Opt‐out screening strategy for <scp>HIV</scp> infection among patients attending emergency departments: systematic review and meta‐analysis

Henriquez-Camacho, Cesar; Villafuerte-Gutierrez, Paola; Perez-Molina, José A.; Losa, Juan Emilio; Gotuzzo, Eduardo; Cheyne, N

doi:10.1111/hiv.12474

Cited by 34 publications

(35 citation statements)

References 41 publications

(30 reference statements)

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“…To determine the best method of HCV case‐finding in the ED, further research is now warranted to find the most optimal mechanism of screening, communicating results and setting up ED patients with liver‐related care. Other mechanisms of ED screening can vary from incorporating testing into patients already receiving a phlebotomy in the ED, to opt‐out programmes 14 . In this study, a highly conservative estimate was used for the probability of a patient receiving screening (50%).…”

Section: Discussionmentioning

confidence: 99%

“…The ED patient population has also been associated with a higher burden of HCV infection when compared to the general population in both the United States and Canada 9‐11 . Screening initiatives within EDs have been associated with detection of newly diagnosed infections and an increase in the number of patients who are linked to timely care 12‐14 . Previous research has already established the feasibility of the ED as a cost‐effective and effective setting for routine human immunodeficiency virus (HIV) screening 14,15 .…”

Section: Introductionmentioning

confidence: 99%

“…Screening initiatives within EDs have been associated with detection of newly diagnosed infections and an increase in the number of patients who are linked to timely care 12‐14 . Previous research has already established the feasibility of the ED as a cost‐effective and effective setting for routine human immunodeficiency virus (HIV) screening 14,15 . Using results from an ongoing pilot ED HCV screening initiative, the objective of this study was to explore the potential health and economic impact of screening for HCV in the ED.…”

Section: Introductionmentioning

confidence: 99%

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The emergency department as a setting‐specific opportunity for population‐based hepatitis C screening: An economic evaluation

Mendlowitz

Naimark

Wong

et al. 2020

Liver International

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Background and Aims:The World Health Organization's hepatitis C virus (HCV) elimination strategy recognizes the need for interventions that identify populations most affected by infection. The emergency department (ED) has been suggested as a setting for HCV screening. The study objective was to explore the health and economic impact of HCV screening in the ED setting. Methods:We used a microsimulation model to conduct a cost-utility analysis evaluating two ED setting-specific strategies: no screening, and screening and subsequent treatment. Strategies were examined for two populations: (a) the general ED patient population; and (b) ED patients born between 1945 and 1975. The analysis was conducted from a healthcare payer perspective over a lifetime time horizon. A reference and high ED HCV seroprevalence measure were examined in the Canadian healthcare setting.US costs of chronic infection were used for a scenario analysis of screening in the US healthcare setting. Results: For birth cohort screening, in comparison to no screening, one liver-related death was averted for every 760 and 123 persons screened for the reference and high seroprevalence measures. For general population screening, one liver-related death was averted for every 831 and 147 persons screened for the reference and high seroprevalence measures. In comparison to no screening, birth cohort screening was cost-effective at CAN$25,584/quality-adjusted life year (QALY) and US$42,615/QALY. General population screening was cost-effective at CAN$19,733/QALY and US$32,187/QALY. Conclusions: ED screening may represent a cost-effective component of populationbased strategies to eliminate HCV. Further studies are warranted to explore the feasibility and acceptability of this approach. K E Y W O R D S cost-utility analysis, economic evaluation, emergency department, hepatitis C, screening | 1283 MENDLOWITZ ET aL.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The emergency department as a setting‐specific opportunity for population‐based hepatitis C screening: An economic evaluation

Mendlowitz

Naimark

Wong

et al. 2020

Liver International

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“…That approach is less time consuming than the "opt in", the classical pretest counselling, and was the screening method adopted in this study. A recent review has indeed shown that "opt out" was as good as "opt in" in detecting new cases of HIV infection [22]. Blood donation represented the main screening occasion probably due to the fact that in Cameroon, two donors are requested by blood bank institutes before selling each pine of blood for blood transfusion, becoming an important HIV screening opportunity.…”

