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Martínez-Sanz J, Vivancos MJ, Sánchez-Conde M, Gómez-Ayerbe C, Polo L, Labrador C, González P, Mesa A, Muriel A, Chamorro C, de la Fuente Y, Pérez Elías P, Uranga A, Herrero M, Ares S, Barea R, Moreno S, Pérez-Elías MJ. Hepatitis C and HIV combined screening in primary care: A cluster randomized trial. J Viral Hepat 2021; 28:345-352. [PMID: 32979880 DOI: 10.1111/jvh.13413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/23/2020] [Accepted: 08/31/2020] [Indexed: 12/17/2022]
Abstract
Hepatitis C virus (HCV) and HIV are major causes of worldwide disease. We aimed to evaluate the effect of a combined screening programme, which included a risk-assessment questionnaire and rapid tests for point-of-care diagnosis, on screening and new diagnosis rates. This prospective, cluster randomized study was carried out in primary care. The intervention arm included a 4-hour educational programme, the use of a risk-assessment questionnaire and rapid tests. In the control centres, only the educational intervention was provided. The main variables compared were the screening coverage and the number and rate of new HCV and HIV diagnoses. Of a total of 7991 participants, 4670 (58.5%) and 2894 (36.2%) presented a risk questionnaire for HIV or HCV, respectively. The younger participants, men and those from Latin America and Eastern Europe, showed the greatest risk of presenting with a positive questionnaire. The overall screening coverage was higher within the intervention arm (OR 17.7; 95% CI 16.2-19.5; P < .001). Only two HIV-positives were identified compared to one in control centres. The rate of HCV diagnoses was higher among intervention centres, with 37 versus seven positive tests (OR 5.2; 95% CI 2.3-11.6; P < .001). Of them, 10 were new diagnoses and 27 had been previously diagnosed, although not linked to care. In conclusion, a simple operational programme can lead to an increase in HCV and HIV screening rates, compared to an exclusively educational programme. The selection of at-risk patients with a self-questionnaire and the use of rapid tests significantly increased the diagnostic rate of HCV infection.
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Affiliation(s)
- Javier Martínez-Sanz
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - María Jesús Vivancos
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Matilde Sánchez-Conde
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | | | - Lidia Polo
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Alba Mesa
- Centro de Salud Avenida de Aragón, Madrid, Spain
| | - Alfonso Muriel
- Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | | | | | | | | | - Sara Ares
- Centro de Salud Mar Báltico, Madrid, Spain
| | | | - Santiago Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - María Jesús Pérez-Elías
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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Martínez Sanz J, Pérez Elías MJ, Muriel A, Gómez Ayerbe C, Vivancos Gallego MJ, Sánchez Conde M, Herrero Delgado M, Pérez Elías P, Polo Benito L, de la Fuente Cortés Y, Barea R, Sullivan AK, Fuster Ruiz de Apodaca MJ, Galindo MJ, Moreno S. Outcome of an HIV education program for primary care providers: Screening and late diagnosis rates. PLoS One 2019; 14:e0218380. [PMID: 31265464 PMCID: PMC6605851 DOI: 10.1371/journal.pone.0218380] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/31/2019] [Indexed: 12/16/2022] Open
Abstract
Background Late HIV diagnosis remains one of the challenges in combating the epidemic. Primary care providers play an important role in screening for HIV infection. Our study aims to evaluate the relationship between knowledge and barriers to HIV testing and screening outcomes. The impact of an education program for primary care providers, towards improving HIV testing and late diagnosis rates, is also assessed. Methods A self-administered questionnaire that was developed within the framework of the European project OptTEST was used to examine HIV knowledge and barriers to HIV testing scores before and after being involved in an HIV education program. A quasi-experimental design with pre- and post-intervention measures was performed to investigate its impact. We performed multivariable logistic regression analysis to assess the relationship between variables for the HIV testing offer. Results A total of 20 primary care centers and 454 primary care staff were included. Baseline OptTEST results showed that more knowledgeable staff offered an HIV test more frequently (OR 1.07; CI 95% 1.01–1.13; p = 0.027) and had lower barrier scores (OR 0.89; CI 95% 0.77–0.95; p = 0.005). Nurses had lower scores in knowledge-related items (OR 0.28; CI 95% 0.17–0.46; p<0.001), but higher scores in barrier-related items than physicians (OR 3.28; CI 95% 2.01–5.46; p<0.001). Specific centers with more knowledgeable staff members had a significant association with a greater level of new HIV diagnosis rates (OR 1.61; CI 95% 1.04–2.49; p = 0.032). After the intervention, we found that 12 out of 14 individual questions showed improved scores. In the 6 months after the training program, we similarly found a higher HIV testing rate (OR 1.19; CI 1.02–1.42; p = 0.036). Conclusions This study highlights the association between knowledge and barriers to HIV testing, including HIV testing rates. It shows that it is possible to modify knowledge and reduce perceived barriers through educational programs, subsequently improving HIV screening outcomes.
