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Title: | Targeted HIV Screening in Eight Emergency Departments: The DICI-VIH Cluster-Randomized Two-Period Crossover Trial | Authors: | Leblanc, Judith Hejblum, Gilles Costagliola, Dominique Durand-Zaleski, Isabelle Lert, France de Truchis, Pierre VERBEKE, Geert Rousseau, Alexandra Piquet, Helene Simon, Francois Pateron, Dominique Simon, Tabassome Cremieux, Anne-Claude |
Issue Date: | 2018 | Publisher: | MOSBY-ELSEVIER | Source: | ANNALS OF EMERGENCY MEDICINE, 72(1), p. 41-53 | Abstract: | Study objective: This study compares the effectiveness and cost-effectiveness of nurse-driven targeted HIV screening alongside physician-directed diagnostic testing (intervention strategy) with diagnostic testing alone (control strategy) in 8 emergency departments. Methods: In this cluster-randomized, 2-period, crossover trial, 18- to 64-year-old patients presenting for reasons other than potential exposure to HIV were included. The strategy applied first was randomly assigned. During both periods, diagnostic testing was prescribed by physicians following usual care. During the intervention periods, patients were asked to complete a self-administered questionnaire. According to their answers, the triage nurse suggested performing a rapid test to patients belonging to a high-risk group. The primary outcome was the proportion of new diagnoses among included patients, which further refers to effectiveness. A secondary outcome was the intervention's incremental cost (health care system perspective) per additional diagnosis. Results: During the intervention periods, 74,161 patients were included, 16,468 completed the questionnaire, 4,341 belonged to high-risk groups, and 2,818 were tested by nurses, yielding 13 new diagnoses. Combined with 9 diagnoses confirmed through 97 diagnostic tests, 22 new diagnoses were established. During the control periods, 74,166 patients were included, 92 were tested, and 6 received a new diagnosis. The proportion of new diagnoses among included patients was higher during the intervention than in the control periods (3.0 per 10,000 versus 0.8 per 10,000; difference 2.2 per 10,000, 95% CI 1.3 to 3.6; relative risk 3.7, 95% CI 1.4 to 9.8). The incremental cost was (sic)1,324 per additional new diagnosis. Conclusion: The combined strategy of targeted screening and diagnostic testing was effective. | Notes: | [Leblanc, Judith; Simon, Tabassome] Grp Hosp Hop Univ Est Parisien, AP HP, Clin Res Ctr East Paris, Paris, France. [Leblanc, Judith; Cremieux, Anne-Claude] Univ Paris Saclay, Univ Versailles St Quentin, INSERM UMR 1173, Garches, France. [Hejblum, Gilles; Costagliola, Dominique] UPMC Univ Paris 06, Sorbonne Univ, INSERM, Inst Pierre Louis Epidemiol & Sante Publ UMRS 113, Paris, France. [Durand-Zaleski, Isabelle] Hop Hotel Dieu, AP HP, URC Eco Ile de France, Paris, France. [Durand-Zaleski, Isabelle] Univ Paris Diderot, Univ Paris 07, INSERM, ECEVE,UMR 1123, Paris, France. [Durand-Zaleski, Isabelle] Hop Henri Mondor, AP HP, Sante Publ, Creteil, France. [Lert, France] Univ Paris Sud, Univ Paris 11, INSERM, Ctr Res Epidemiol & Populat Hlth,U1018, Villejuif, France. [de Truchis, Pierre] Hop Raymond Poincare, AP HP, Infect Dis Dept, Garches, France. [Verbeke, Geert] Katholieke Univ Leuven, Interuniv Inst Biostat & Stat Bioinformat, Leuven, Belgium. [Verbeke, Geert] UHasselt, Hasselt, Belgium. [Rousseau, Alexandra] Grp Hosp Hop Univ Est Parisien, AP HP, Clin Res Unit East Paris, Paris, France. [Piquet, Helene; Pateron, Dominique] Hop St Antoine, AP HP, Emergency Dept, Paris, France. [Simon, Francois] Hop St Louis, AP HP, INSERM U941, Microbiol Dept, Paris, France. [Simon, Tabassome] Grp Hosp Hop Univ Est Parisien, AP HP, Dept Clin Pharmacol, Paris, France. [Simon, Tabassome] Grp Hosp Hop Univ Est Parisien, AP HP, Clin Res Platform East Paris, Paris, France. [Simon, Tabassome] UPMC Univ Paris 06, Sorbonne Univ, INSERM, UMR 1148, Paris, France. [Cremieux, Anne-Claude] Univ Paris Diderot, Univ Paris 07, Hop St Louis, AP HP,Infect Dis Dept, Paris, France. | Document URI: | http://hdl.handle.net/1942/28605 | ISSN: | 0196-0644 | e-ISSN: | 1097-6760 | DOI: | 10.1016/j.annemergmed.2017.09.011 | ISI #: | 000438661000012 | Category: | A1 | Type: | Journal Contribution | Validations: | ecoom 2019 |
Appears in Collections: | Research publications |
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