Section: Discussionmentioning

confidence: 99%

Mother to Child Transmission of HIV after Option B+ in Low Income Environment

Valère¹,

Kamgaing²,

Mefo³

et al. 2018

OJOG

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Background: In Cameroon, the prevalence of HIV in pregnant women was 7.8% in 2012, and they were 8500 HIV positive newborns in 2013. Option B+ is the first highly active antiretroviral therapy (HAART) preventive protocol. The objective was to evaluate the rate of HIV transmission on children born from mothers who were on Option B+ during pregnancy, in three university teaching hospitals of the University of Yaoundé I. Methods: It was a retrospective, cross-sectional study over a period of four years (2013-2017). We included HIV positive mothers not on previous antiretroviral treatment and who received a single tablet daily of combined tenofovir (300 mg) + Lamivudine (300 mg) + Efavirenz (600 mg) started at any time during pregnancy. Newborn received nevirapine syrup according to WHO option B+ protocol. Results: 179 women were included. The average age was 33.5 ± 2.92 years, all ages were represented. Blood donation was the most frequent HIV positive screening opportunity, voluntary testing rate was 29% (29/179), and adherence rate was 98.9%. Few male partners were involved (58/179). Premature deliveries and low birth weight were rare (5/179; 10/179)), the indication of mode of delivery was strictly obstetrical, newborn feeding choice didn't affect the transmission outcome, and the mother to child transmission rate was 2.2% (4/179). Conclusion: Option B+ could achieve the lowest mother to child transmission ever in Cameroon and should be generalized in high endemicity low resources settings.

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“…This has led to increased screening for populations that may otherwise have poor access to the primary care settings in which screening is traditionally performed. [14][15][16][17][18][19][20] These efforts are not widely extended to adolescents. Adolescents experience fragmented health care with frequent ED utilization [21][22][23] and often have high-risk sexual behaviors 24,25 and low HIV screening rates.…”

mentioning

confidence: 99%

Unique Needs for the Implementation of Emergency Department Human Immunodeficiency Virus Screening in Adolescents

Gutman

Duda

Newton

et al. 2020

Academic Emergency Medicine

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Background: The Centers for Disease Control and Prevention (CDC) recommend universal human immunodeficiency virus (HIV) screening starting at 13 years, which has been implemented in many general U.S. emergency departments (EDs) but infrequently in pediatric EDs. We aimed to 1) implement a pilot of routine adolescent HIV screening in a pediatric ED and 2) determine the unique barriers to CDC-recommended screening in this region of high HIV prevalence. Methods: This was a prospective 4-month implementation of a routine HIV screening pilot in a convenience sample of adolescents 13 to 18 years at a single pediatric ED, based on study personnel availability. Serumbased fourth-generation HIV testing was run through a central laboratory. Parents were allowed to remain in the room for HIV counseling and testing. Data were collected regarding patient characteristics and HIV testing quality metrics. Comparisons were made using chi-square and Fisher's exact tests. Regression analysis was performed to assess for an association between parent presence at the time of enrollment and adolescent decision to participate in HIV screening.

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Opt‐out screening strategy for HIV infection among patients attending emergency departments: systematic review and meta‐analysis

Abstract: In this meta-analysis, the testing uptake of the opt-out strategy was not different from that of the opt-in strategy to detect new cases of HIV infection in EDs.

Cited by 34 publications

References 41 publications

The emergency department as a setting‐specific opportunity for population‐based hepatitis C screening: An economic evaluation

The emergency department as a setting‐specific opportunity for population‐based hepatitis C screening: An economic evaluation

Mother to Child Transmission of HIV after Option B+ in Low Income Environment

Unique Needs for the Implementation of Emergency Department Human Immunodeficiency Virus Screening in Adolescents

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