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Affiliation(s)
- Javier Martínez Sanz
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - María Jesús Pérez Elías
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
- * E-mail: ,
| | - Alfonso Muriel
- Biostatistics Unit, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Cristina Gómez Ayerbe
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | | | - Matilde Sánchez Conde
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | | | | | | | | | | | - Ann K. Sullivan
- Chelsea and Westminster Healthcare NHS Foundation Trust, London, United Kingdom
| | | | - María José Galindo
- Infectious Diseases Unit, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Santiago Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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[Acceptability of the opportunistic search for human immunodeficiency virus infection by serology in patients recruited in Primary Care Centres in Spain]. Aten Primaria 2018; 48:383-93. [PMID: 26522781 PMCID: PMC6877831 DOI: 10.1016/j.aprim.2015.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 07/19/2015] [Accepted: 07/22/2015] [Indexed: 11/22/2022] Open
Abstract
Objetivo Valorar la aceptabilidad de la prueba del virus de la inmunodeficiencia humana (VIH) mediante búsqueda oportunista. Diseño Estudio observacional, transversal. Emplazamiento Centros de atención primaria (CAP) del Sistema Nacional de Salud. Participantes Pacientes de 18 a 65 años a los que hubiese que realizar una analítica y que nunca antes se hubiesen realizado la prueba del VIH. Mediciones principales Edad, sexo, pareja estable, nivel de instrucción, consumo de tabaco/alcohol, motivo de la analítica, aceptabilidad de la prueba del VIH, motivo por el que no acepta o por el que no se le ha realizado antes. Se realizó un análisis estadístico descriptivo, bivariante y multivariante (regresión logística). Resultados Doscientos ocho médicos de 150 CAP captaron 3.314 pacientes. La aceptabilidad del test del VIH fue del 93,1% (IC 95%: 92,2-93,9). De estos, el 56,9% no se la habían realizado antes por no considerarse en riesgo, y el 34,8% por no habérsela ofertado su médico. Del 6,9% que rechazaron la serología, el 73,9% alegaron no considerarse en riesgo. Mediante análisis de regresión logística las variables que mostraron relación con la aceptabilidad de la prueba positivamente fueron: la edad (grupo de 26 a 35 años; OR = 1,79; IC 95%:1,10-2,91) y ser no fumador (OR = 1,39; IC 95%: 1,01-1,93). Los residentes en poblaciones entre 10.000 y 50.000 habitantes (OR = 0,57; IC 95%: 0,40-0,80) fueron los que en menor grado aceptaron la prueba. La prevalencia de VIH detectada fue del 0,24%. Conclusiones La prueba serológica del VIH tiene una alta aceptación entre los usuarios que acuden para hacerse un análisis de sangre a los CAP. La búsqueda oportunista es coste-efectiva.
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Puentes Torres RC, Aguado Taberné C, Pérula de Torres LÁ, Espejo Espejo J, Castro Fernández C, Fransi Galiana L. [Acceptability and feasibility among primary care doctors of the opportunistic search for HIV in Health Care centers in Spain]. Aten Primaria 2017; 49:593-602. [PMID: 28501395 PMCID: PMC6876014 DOI: 10.1016/j.aprim.2017.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 02/05/2017] [Accepted: 02/20/2017] [Indexed: 12/03/2022] Open
Abstract
Objetivo Valorar la aceptabilidad y la factibilidad de la búsqueda oportunista del VIH por parte de los profesionales de atención primaria. Conocer el perfil del médico que participa en este tipo de estudio. Diseño Estudio observacional, transversal. Emplazamiento Centros de atención primaria del Sistema Nacional de Salud. Participantes Médicos de familia y residentes que participaron en el estudio VIH-AP para medir la aceptabilidad de la búsqueda oportunista del VIH por parte de los pacientes. Mediciones principales Mediante encuesta autocumplimentada se determinó: edad, sexo, cualidad de docente, años de investigación, tiempo trabajando con el mismo cupo, aceptabilidad y factibilidad de la búsqueda oportunista del VIH. Resultados Un total de 197 médicos con una media de edad de 45,2 ± 9,7 (DT) años. El 18,8% eran menores de 36 años, el 70,1% mujeres y el 62,4% docentes. El 55,8% trabajaban en localidades mayores de 100.000 habitantes y la media de años ocupando el mismo cupo fue de 6,4 ± 6,6. El 91,9% (IC 95%: 88,1-98,7) consideró la búsqueda oportunista del VIH aceptable, el 89,3% (IC 95%: 85,0-93,6), factible de realizar, mostrando el análisis multivariante relación positiva con el realizar actividad docente (OR: 2,74; IC 95%: 1,16-6,49). La aceptación de la prueba por parte de los pacientes fue del 93,1%, y esta se relacionó positivamente con el tiempo que el médico había trabajado en el mismo cupo, la cualidad de docente y los años dedicados a la investigación. Conclusiones La búsqueda oportunista del VIH es un método aceptable y factible para los profesionales de atención primaria.
