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Báo cáo y học: " Another look at Emergency Department HIV screening in practice: no need to revise expectations"

Another look at Emergency Department HIV screening in practice: no need to revise expectations | Brown et al. AIDS Research and Therapy 2010 7 1 http www.aidsrestherapy.eom content 7 1 1 AIDS RESEARCH AND THERAPY RESEARCH Open Access Another look at Emergency Department HIV screening in practice no need to revise expectations Jeremy Brown1 Manya Magnus2 Maggie Czarnogosrki3 Vanessa Lee1 Abstract Background A recent study reported a lower than expected specificity and positive predictive value of the rapid oral HIV test in the setting of routine emergency department ED screening. These results appeared inconsistent with the findings in another urban Emergency Department during the same time period. Objective To compare the specificity and positive predictive vale PPV of an oral rapid HIV test used in an ED screening program in Washington DC with that performed in the USHER clinical trial. Design Period cross-sectional analysis of rapid oral HIV testing conducted in an ongoing HIV screening program emergency department patients. Setting The George Washington University Emergency Department Washington DC from 7 February to 1 October 2007. Patients 1 560 adults seen in the ED for non-HIV-related presenting complaints who participated in the HIV screening program. Intervention Rapid HIV testing with the OraQuick ADVANCE Rapid HIV-1 2 Antibody Test OraSure Technologies Bethlehem Pennsylvania . Patients with reactive rapid test results were offered Western blot testing for confirmation. Measurements Specificity and positive predictive value for the program were determined. Findings were compared to those found in the USHER trial. Results Of 1 560 patients screened for HIV 13 0.8 95 CI 0.38 to 1.28 had a reactive HIV screening test and all were confirmed to be positive by Western Blot. The specificity was 100 95 CI 99.6 -100 . Limitation Since non-reactive tests were not confirmed the test sensitivity cannot be determined. Conclusion Review of our data conflict with findings from the USHER study surrounding false positive OraQuick HIV screening. Our data suggest that