医疗机构门诊艾滋病筛查策略实施效果比较

Comparison of effectiveness between two HIV screening strategies in outpatient setting

目的 比较在门诊患者中实施病症筛查和抽血患者全员筛查策略在促进HIV感染者多发现、早发现方面的效果.方法 于2011年7-11月,采用流行病学类实验设计方法,在广西壮族自治区选取艾滋病流行水平、人口和医疗资源均相近的L县和J县的县医院门诊部为研究现场,分别实施HIV病症筛查策略和抽血患者全员筛查策略,并选取两所医院15岁以上的就诊患者为研究对象,分别为62 106和58 057人次.在实施策略期间,收集两所医院各科室门诊逐月就诊人次数,通过医院HIV筛查实验室检测记录获取不同科室患者检测情况、初筛阳性结果.采用x2检验比较两种策略在新发现HIV阳性者比例、HIV阳性检出率和HIV阳性者早期感染等指标上的差异.结果 实施抽血患者全员筛查策略的J县县医院和实施病症筛查策略的L县县医院门诊患者中,接受HIV检测的比例分别为9.69％ （527/58 057）和1.38％（859/62 106）；年龄分别为（46.23±16.81）、（40.75±15.48）岁,差异有统计学意义（t=8.81,P＜0.05）；J县县医院新发现HIV阳性者比例[0.03％（19/58 057）]高于L县[0.02％（10/62 106）]（P＜0.05）,而J县县医院HIV阳性检出率[0.34％（19/5627）]低于L县[1.16％ （10/859）]（x2=9.66,P＜0.05）.结论 医疗机构实施抽血患者全员筛查策略相对病症筛查策略可以发现更多HIV感染者.

Objective To determine whether non-targeted testing strategy （screening all patients with blood sample withdrawn） could identify more patients with newly diagnosed HIV infection than symptom and risk behavior based targeted testing strategy or not.Methods Controlled trial design was applied in this study.From July to November 2011,outpatient department of L and J county hospital in Guangxi province were selected to conduct the targeted strategy and non-targeted strategy respectively.The two counties had similar population,outpatient volume,previous testing rate and number of newly identified HIV cases.Outpatients older than 15 years were recruited as study subjects,with 62 106 person time in L hospital and 58 257 in J hospital.Data about visit number,persons receiving HIV testing and HIV positive cases were collected by outpatient department.Chi-square test was used to compare the percentage of newly identified HIV cases,HIV positive detection rate and proportion of cases in early AIDS phase between two strategies.Results During the study period,9.69％ （5627/58057） of all outpatients in J hospital with non-targeted strategy and 1.38％ （859/62106） of all outpatients in L hospital with targeted strategy received HIV test.The average age of patients receiving HIV testing was 46.23 _± 16.81 and 40.75 ± 15.48respectively,which was statistically different （t =8.81,P ＜ 0.05）.The percentage of newly identified HIV cases was significantly greater in J hospital （0.03％ （19/58057）） than that in L hospital （0.02％（10/62106）） （P ＜ 0.05） while the HIV positive detection rate was lower in J hospital （0.34％ （19/5627））than that in L hospital （1.16％ （10/859）） （x2 =9.66,P ＜ 0.05）.Conclusion In a concentrated epidemic,a hospital based non-targeted strategy could detect more unidentified HIV cases than targeted strategy.