the viruses circulating in these individuals, and the presence of clinically significant mutations which impact on treatment and control.Blood-borne virus (BBV) testing in non-traditional settings is feasible, with emergency departments (ED) potentially effective at reaching vulnerable and underserved populations. We investigated the feasibility of BBV testing within two inner-London EDs. Residual samples from biochemistry for adults (⩾18 years) attending The Royal Free London Hospital (RFLH) or the University College London Hospital (UCLH) ED between January and June 2015 were tested for human immunodeficiency virus (HIV)Ag/Ab, anti-hepatitis C (HCV) and HBsAg. PCR and sequence analysis were conducted on reactive samples. Sero-prevalence among persons attending RFH and UCLH with residual samples (1287 and 1546), respectively, were 1.1% and 1.0% for HBsAg, 1.6% and 2.3% for anti-HCV, 0.9% and 1.6% for HCV RNA, and 1.3% and 2.2% for HIV. For RFH, HBsAg positivity was more likely among persons of blackvs.white ethnicity (odds ratio 9.08; 95% confidence interval 2.72–30), with anti-HCV positivity less likely among females (0.15, 95% CI 0.04–0.50). For UCLH, HBsAg positivity was more likely among non-white ethnicity (13.34, 95% CI 2.20–80.86 (Asian); 8.03, 95% CI 1.12–57.61 (black); and 8.11, 95% CI 1.13–58.18 (other/mixed)). Anti-HCV positivity was more likely among 36–55 year oldsvs.⩾56 years (7.69, 95% CI 2.24–26.41), and less likely among females (0.24, 95% CI 0.09–0.65). Persons positive for HIV-markers were more likely to be of blackvs.white ethnicity (4.51, 95% CI 1.63–12.45), and less likely to have one ED attendance (0.39, 95% CI 0.17–0.88), or female (0.12, 95% CI 0.04–0.42). These results indicate that BBV-testing in EDs is feasible, providing a basis for further studies to explore provider and patient acceptability, referral into care and cost-effectiveness.

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Section: Introductionmentioning

confidence: 99%

Seroprevalence of HCV, HBV and HIV in two inner-city London emergency departments

et al. 2019

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“…The one study conducted to date to evaluate the feasibility of this approach reports promising findings. Sixty percent of eligible patients consented to testing, and more than half returned for followup, which is comparable to that seen in other public health venues [32]. Optimal strategies for targeted screening found that it is possible to identify a ''high-risk'' group, which would identify nearly 90% of cases while testing only about 50% of the ED population.…”

Section: Public Health Interventionsmentioning

confidence: 55%

Communicable Respiratory Threats in the ED: Tuberculosis, Influenza, SARS, and Other Aerosolized Infections

Rothman

Hsieh

Yang

2006

Emergency Medicine Clinics of North America

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Respiratory infections are the most common communicable infectious diseases. EDs are the front line for patients with respiratory infections because of their acute nature and because the ED is the principal site of health care for those at highest risk. These diseases include influenza, tuberculosis, and measles, together accounting for 25% of infectious causes of death worldwide. These are emerging and biothreat agents that follow the same route of transmission, such as pneumonic plague. We discuss epidemiology, pathogenesis, diagnosis, and treatment of each agent. Emphasis is on the ED's role as a public health prevention arena, with attention to education and disease prevention, early identification of disease in patients at risk, and reduction of illnesses.

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“…A study conducted among patients being attended at an adult emergency unit, including those living with HIV, has shown that triage, counseling and patient education are of special importance [56]. According to this study, it was counseling that took up most of the time, reaching out not only to patients, but also to family members and partners.…”

Section: Discussionmentioning

confidence: 98%

An evaluation of factors associated with taking and responding positive to the tuberculin skin test in individuals with HIV/AIDS

et al. 2011

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BackgroundThe tuberculin skin test (TST) is still the standard test for detecting latent infection by M tuberculosis (LTBI). Given that the Brazilian Health Ministry recommends that the treatment of latent tuberculosis (LTBI) should be guided by the TST results, the present study sets out to describe the coverage of administering the TST in people living with HIV at two referral health centers in the city of Recife, where TST is offered to all patients. In addition, factors associated with the non-application of the test and with positive TST results were also analyzed.MethodsA cross-sectional study was carried out with HIV patients, aged 18 years or over, attending outpatient clinics at the Correia Picanço Hospital/SES/PE and the Oswaldo Cruz/UPE University Hospital, who had been recommended to take the TST, in the period between November 2007 and February 2010. Univariate and multivariate logistic regression analyses were carried out to establish associations between the dependent variable - taking the TST (yes/no), at a first stage analysis, and the independent variables, followed by a second stage analysis considering a positive TST as the dependent variable. The odds ratio was calculated as the measure of association and the confidence interval (CI) at 95% as the measure of accuracy of the estimate.ResultsOf the 2,290 patients recruited, 1087 (47.5%) took the TST. Of the 1,087 patients who took the tuberculin skin test, the prevalence of TST ≥ 5 mm was 21.6% among patients with CD4 ≥ 200 and 9.49% among those with CD4 < 200 (p = 0.002). The patients most likely not to take the test were: men, people aged under 39 years, people with low educational levels and crack users. The risk for not taking the TST was statiscally different for health service. Patients who presented better immunity (CD4 ≥ 200) were more than two and a half times more likely to test positive that those with higher levels of immunodeficiency (CD4 < 200).ConclusionsConsidering that the TST is recommended by the Brazilian health authorities, coverage for taking the test was very low. The most serious implication of this is that LTBI treatment was not carried out for the unidentified TST-positive patients, who may consequently go on to develop TB and eventually die.

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Feasibility of an Emergency Department‐based Tuberculosis Counseling and Screening Program

Cited by 12 publications

References 19 publications

Seroprevalence of HCV, HBV and HIV in two inner-city London emergency departments

Seroprevalence of HCV, HBV and HIV in two inner-city London emergency departments

Communicable Respiratory Threats in the ED: Tuberculosis, Influenza, SARS, and Other Aerosolized Infections

An evaluation of factors associated with taking and responding positive to the tuberculin skin test in individuals with HIV/AIDS

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