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Affiliation(s)
| | - Cristina Aguado Taberné
- Centro de Salud Santa Rosa, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España
| | - Luis Ángel Pérula de Torres
- Unidad docente de Medicina Familiar y Comunitaria, Distrito Sanitario de Córdoba y Guadalquivir, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España
| | - José Espejo Espejo
- Centro de Salud Santa Rosa, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España
| | - Cristina Castro Fernández
- Centro de Salud Santa Rosa, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España
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Leblanc J, Rousseau A, Hejblum G, Durand-Zaleski I, de Truchis P, Lert F, Costagliola D, Simon T, Crémieux AC. The impact of nurse-driven targeted HIV screening in 8 emergency departments: study protocol for the DICI-VIH cluster-randomized two-period crossover trial. BMC Infect Dis 2016; 16:51. [PMID: 26831332 PMCID: PMC4736610 DOI: 10.1186/s12879-016-1377-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 01/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2010, to reduce late HIV diagnosis, the French national health agency endorsed non-targeted HIV screening in health care settings. Despite these recommendations, non-targeted screening has not been implemented and only physician-directed diagnostic testing is currently performed. A survey conducted in 2010 in 29 French Emergency Departments (EDs) showed that non-targeted nurse-driven screening was feasible though only a few new HIV diagnoses were identified, predominantly among high-risk groups. A strategy targeting high-risk groups combined with current practice could be shown to be feasible, more efficient and cost-effective than current practice alone. METHODS/DESIGN DICI-VIH (acronym for nurse-driven targeted HIV screening) is a multicentre, cluster-randomized, two-period crossover trial. The primary objective is to compare the effectiveness of 2 strategies for diagnosing HIV among adult patients visiting EDs: nurse-driven targeted HIV screening combined with current practice (physician-directed diagnostic testing) versus current practice alone. Main secondary objectives are to compare access to specialist consultation and how early HIV diagnosis occurs in the course of the disease between the 2 groups, and to evaluate the implementation, acceptability and cost-effectiveness of nurse-driven targeted screening. The 2 strategies take place during 2 randomly assigned periods in 8 EDs of metropolitan Paris, where 42 % of France's new HIV patients are diagnosed every year. All patients aged 18 to 64, not presenting secondary to HIV exposure are included. During the intervention period, patients are invited to fill a 7-item questionnaire (country of birth, sexual partners and injection drug use) in order to select individuals who are offered a rapid test. If the rapid test is reactive, a follow-up visit with an infectious disease specialist is scheduled within 72 h. Assuming an 80 % statistical power and a 5 % type 1 error, with 1.04 and 3.38 new diagnoses per 10,000 patients in the control and targeted groups respectively, a sample size of 140,000 patients was estimated corresponding to 8,750 patients per ED and per period. Inclusions started in June 2014. Results are expected by mid-2016. DISCUSSION The DICI-VIH study is the first large randomized controlled trial designed to assess nurse-driven targeted HIV screening. This study can provide valuable information on HIV screening in health care settings. TRIAL REGISTRATION ClinicalTrials.gov: NCT02127424 (29 April 2014).
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Affiliation(s)
- Judith Leblanc
- Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Center of East of Paris (CRC-Est), F75012, Paris, France. .,Université Paris Saclay - Université Versailles Saint-Quentin, Doctoral School of Public Health (EDSP), UMR 1173, F92380, Garches, France.
| | - Alexandra Rousseau
- AP-HP, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Unit of East of Paris (URC-Est), F75012, Paris, France.
| | - Gilles Hejblum
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France.
| | - Isabelle Durand-Zaleski
- AP-HP, Hôpital Hôtel-Dieu, URC Eco Île-de-France, F75004, Paris, France. .,Université Paris Diderot, Univ Paris 07, INSERM, ECEVE, UMR 1123, F75019, Paris, France. .,AP-HP, Hôpital Henri-Mondor, Santé publique, F94010, Créteil, France.
| | - Pierre de Truchis
- AP-HP, Hôpital Raymond-Poincaré, Infectious Disease Department, F92380, Garches, France.
| | - France Lert
- Université Paris Sud, Univ Paris 11, INSERM, Centre for research in Epidemiology and population health, U 1018, F94800, Villejuif, France.
| | - Dominique Costagliola
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP UMRS 1136), F75012, Paris, France.
| | - Tabassome Simon
- AP-HP, Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Department of clinical pharmacology and Clinical Research Center of East of Paris (CRC-Est), F75012, Paris, France. .,Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR 1148, F75018, Paris, France.
| | - Anne-Claude Crémieux
- AP-HP, Hôpital Raymond-Poincaré, Infectious Disease Department, F92380, Garches, France. .,Université Versailles Saint-Quentin, UMR 1173, F92380, Garches, France.
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